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Cancer in Transgender and Gender-Diverse PersonsA Review

To identify the key insights or developments described in this article

1 Credit CME

JAMA Oncology

Published Online: February 9, 2023

Review

Article Information and Disclosures

Alberto Giovanni Leone, MD¹;

Dario Trapani, MD^2,3;

Matthew B. Schabath, PhD⁴;

Joshua D. Safer, MD^5,6;

N. F. N. Scout, PhD⁷;

Matteo Lambertini, MD^8,9;

Rossana Berardi, MD¹⁰;

Silvia Marsoni, MD¹¹;

Francesco Perrone, MD¹²;

Saverio Cinieri, MD¹³;

Rosalba Miceli, PhD¹;

Federica Morano, MD¹;

Filippo Pietrantonio, MD¹

Author Affiliations

¹Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
²European Institute of Oncology, IRCCS, Milan, Italy
³Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
⁴H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
⁵Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York
⁶Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
⁷National LGBT Cancer Network, Providence, Rhode Island
⁸Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
⁹Department of Medical Oncology, Unità Operativa Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
¹⁰Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
¹¹IFOM, FIRC Institute of Molecular Oncology, Milan, Italy
¹²Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
¹³Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy

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Abstract

Importance Transgender and gender-diverse individuals face unique challenges, including barriers to health care access and inequities in treatment, that may influence cancer risk and outcomes.

Observations In this narrative review, a scoping review was conducted focusing on primary and secondary prevention and epidemiology of cancer, barriers to health care services, and health care practitioners’ knowledge about specific issues pertaining to transgender and gender-diverse individuals. PubMed, the Cochrane Library, and Embase, were reviewed for citations from their inception to December 31, 2021. This review revealed that transgender and gender-diverse people had a high prevalence of tobacco consumption and alcohol use and high rates of infection with human papillomavirus (HPV) and HIV. Transgender and gender-diverse individuals were less likely to adhere to cancer screening programs and had a higher incidence of HIV- and HPV-associated cancers. Social and economic determinants seemed to drive these disparities in risk factors and outcomes. A lack of knowledge about gender minorities’ health needs among health care practitioners was evidenced, and it represented a major hurdle to cancer prevention, care, and survivorship for transgender and gender-diverse individuals. Discrimination, discomfort caused by gender-labeled oncological services, stigma, and lack of cultural sensitivity of health care practitioners were other barriers met by transgender and gender-diverse persons in the oncology setting.

Conclusions and Relevance The findings suggest that transgender and gender-diverse peoples’ needs in the cancer care continuum are not optimally addressed. Effective solutions are needed to offer the best care to every patient in a person-centric and gender diversity–sensitive environment.

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Article Information

Accepted for Publication: November 1, 2022.

Published Online: February 9, 2023. doi:10.1001/jamaoncol.2022.7173

Corresponding Author: Filippo Pietrantonio, MD, Department of Medical Oncology, Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy (filippo.pietrantonio@istitutotumori.mi.it).

Author Contributions: Drs Leone and Pietrantonio had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Leone, Trapani, Safer, Marsoni, Perrone, Cinieri, Pietrantonio.

Acquisition, analysis, or interpretation of data: Leone, Schabath, Scout, Lambertini, Berardi, Cinieri, Miceli, Morano, Pietrantonio.

Drafting of the manuscript: Leone, Trapani, Schabath, Marsoni, Cinieri, Miceli, Pietrantonio.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Trapani, Lambertini, Morano.

Supervision: Leone, Trapani, Safer, Berardi, Marsoni, Perrone, Cinieri, Miceli, Morano, Pietrantonio.

Conflict of Interest Disclosures: Dr Schabath reported receiving personal fees from Bristol Myers Squibb outside the submitted work. Dr Lambertini reported having an advisory role for and receiving speaker honoraria from Roche, Novartis, Eli Lilly & Company, and Pfizer; having an advisory role for AstraZeneca, MSD, Exact Sciences, and Seagen; receiving speaker honoraria from Takeda, Sandoz, Ipsen, Knight, Libbs, and Daiichi Sankyo; and having an advisory role for and receiving travel support and a research grant (to the institution) from Gilead outside the submitted work. Dr Berardi reported receiving personal fees from Amgen, MSD, Bristol Myers Squibb, Eisai, Roche, and AstraZeneca outside the submitted work. Dr Perrone reported receiving personal fees from Bayer, Roche, Incyte, Ipsen, AstraZeneca, Sanofi, Astellas, Eli Lilly & Company, GSK, Boeringher Ingelheim, and Pfizer outside the submitted work. Dr Cinieri reported receiving personal fees from Lilly Oncology, Seagen, and AstraZeneca outside the submitted work. Dr Morano reported receiving honoraria from Servier and Eli Lilly & Company, research grants from Incyte, and nonfinancial travel support from Daiichi Sankyo outside the submitted work. Dr Pietrantonio reported receiving grants from BMS, Incyte, and AstraZeneca and personal fees from BMS, MSD, AstraZeneca, Amgen, Merck Serono, Eli Lilly & Company, Pierre Fabre, Servier, Bayer, and Organon outside the submitted work. No other disclosures were reported.

Additional Contributions: The Italian Association of Medical Oncology and Elma Academy staff helped in reviewing the data

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.