Table 4.
Summary of Epidemiologic Studies That Evaluated Cancer Endpoints Among Transgender People
| Study Population | First Author, Year (Reference No.) | Sample Sizes | Measures | Cancer Site or Type | Result and Comparisona | 95% CI |
|---|---|---|---|---|---|---|
| Dutch cohort of transgender patients treated with cross-sex hormones at a specialized clinic in Amsterdam, Netherlands | Asscheman, 1989 (112) | 303 transwomen | Incidence and mortality | None | ||
| 122 transmen | None | |||||
| van Kesteren, 1997 (102) | 816 transwomen | SMR | All sites (n = 7) | 0.5b | 0.2, 0.9 | |
| Lung (n = 3) | 0.5b | 0.1, 1.4 | ||||
| Stomach (n = 1) | ||||||
| Leukemia (n = 1) | ||||||
| Meningioma (n = 1) | ||||||
| Glioblastoma (n = 1) | ||||||
| Incidence | Prostate (n = 1) | |||||
| 293 transmen | Mortality | Colon (n = 1) | ||||
| Asscheman, 2011 (113) | 966 transwomen | SMR | All sites (n = 28) | 1.0b | 0.9, 1.1 | |
| Lung (n = 13) | 1.4b | 1.1, 1.6 | ||||
| Hematological (n = 6) | 2.6b | 2.0, 3.3 | ||||
| Gastrointestinal tract (n = 3) | 0.4b | 0.3, 0.6 | ||||
| Brain (n = 2) | 1.6b | 1.0, 2.5 | ||||
| Kidney (n = 1) | ||||||
| Melanoma (n = 1) | ||||||
| Bone (n = 1) | ||||||
| Prostate (n = 1) | ||||||
| 596 ethinyl estrogen users | Mortality HR | All sites (n = 17) | 1.4c | 0.6, 3.0 | ||
| 365 transmen | SMR | All sites (n = 5) | 1.0d | 0.7, 1.4 | ||
| Gastrointestinal tract (n = 2) | 2.4d | 0.9, 5.2 | ||||
| Lung (n = 1) | ||||||
| Hematological (n = 1) | ||||||
| Sarcoma (n = 1) | ||||||
| Gooren, 2013 (45) | 2,307 transwomen | Incidence | Breast (n = 2) | 4.1e | ||
| 795 transmen | Breast (n = 1) | |||||
| Gooren, 2014 (69) | 2,306 transwomen | Incidence | Prostate (n = 1) | |||
| Swedish national cohort of persons with documented official gender change and surgical affirmation | Dhejne, 2011 (114) | 324 transgender persons (133 transmen, 191 transwomen combined) | Mortality HR | All sites (n = 8) | 2.1f | 1.0, 4.6 |
| Lung (n = 3) | ||||||
| Tongue (n = 1) | ||||||
| Pharynx (n = 1) | ||||||
| Pancreas (n = 1) | ||||||
| Liver (n = 1) | ||||||
| Unspecified (n = 1) | ||||||
| Belgian clinic patients treated at a specialized clinic in Ghent, Belgium | Wierckx, 2012 (115) | 50 transwomen | Prevalence | None | ||
| 50 transmen | Prolactinoma (n = 1)g | |||||
| Wierckx, 2013 (116) | 214 transwomen | Prevalence | All sites (n = 6) | 28h | ||
| 28i | ||||||
| Colon (n = 3) | ||||||
| Melanoma (n = 2) | ||||||
| Lymphoma (n = 1) | ||||||
| 138 transmen | None | |||||
| US veterans’ cohort of persons with at least 1 diagnostic code indicative of transgender status | Blosnich, 2014 (117) | 3,327 transgender persons | Proportional mortality | All sites (n = 65) | 21j | |
| Brown, 2015 (118) | 3,556 “men” | SIR | Breast (n = 3) | 33.3b | 21.9, 45.2 | |
| 0.7d | 0.03, 5.6 | |||||
| 1,579 “women” | Breast (n = 7) | 77.8b | 59.0, 94.0 | |||
| 1.6d | 0.2, 7.2 | |||||
| Brown, 2016 (119) | 5,135 transgender veterans | Lifetime POR | Breast (n = 33) | 0.3f | 0.2, 0.5 | |
| Prostate (n = 190) | 1.4f | 1.2, 1.7 |
Abbreviations: CI, confidence interval; HR, hazard ratio; POR, prevalence odds ratio; SIR, standardized incidence ratio; SMR, standardized mortality ratio.
a Reported only for sites with 2 or more cases.
b General population males.
c Nonusers.
d General population females.
e Per 100,00 person-years versus 1.2 in general population males.
f Matched controls.
g Diagnosed before initiation of hormone therapy.
h Per 1,000 versus 21.9 in general population males.
i Per 1,000 versus 24.9 in general population females.
j Result expressed as percentage versus 23.6% in general population.