Gender Identity Disparities in Cancer Screening Behaviors

Published:January 12, 2018DOI:


      Transgender (trans) and gender-nonconforming adults have reported reduced access to health care because of discrimination and lack of knowledgeable care. This study aimed to contribute to the nascent cancer prevention literature among trans and gender-nonconforming individuals by ascertaining rates of breast, cervical, prostate, and colorectal cancer screening behaviors by gender identity.


      Publicly available de-identified data from the 2014–2016 Behavioral Risk Factor Surveillance System surveys were utilized to evaluate rates of cancer screenings by gender identity, while controlling for healthcare access, sociodemographics, and survey year. Analyses were conducted in 2018.


      Weighted chi-square tests identified significant differences in the proportion of cancer screening behaviors by gender identity among lifetime colorectal cancer screenings, mammography tests, Pap tests, prostate-specific antigen tests, discussing prostate-specific antigen test advantages/disadvantages with their healthcare provider, and up-to-date colorectal cancer screenings and Pap tests (all p<0.048). Weighted logistic regressions found that although some differences based on gender identity were fully explained by covariates, gender-nonconforming individuals had reduced odds of ever having a sigmoidoscopy/colonoscopy compared to cisgender (cis) men (AOR=0.46) and cis women (AOR=0.43), whereas trans men were more likely to have an up-to-date colorectal cancer screening as compared to cis men (AOR=2.29) and cis women (AOR=1.97). Trans women were less likely than cis women to have ever had a mammography screening (AOR=0.33) and trans men were more likely than cis women to have an up-to-date mammography test (AOR=2.03). Finally, trans men and gender-nonconforming individuals had reduced odds of lifetime Pap tests versus cis women (AOR=0.50 and 0.20, respectively), and gender-nonconforming individuals had lower odds of being up-to-date for Pap tests (AOR=0.33; all p<0.05).


      The findings indicate that gender identity disparities in cancer screenings persist beyond known sociodemographic and healthcare factors. It is critical that gender identity questions are included in cancer and other health-related surveillance systems to create knowledge to better inform healthcare practitioners and policymakers of appropriate screenings for trans and gender-nonconforming individuals.
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