This may contribute to higher rates of tobacco use, obesity, alcohol use and other cancer risk factors in gender-diverse people.

Research to date shows that transgender adults over age 45 are screened for colon cancer at a lower rate than cisgender patients. They are also more likely to be diagnosed at later stages of lung cancer. This can be devastating, because finding lung cancer before it spreads can literally mean the difference between life and death.

The University of California, San Francisco, one of the few places that has protocols for the care of transgender patients, recommends that transgender women who are older than 50 and have been taking a feminizing hormone for five years begin getting screened for breast cancer. However, according to a recent Canadian study, only about 1 in 3 transgender women who are eligible for breast cancer screening receive mammograms, compared with 2 in 3 eligible cisgender women.

In a 2021 study, researchers found that transgender patients with non-Hodgkin lymphoma, prostate cancer or bladder cancer had roughly twice the death rate of their cisgender counterparts. Since the researchers were able to firmly identify only 589 transgender individuals out of nearly 11.8 million records, they could not accurately compare rates for other types of cancer.

Since 2017, the American Society of Clinical Oncology has recommended including data about patients’ sexual and gender minority status in cancer registries and clinical trials. However, in 2022 the society found that only half of oncology care providers are routinely collecting gender identity information. So it’s clear that there’s still a lot to learn about the barriers to inclusive cancer care.

Lack of training in both medical school and residencies – intensive training stints where new doctors hone their skills – perpetuates these disparities.

Medical education is plagued by biases that reflect society’s stereotypes and prejudices. Further, researchers have found that students can unconsciously absorb biases or stereotypes encountered in their medical education.

And just 26% of doctors directing family medicine clerkships – courses in which medical students start working and interacting with real patients – say they feel comfortable teaching transgender health care.

So the Association of American Medical Colleges has called for emphasizing at all levels of training the health of people who are lesbian, gay, bisexual, transgender, queer or questioning and other identities – known as LGBTQ+. The association recommends that schools take a “layered” approach that integrates education on gender-affirming health care across their curricula. This can include incorporating LGTBQ+ health in early coursework, using practice patients in simulation, and creating opportunities to care for patients with lived experience.

Many medical schools still fail to integrate gender-affirming care throughout the curriculum, though. Instead, medical schools often append it to the existing curriculum – offering dedicated lectures or small-group activities that address LGBTQ+ health. Medical schools overall are providing a median of only five hours of instruction on gender-affirming health care practices.

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