medwireNews: Analysis of the US National Cancer Database (NCDB) points to disparities in the treatment and outcomes of breast cancer in transgender and gender-diverse (TGD) patients compared with those who are cisgender.
Noting that “outcomes data on this vulnerable population are sparse,” the investigators used the NCDB to compare “patient sociodemographic and tumor characteristics, treatment, and overall survival (OS) […] between TGD and cisgender patients with breast cancer.”
Among 4,376,089 adults diagnosed with breast cancer between 2004 and 2022, 4,338,258 (99.1%) were cisgender female, 37,579 (0.9%) were cisgender male, and 252 (0.006%) were TGD.
Compared with a cisgender cohort (n=211) matched on clinically meaningful variables, such as age, sex assigned at birth, race and ethnicity, year of diagnosis, stage, and tumor receptor status, TGD patients had a significantly lower likelihood of receiving endocrine therapy for hormone receptor (HR)-positive breast cancer or undergoing postmastectomy breast reconstruction, at respective odds ratios (ORs) of 0.50 and 0.21.
After a median 57.7 months of follow-up, 5-year OS was significantly poorer for TGD patients than their cisgender counterparts, at rates of 84.6% and 91.7%, respectively, and this difference “persisted when excluding those with unknown sex assigned at birth,” with rates of 84.1% versus 93.9%, report Chandler Cortina, from the Medical College of Wisconsin in Milwaukee, USA, and associates in JAMA Oncology
Discussing the findings, they say: “Prior survey data identified that some TGD persons would not cease gender-affirming hormone therapy (GAHT) for HR-positive breast cancer given concerns regarding gender-related adverse effects.
“Omission of endocrine therapy has been demonstrated to result in inferior outcomes, and patient-centered work is needed to inform how to balance GAHT while maintaining guideline-concordant care.”
The team also highlights the need for “further studies investigating breast cancer–specific mortality among TGD persons are warranted” as “[t]he inferior OS difference in this cohort may be due to treatment differences or non-breast cancer causes.”
Cortina et al admit limitations of the analysis, such as “self-reported gender identity possibly being underreported and the small sample size,” as well as the lack of data on GAHT use, but they believe that the “findings provide novel hypothesis-generating data.”
The researchers conclude: “Prospective research with granular data points is essential to identify the etiology of these disparities to ensure equitable breast cancer care that aligns with gender identity and optimizes outcomes.”
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