The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV), tobacco, alcohol, lung, breast, colorectum, and built multivariable logistic models to examine the association between gender identity and the presence of cancer or pre- cancer. Results indicated similar odds of developing cancer across gender identities, but transgender individuals exhibited significantly higher risks for pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-related, tobacco-related, alcohol-related, and colorectal pre- cancers compared to cisgender men. These findings underscore the need for tailored interventions and policies addressing cancer health disparities affecting the transgender population.

The authors have declared no competing interest.

This study was supported by grants R21CA245858 and R21CA245858-01A1S1 from the National Institutes of Health (NIH). This study was also partially supported by NIH grants R01CA246418, R01CA246418-02S1, R21CA253394- 01A1, R01AG080624, and R21AG068717.

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This study was approved by the University of Florida (UF) Institutional Review Board.

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