Cancer screening in the transgender population: Examining the specificities of cancer risk from a health equity perspective—An analytical cross-sectional study.

Abstract

e22545 Background: The transgender population faces significant structural and social barriers to healthcare access. In oncology, these disparities are intensified by the absence of adapted clinical protocols, lack of professional training, and scarcity of epidemiological data reflecting their biological and social specificities. We aimed to evaluate cancer screening adequacy and identify healthcare inequities in this population. Methods: This analytical cross-sectional study included 170 transgender and non-binary individuals over 18 years of age. Data were collected using a structured 32-item questionnaire addressing sociodemographic characteristics, personal and family history, habits, exposures, and healthcare experiences. Data collection occurred in-person and online at LGBTI+ reference centers, community clinics, and non-governmental organizations. Statistical analysis employed Chi-square, Fisher's exact, and Poisson regression tests using R software. Results: Non-binary individuals had higher income and education levels, while transgender women and travestis reported greater social vulnerability and less access to health insurance. Hormone therapy use varied from 93% among travestis to 68% among transgender men. Industrial silicone use ranged from 70% among travestis to 30% among transgender women. Smoking prevalence was 44% among transgender men and 26% among non-binary individuals. HIV prevalence was significant (26% travestis, 21% transgender women), with anal cancer screening adherence at 19%, exceeding literature benchmarks and strongly associated with regular healthcare access (PR 1.50; 95% CI 1.05–2.14; p = 0.02), reflecting the effectiveness of integrated HIV care through the Brazilian public health system. Cancer screening adherence varied by type: cervical 49%, colorectal 7%. Consistent use of one's social name was positively associated with screening adherence, particularly for gender-specific cancers (PR 1.28; 95% CI 1.02–1.61; p = 0.035). Conclusions: Significant inequities exist in cancer prevention and screening for the transgender population, with adherence varying by cancer type, gender identity, and healthcare access. Gender-specific clinical protocols addressing distinct biological exposures (hormone therapy, silicone, smoking), professional training, and targeted public policies are fundamental to reduce disparities. This study provides novel epidemiological data on barriers and facilitators to cancer screening among transgender people in Brazil, highlighting the urgent need for structural interventions and integrated care models that address biological specificities and social determinants.