Lung cancer screening eligibility and utilization among transgender patients: an analysis of the 2017-2018 United States Behavioral Risk Factor Surveillance System survey

Lung Cancer

Stowell JT, et al. Nicotine Tob Res 2020.


INTRODUCTION: Transgender and gender diverse (TGD) persons disproportionately face many health disparities including a higher risk of lung cancer. Lung cancer screening (LCS) using low-dose chest CT has reduced lung cancer mortality in eligible high-risk smokers across several large trials yet utilization of LCS remains low. TGD persons may be less likely to receive recommended cancer screening compared to cisgender populations. We sought to compare eligibility for and utilization of LCS between TGD and cisgender persons in the United States. We also examined if the utilization of LCS varied by smoking status within each gender identity group.

METHODS: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional survey to determine eligibility and utilization of LCS among TGD participants compared to cisgender persons. Logistical regression analysis of potentially confounding variables included age category, race/ethnicity, income, employment status, health insurance, and having a personal doctor.

RESULTS: Of 37,023 weighted respondents, 0.5% were TGD. Although eligibility for LCS was statistically similar (8.8% TGD vs 12.2% cisgender) (Adjusted OR 0.81, 95% CI 0.27 to 2.39, p = 0.703), only 2.3% of TGD participants reported obtaining a LCS chest CT versus 17.2% of cisgender participants (Adjusted OR 0.04, 95% CI 0.01 to 0.59, p = 0.019). Smoking status showed no association with LCS utilization among gender identity groups.

CONCLUSIONS: TGD persons may be less likely to receive LCS despite having similar smoking status and eligibility of cisgender persons, suggesting a disparity in utilization of this preventative health service.