Disparities in cancer screening across disease sites for transgender and gender-diverse patients.

10530 Background: Over 2 million Americans identify as transgender, nonbinary, or gender-diverse (TGD) and limited data exist on cancer screening in this population. This study examines uptake rates of recommended breast, cervical, colorectal, and prostate cancer screening in TGD persons and reports factors predictive of screening uptake. Methods: A cross-sectional single-institution cohort study was conducted at a tertiary referral center with a specialized LGBTQIA+ Inclusion Health Clinic (IHC). Adult patients self-identifying as TGD with a healthcare encounter from January 2023-May 2025 were identified in our Clinical Research Data Warehouse. Demographic, clinical, and screening data for breast, cervical, colorectal, and prostate cancers were collected. The American Cancer Society, National Comprehensive Cancer Network, and UCSF transgender breast cancer screening guidelines were used as standards for screening indications. Multivariable logistic regression was conducted to evaluate factors predictive of guideline-concordant screening uptake. Results: We identified 2,478 TGD patients (821 transgender men (TGM), 789 transgender women (TGW), and 868 gender-diverse (GD) patients). Median age was 28 years (range 18-86) and 62% were treated at the IHC. Most patients were White (78.3%) and non-Hispanic (91.1%). Sixty-four percent of patients used private health insurance, 26.2% used government insurance, and 9.2% were uninsured. Average duration of gender-affirming hormone therapy was 4.0 years (IQR 2.0, 6.0), and 31% of patients had received gender-affirming surgery. Fifty-two percent of patients had some family cancer history at any disease site. Rates of guideline-concordant cancer screening uptake are presented in Table 1. On multivariate analyses, GD gender identity (OR 2.55, 95% CI 1.68-3.88, p<0.001), age (OR 1.05, 95% CI 1.02-1.08, p<0.001), and treatment at the IHC (OR 2.24, 95% CI 1.50-3.40, p<0.001) were predictors of cervical cancer screening uptake. No significant predictors were identified of screening uptake for other disease sites. Conclusions: Gender-specific medical care is valuable for promoting guideline-concordant cancer screening uptake. Even in a specialized care center, we found poor rates of recommended cancer screening uptake in TGD patients, demonstrating opportunities to improve uptake of gender-specific cancer screening. Rates of guideline-concordant cancer screening uptake by disease site and gender identity. Disease Site Overall (n=2,478) TGW (n=789) TGM (n=821) GD (n=868) p -value Breast 49.2% 40.8% 38.5% 60.0% 0.12 Cervical 41.3% NA 31.5% 51.2% <0.001 Colorectal 43.4% 41.7% 31.0% 51.4% 0.3 Prostate 20.7% 19.6% NA 26.3% 0.7