Cancer risk and screening in transgender and gender-diverse individuals on gender-affirming hormone therapy: a review article for the Australasian context.
Awadalla R, Davies D, Brownie S, Rossiter R • The New Zealand medical journal • 2026
The available evidence does not demonstrate a consistent, statistically significant increase in common cancers among TGD individuals receiving GAHT, though emerging concerns include malignancies in surgically constructed tissues, increased breast cancer risk with duration of oestrogen therapy, and higher-grade prostate cancer presentations in trans women.
Key Findings
Results
Current evidence does not demonstrate a consistent, statistically significant increase in common cancers among transgender and gender-diverse individuals receiving gender-affirming hormone therapy.
A systematic review was conducted in accordance with PRISMA 2020 guidelines
Searches were performed across PubMed/MEDLINE, Embase, Scopus and the Cochrane Library for literature published up to December 2025
The authors note the evidence is 'limited by short follow-up durations and small cohort sizes'
Key evidence sources were narratively synthesised rather than meta-analysed
Results
Breast cancer risk in trans women appears to increase with the duration of oestrogen therapy, though it remains lower than in cisgender women.
The relationship between oestrogen therapy duration and breast cancer risk was identified as a key clinical concern
Despite the increase relative to baseline male risk, the absolute risk remains lower than that seen in cisgender women
This finding was drawn from epidemiological studies and case reports reviewed under PRISMA 2020 guidelines
The evidence base is limited by short follow-up durations and small cohort sizes
Results
Prostate cancer may present at a higher grade in trans women receiving oestrogen therapy.
Higher-grade prostate cancer presentations were identified as an emerging clinical concern in trans women on oestrogen
The mechanism or frequency of this finding is not specified in the abstract
This finding was identified through review of epidemiological studies, case reports, and clinical guidelines
The authors note this represents a novel clinical concern warranting clinical vigilance
Results
Emerging case reports highlight malignancies occurring in surgically constructed tissues including the neophallus and neovagina.
These malignancies in surgically constructed tissues represent 'novel clinical concerns' identified in the review
Both neophallus (surgically constructed penis) and neovagina (surgically constructed vagina) were identified as sites of reported malignancy
The authors recommend clinicians 'maintain a low threshold for investigating suspicious lesions, particularly in surgically altered tissues'
These findings are based on case reports rather than larger epidemiological studies
Results
Screening participation is consistently lower in transgender and gender-diverse populations, often resulting in later-stage diagnoses.
Lower screening uptake was identified as a consistent pattern across TGD populations
Later-stage diagnoses were identified as a downstream consequence of reduced screening participation
The development of 'culturally safe and inclusive primary care environments is paramount to improving screening uptake'
This finding informed the recommendation that equitable health outcomes require structural improvements in primary care
Conclusions
The review recommends an organ-inventory approach to cancer screening in TGD individuals, based on organs present rather than gender identity.
Cancer screening 'should be guided by an organ-inventory approach, based on the organs a person has rather than their gender identity'
This approach was proposed as a practical recommendation tailored to the Australasian context, specifically Australia and New Zealand
Recommendations were developed for Australasian general practitioners
The approach addresses the mismatch between administrative gender identity records and actual organ-based screening needs
What This Means
This research suggests that transgender and gender-diverse (TGD) people taking gender-affirming hormone therapy (GAHT) do not appear to have a consistently higher risk of common cancers compared to the general population, based on currently available studies. However, the researchers note that most existing studies have been relatively short in duration and involved small numbers of participants, meaning definitive conclusions are difficult to draw. Some specific concerns were identified: trans women (people assigned male at birth who identify as women) taking oestrogen appear to have a rising breast cancer risk the longer they take the hormone, though still lower than in women who were assigned female at birth. Prostate cancer, when it does occur in trans women on oestrogen, may be more aggressive. There are also emerging case reports of cancers developing in surgically constructed body parts such as a neovagina or neophallus, highlighting the need for doctors to remain alert to unusual symptoms in these tissues.
A major finding is that TGD individuals are less likely to participate in cancer screening programs, which can lead to cancers being caught at a later, harder-to-treat stage. The researchers suggest this is partly due to healthcare environments that are not culturally safe or inclusive for TGD people. To address this, the review recommends that doctors use an 'organ inventory' approach — screening patients based on what organs they actually have, rather than their registered gender — so that no relevant screening is missed or inappropriately applied.
This research matters because it provides practical guidance for general practitioners in Australia and New Zealand on how to deliver equitable cancer care to TGD patients. It highlights both the gaps in current evidence and the immediate steps clinicians can take, including maintaining a lower threshold for investigating unusual symptoms in surgically altered tissues and working to create more welcoming healthcare environments to improve screening uptake in TGD communities.
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Awadalla R, Davies D, Brownie S, Rossiter R. (2026). Cancer risk and screening in transgender and gender-diverse individuals on gender-affirming hormone therapy: a review article for the Australasian context.. The New Zealand medical journal. https://doi.org/10.26635/6965.7324