Projected Cancer Burden among Sexual and Gender Minorities by Generation in the United States.

BACKGROUND: Sexual and gender minority (SGM) representation is growing in the United States. This study estimated future SGM cancer burden amidst shifting cancer patterns. METHODS: Age-specific incidence data for breast, prostate, colorectal, lung, and melanoma were obtained from the Surveillance, Epidemiology, and End Results Program's 12-registry database. Nordpred age-period-cohort models projected incidence through 2040-2044. Rates were applied to U.S. Census population estimates and generation- and sex-specific SGM identification proportions from Gallup's 2023-2024 surveys. Prophet was used for sensitivity analysis. RESULTS: At ages 55-59, breast cancer cases among Millennial SGMs were 3,672% higher than among Silent Generation SGMs (34,850 vs 924 cases), melanoma cases were 1,061% higher (5,526 vs 476 cases), and colorectal cancer cases were 2,206% higher (23,594 vs 1,023 cases). Compared with Generation X, Millennial prostate cancer cases were 142% higher (8,100 vs 3,344 cases), and lung cancer cases were 169% higher (5,451 vs 2,029 cases). By 2040-2044, Millennials were projected to account for 68.4% of breast cancer cases and 59.7% of colorectal cancer cases among SGMs. CONCLUSIONS: At ages 55-59, five-year cancer burden was projected to be 15 times higher among Millennial than Silent Generation SGMs (77,521 vs 5,134 cases), driven primarily by the larger SGM population in younger generations. Oncology systems will need to prepare for the increase in cancer-care demand. IMPACT: These findings identify a substantial generational shift in SGM cancer burden and may inform oncology workforce capacity, culturally responsive cancer care, and health-system preparation for this growing population.