Background: Over a million Americans identify themselves as transgender and this population is growing. Transgender status was a pre-existing condition prior to the Affordable Care Act (ACA), and transgender individuals faced unique disparities in gender-specific cancer screening in part due to discrimination in health insurance coverage. Modern literature for transgender adults’ adherence to cancer screening is limited. To fill this knowledge gap, we conducted a cross sectional study to investigate transgender individuals’ self-reported adherence to cancer screening and access to primary care compared to cisgender individuals. Methods: The Behavioral Risk Factor Surveillance System database was queried for transgender (either male-to-female [MTF] or female-to-male [FTM]) and cisgender adults from 2014-2016 and 2018. Primary endpoints were adherence to breast and cervical cancer screening guidelines and access to primary health care. Those with prior hysterectomy, breast and cervical cancer were excluded. Multivariable logistic regression was performed to evaluate the association of transgender status with cancer screening and healthcare access, after adjusting for demographic characteristics and survey weights. Results: A total of 219,665 and 206,446 participants were eligible for breast and cervical cancer screening, respectively. Of those, 614 (0.28%) and 587 (0.29%) transgender participants were eligible for each cancer screening type, respectively, representing a weighted estimate of nearly 200,000 transgender participants total. When compared to cisgender counterparts, transgender participants were less likely to adhere to breast cancer screening (FTM: OR 0.47, p < 0.001; MTF: OR 0.04, p < 0.001) and to have received any breast cancer screening (FTM: OR 0.32, p < 0.001; MTF: OR 0.02, p < 0.001). Similarly, FTM participants were less likely to adhere to cervical cancer screening (OR 0.42, p < 0.001) and to have received any cervical cancer screening (OR 0.26, p < 0.001). In addition, transgender participants were more likely to have no primary care physician (FTM: OR 0.79, p < 0.001; MTF: OR 0.58, p < 0.001) and to be unable to see a physician when needed within the past year due to medical cost (FTM: OR 1.44, p < 0.001; MTF: OR 1.36, p < 0.001). Conclusions: Despite the implementation of the ACA, limited primary care access and poor adherence to breast and cervical cancer screening are evident for transgender populations. Further research efforts to improve the utilization of preventive cancer services are needed for this underserved population.