Health

What Trans People Should Know About Breast Cancer Screening

Breast cancer may be associated with the color pink and the term “women’s health,” but people of any gender can get it, including transgender men, transgender women, cisgender men, and nonbinary people. Screening in the transgender population has unique needs so it’s important for health providers and patients alike to know when it’s needed or how to go about screening, especially in a way that is comfortable for the patient.

“The incidence of breast cancer in individuals assigned female at birth and taking testosterone, and folks who are assigned male at birth taking estrogen are pretty similar and incidence of both are much, much lower when compared with the incidence of breast cancer in cisgender females,” says Julie Thompson, a certified physician’s assistant and medical director of Trans Health at Fenway Health in Boston.

Early studies suggest that rates of chest cancer in transgender men are similar to men assigned male at birth.

A Dutch study published in 2019 showed that both trans women and trans men had lower rates of breast cancer than cisgender women.

While trans women’s risk of breast cancer increased as they took estrogen hormone therapy and grew breast tissue, it remained lower than women assigned female at birth.

When Should You Get Screened?

In its most recent statement, the U.S. Preventive Services Task Force (USPSTF) recommends that all women get screened for breast cancer every other year beginning at age 40.

Anyone assigned female at birth who hasn’t had reconstructive chest surgery would follow that recommendation, according to Thompson. But the new recommendations are still a topic of debate among oncologists. Based on the National Comprehensive Cancer Network, American College of Radiology, American College of Obstetrics and Gynecology, and American College of Surgeons, the recommendation is getting a mammogram screening annually.

According to the American College of Radiology, mammograms may be appropriate for trans women “with five or more years of hormone use” if they are average risk and 40 years of age or older or if they have higher than average risk and are 25 to 30 years old.

For transgender and nonbinary people who have had breast tissue removed in chest reconstruction surgery, some breast tissue will remain depending on the type of surgery — tissue that is still susceptible to cancer but is harder to screen. For patients that have had this procedure, typically trans men, it is recommended that they have chest exams performed.

“If someone’s had chest reconstruction surgery, typically doing a mammogram is not possible,” Thompson says. “There’s just not enough chest tissue available to do that screening. And actually, right now, there’s no reliable evidence-based screening for those individuals.” She says it’s important that people who have had top surgery — surgery that removes or adds breast tissue and reshapes the chest to create a more masculine or feminine appearance — talk to their doctors about family history of breast cancer and that they always alert their doctor if they feel any lumps.


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