All genders are eligible to apply for the program. Breast cancer, so it’s important for trans men and trans women to consider that as part of their health care.
“Anyone who has breast tissue could potentially or theoretically develop breast cancer,” says Fan Liang, MD, medical director of the Center for Transgender Health at Johns Hopkins Medicine in Baltimore.
Your breast cancer risk is affected by many factors, including your medical history and any family history. You also have to consider whether or not you are able to get gender-affirming treatment.
There aren’t yet official breast cancer screening guidelines that are specific to trans people. Experts do however have general recommendations.
Your doctor should discuss with you what type of screening is needed, when it should be started, and how often. You should always see your doctor if you find a lump in your breasts or any other abnormalities. (“Screening” refers to routine checking for possible Signs of breast carcinoma(This does not include diagnosing a lump, or any other changes.)
Trans Women: Breast Cancer Screening Recommendations
Every person is different. In gauging trans women’s breast cancer risk, one of the factors that doctors consider include whether they are taking hormone therapy, their age, and for how long. That’s on top of all the other Factors that increase breast cancer riskA person may have.
Women who are trans and take estrogen in hormone therapy If you’re older than 50, get a mammogram every 2 years after you’ve been taking hormones for at least 5 to 10 years.
Some trans women do not receive gender-affirming hormonal therapy. Breast tissue will form in those who do. Breast cancer can be caused by any type of breast tissue. Breast cancer risk can be increased by using estrogen therapy.
If you start taking estrogen as an adult, it may not raise your risk as much as if you start taking it as a teen because over your lifetime, you’d have less exposure to estrogen. There hasn’t been a lot of research in this area yet, so it’s not clear how much taking estrogen raises risk for people of various ages.
Trans women who have the BRCA1 and BRCA2 genes, as well as a strong family history with breast cancer, are eligible.Your risk of developing breast cancer increases by these genes. So it’s very important that you discuss with your doctor how to manage this risk, such as with screenings or other preventive care. You may need to start getting mammograms earlier – and get them more often.
“There are other health conditions, not just cancer, that might not make you a good candidate for estrogen,” says Gwendolyn Quinn, PhD, professor of obstetrics and gynecology at NYU Grossman School of Medicine in New York. “That’s why the decision to use hormones should be overseen by a health care provider, but many trans people don’t have access to a clinician and buy their hormones on the internet.”
If you aren’t taking gender-affirming therapy but are considering it, make sure your doctor knows that you are BRCA-positive.
“It’s not a formal recommendation, but there has been talk about testing trans women for BRCA before starting gender-affirming hormones,” Quinn says. “But a lot of people feel that gender-affirming hormones are lifesaving and that it’s unreasonable to ask that trans women get tested first.”
If you do have a doctor and want to get tested for the BRCA genes – and other genes linked to breast cancer – your doctor can help you find out about what’s involved.
Trans women who don’t take hormones: Although there’s no recommended screening timing, be sure to see your doctor if you notice any breast lumps or changes – and tell them about anyone in your family who’s had breast cancer.
Transgender women who had breast augmentation: Trans women may choose breast augmentation to enhance their breasts. This procedure can be performed with implants, fat transfer from another part of the body or a combination.
Fat transfer uses your own body fat from somewhere else on your body to create breasts, and studies don’t show that this raises breast cancer risk. Today’s breast implants don’t cause breast cancer, either. Anaplastic large cell lymphoma (ALCL) is a rare form. They have been shown to be associated with a low chance of breast cancer. There hasn’t been a lot of research on implant-related ALCL specifically in trans women. But in one review, researchers called it a “rare but serious” complication and recommended being aware of the risk and keeping up with any follow-up care after getting the implants.
Trans Men: Breast Cancer Screening Recommendations
Among the many factors that can affect your risk are whether you’ve had “top surgery” to change the appearance of your chest, whether you take testosterone, and whether you have certain genes that make breast cancer more likely.
Trans men who did not have top surgery, or only had breast reduction, are eligible: Starting at age 40, get a mammogram each year or so.
If you haven’t had top surgery, your breast cancer risk is the same as it was before you transitioned. That’s true whether or not you’ve had a hysterectomy (surgery to remove your uterus). Breast cancer risk is only slightly lower when the uterus and ovaries are removed. The greatest impact on breast cancer risk is made by removing the breasts.
Trans men who underwent top surgery:Your doctor might recommend you self-examine and have your breasts examined by a doctor.
Trans men are not all granted top surgery. Some do. Top surgery lowers breast cancer risk, but not as much as a mastectomy you’d get to prevent or treat breast cancer.
The goal of a breast cancer mastectomy is to remove as much breast tissue and tissue underneath the arms as possible. With top surgery, the aim is different: to change the chest’s appearance to be flatter. “The breast mass is removed, but we don’t go after every single cell because it’s not necessary to do that in order to get the overall result that we want,” Liang says.
“How much surgery lowers [breast cancer] risk depends on how much tissue is left behind, including the nipple, where there’s also potential for cancer cells to develop,” Quinn says.
Trans men who are carriers of the BRCA1 or BRCA2 mutations and have had top surgery (but no complete) Preventive mastectomy): Annual breast cancer screenings may be necessary. Since you likely won’t have enough breast tissue to put into a mammogram machine, a breast cancer specialist may need to give you a chest exam. It’s important that your doctors know that you are BRCA+ so they can make a preventive screening plan for you based on how much breast tissue you have.
Trans men who receive hormone therapy with testosterone Testosterone suppresses estrogen. Your breast cancer risk will be lower if hormone therapy with testosterone is continued over time. But if you don’t take testosterone – or if you only take a low dose or take it intermittently – you won’t have that protective benefit.
There is always a chance of breast cancer regardless of whether you have taken testosterone therapy. You can ask your doctor about the screening that you should have.
Finding Gender-Affirming Care
Experts can make recommendations for cancer screenings for transgender people. However, it is not always easy to find a gender-affirming provider of health care in certain places.
The World Professional Association for Transgender Health is a member. an online directoryProviders of gender-affirming healthcare. Call local doctors to ask about the experience of trans patients.
“If you can’t find a transgender health clinic near where you live, call the doctor beforehand,” Liang says. “Ask about the provider’s experience with transgender preventive care. See how they respond to the question – whether they have an understanding of what you need or whether the question seems to them to come out of left field.” Your health concerns – about breast cancer or anything else – should be taken seriously and treated with respect by your health care team.
