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. However, experts have some general recommendations. These are detailed below.
Talk to your doctor about the screenings you should be doing, how often, and when. If you do notice any unusual breast changes or lumps, consult your doctor immediately. (“Screening” refers to routine checking for possible Signs of breast cancerIt is not possible to diagnose what a lump or any other type of change might be.
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 Risk factors for breast cancerOne person may have.
Trans women who use estrogen for hormone therapy include: 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.
Transgender women may not all be able to receive gender-affirming hormone therapy. Breast tissue can develop in those who take it. Breast cancer can occur in any breast tissue. The risk of breast cancer is increased by 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 with strong family histories of breast cancer and the BRCA1/BRCA2 genes:These genes increase your risk of getting breast cancer. 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.
Breast augmentation for trans women: Trans women may choose breast augmentation to enhance their breasts. This can be done using implants, fat from another area 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 Should Be Screened for Breast Cancer
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 have had only breast reduction or have not had top-of-the-line surgery: Start at 40 to get a mammogram once or twice a year.
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. Breast cancer risk is greatest when the breasts are removed.
Trans men who underwent top surgery:It is possible that your breast tissue may not be sufficient to allow for a mammogram machine. Your doctor may suggest that you perform self-exams, and then have breast exams performed by a doctor.
Some trans men do not get top surgery. However, some trans men do get top surgery. Top surgery lowers breast cancer risk, but not as much as a mastectomy you’d get to prevent or treat breast cancer.
A breast cancer mastectomy is a procedure that removes as much breast tissue possible. This includes tissue under the arms, on the ribcage, and tissue below the arms. 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 undergone standard top (but not complete) surgery. Preventive mastectomy): Annual breast cancer screenings might be required. 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 have received 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 (WPAT) has 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.
