People of all races can have it breast cancerTherefore, it is important for trans men and transgender women to consider this as part of their health care.
“Anyone with breast tissue can theoretically or potentially develop breast cancer,” says Fan Liang, MD, medical director of the Transgender Health Center at Johns Hopkins Medicine in Baltimore.
Many things affect your breast cancer risk, including your medical history, any family history of breast cancer, whether you have certain genes that increase your risk of breast cancer, and whether you get gender-confirming treatment.
There are still no official breast cancer screening guidelines for transgender people. But experts have general recommendations detailed below.
You should talk to your doctor about which examination you need, when to start, and how often. Of course, if you notice a lump or any unusual change in the breast, see your doctor to get it checked out. (“Sorting” refers to the routine examination of the possibility of this Breast cancer signsnot diagnosing what might be a tumor or any other change.)
Breast cancer screening recommendations for transgender women
Every person is unique. When measuring the risk of breast cancer in transgender women, one factor doctors take into account includes whether, and for how long, they receive hormone therapy. This is above all else Breast cancer risk factors A person may have.
Transgender women taking estrogen as part of hormonal therapy: If you are over 50, get a mammogram every two years after taking hormones for at least 5 to 10 years.
Not all transgender women take hormone therapy that confirms their gender. Those who do will develop breast tissue. Any breast tissue can develop breast cancer. And estrogen, which is part of this treatment, increases the risk of breast cancer.
If you started taking estrogen as an adult, it may not increase your risk as much as if you started as a teen because over the course of your life, you will have less exposure to estrogen. Not much research has been done in this area yet, so it is not clear how much estrogen intake increases the risk for people of different ages.
Transgender women with BRCA1 or BRCA2 genes and/or a strong family history of breast cancer: These genes increase the risk of breast cancer. So it is very important that you discuss with your doctor how to manage these risks, such as with checkups or other preventative care. You may need to start getting mammograms early — and get them often.
“There are other health conditions, not just cancer, that may not make you a good candidate for estrogen,” says Gwendolyn Quinn, PhD, professor of obstetrics and gynecology at Grossman College of Medicine in New York. “This is why the decision to use hormones must be overseen by a healthcare provider, but many transgender people do not have access to a doctor and purchase their hormones online.”
If you’re not taking gender-confirming treatment but are considering it, make sure your doctor knows you have BRCA.
“It’s not an official recommendation, but there has been talk of transgender women testing for BRCA before starting sex-confirming hormones,” Quinn says. “But many people feel that sex-confirming hormones are life-saving and that it is unreasonable to ask trans women to get tested first.”
If you have a doctor and want to get tested for the BRCA genes — and other genes linked to breast cancer — your doctor can help you figure out what that’s involved.
Transgender women who are not on hormones: Although there’s no recommended timing for screening, be sure to see your doctor if you notice any breast lumps or changes — and tell him or her about anyone in your family who has had breast cancer.
Transgender women who have had breast augmentation: Some transgender women choose to have breast augmentation surgery to improve the appearance of their breasts. This is done by transplanting, transferring fat from another part of the body, or a combination of these methods.
Fat transfer uses your own body fat from elsewhere in your body to create breasts, and studies do not show that this increases the risk of breast cancer. Breast implants today do not cause breast cancer either. It has been linked to a lower risk of developing a rare type of cancer called anaplastic large cell lymphoma (ALCL). There hasn’t been much research on ALCL specifically related to transplantation in transgender women. But in one review, researchers called it a “rare but serious” complication and recommended awareness of risks and keeping up with any follow-up care after getting the implants.
Breast cancer screening recommendations for transgender men
Among the many factors that can affect your risk are whether you’ve had “top surgery” to change the appearance of your breasts, whether you take testosterone, and whether you have certain genes that increase your risk of breast cancer.
Trans men who have not had surgery or who have had only breast reduction: Get a mammogram every year or two, starting at age 40.
If you have not had first-degree surgery, your risk of developing breast cancer is the same as it was before the transition. This is true whether you have had a hysterectomy (surgery to remove the uterus). Removing the ovaries and uterus somewhat reduces the risk of breast cancer. Removing both breasts has the greatest impact on breast cancer risk.
Transgender men who have had upper thoracic surgery: You may not have enough breast tissue to put in a mammogram, so your doctor may recommend self-exams and also breast exams by a doctor.
Not every transgender man undergoes surgery. But some do. Top surgery reduces your risk of breast cancer, but not as much as a mastectomy that you would get to prevent or treat breast cancer.
The goal of a mastectomy for breast cancer is to remove as much breast tissue as possible, including tissue under the arms and rib cage. With upper surgery, the goal is different: to change the appearance of the chest to be flatter. “The breast lump is removed, but we don’t go after every cell because it’s not necessary to do so in order to get the overall result we want,” Liang says.
How much does the surgery go down? [breast cancer] The risk depends on the amount of tissue remaining, including the nipple, where there is also the potential for cancerous cells to develop,” Quinn says.
Transgender men who have BRCA1 or BRCA2 gene mutations and have had standard (but not complete) surgery prophylactic mastectomy): You may need to have annual breast cancer screenings. Because you likely won’t have enough breast tissue to place in the mammography machine, your breast cancer specialist may need to do a chest exam. It is important that your doctors know you are BRCA+ so they can create a preventive screening plan for you based on the amount of breast tissue you have.
Trans men taking hormone therapy with testosterone: Testosterone inhibits estrogen. So if you take hormone therapy with testosterone consistently over time, your breast cancer risk is likely to be somewhat lower. But if you don’t take testosterone — or if you only take a low dose or take it intermittently — you won’t get that protective benefit.
Regardless of whether or not you take testosterone therapy, there is still at least some risk of breast cancer. Your doctor can advise you about the examination you need.
Seeking Gender Confirmation Sponsorship
While experts can make recommendations about cancer screening for transgender people, finding a health care provider who confirms gender is easier said than done in some places.
The World Professional Association for Transgender Health has Online guide For sex confirmation care providers. You can also simply contact the doctors in your area and ask about their experience providing care for transgender patients.
“If you can’t find a transgender health clinic near where you live, call your doctor beforehand,” says Liang. “Ask about the provider’s experience with preventative care for transgender people. See how they answer the question – whether they have an understanding of what you need or whether the question seems to them to be out of the field.” Your health concerns – about breast cancer or something else – should be taken seriously and treated with respect by your health care team.