Breast Cancer Screening for Transgender People
Listen to our Real Pink podcast, Breast Health in the LGBTQ+ Community.
The terms below may be helpful in understanding breast cancer screening recommendations for transgender people:
- Transmasculine people (transgender men) – female sex assigned at birth, male gender identity
- Transfeminine people (transgender women) – male sex assigned at birth, female gender identity
- Cisgender men – male sex assigned at birth, male gender identity
- Cisgender women – female sex assigned at birth, female gender identity
Breast cancer and transgender people
Data on breast cancer among transmasculine and transfeminine people are limited.
A few small studies have compared breast cancer rates among transgender people who had hormone treatments, with or without surgery as part of their transition, to breast cancer rates in the general population [76,184]. These early findings suggest [76,184]:
- Transmasculine people have a much lower risk of breast cancer than women in the general population, but a higher risk than men in the general population.
- Transfeminine people have a much lower risk of breast cancer than women in the general population, but a higher risk than men in the general population.
There’s still much to learn about the risk of breast cancer in transgender people. If you’re transgender, talk with your health care provider about your risk of breast cancer.
Resources for finding a health care provider
One step you can take is to find a health care provider who is sensitive to your needs. Getting a referral from a trusted friend may help. The National LGBT Cancer Network has a directory of LGBT-welcoming cancer screening centers that may also be helpful.
Regular visits to a health care provider offer the chance to discuss your risk of breast cancer and get breast cancer screening and other needed health care.
Learn more about finding a health care provider.
Find resources for breast cancer support and financial assistance.
Breast cancer screening recommendations for transgender people
The American College of Radiology (ACR) has breast cancer screening guidelines for transgender people. These guidelines are tailored by [77-78]:
- Sex assigned at birth
- Age
- Personal risk of breast cancer
- Breast development
- Breast surgery, for transmasculine people
- Whether a person has used gender-affirming hormone treatment (and for how long), for transfeminine people
Learn about factors that greatly increase breast cancer risk and affect breast cancer screening and risk reduction options.
Breast cancer screening for transgender people at average risk of breast cancer
If you’re transmasculine and have had top surgery (the removal of both breasts), your risk of breast cancer is low. Although top surgery does not completely protect you from breast cancer, it greatly lowers the risk of breast cancer [70,79-81]. (Top surgery does not remove as much breast tissue as when both breasts are removed to reduce the risk of breast cancer (bilateral mastectomy)).
If you’re transmasculine and have not had top surgery, your breast cancer risk is similar to women in the general population (cisgender women). If you’re at average risk of breast cancer, it’s recommended you follow screening recommendations for women at average risk of breast cancer [77-78].
If you’re transfeminine and at average risk of breast cancer, breast cancer screening recommendations depend on your use of gender-assigning hormone treatments (see table below) [77-78].
Breast cancer screening recommendations from the ACR are shown in the tables below. Talk with your health care provider about the breast cancer screening plan that’s right for you.
Find information for people considering top surgery.
Breast cancer screening for transgender people at higher risk of breast cancer
If you’re at higher risk of breast cancer, you may need to be screened earlier and more often than others.
For example, people with a BRCA1 or BRCA2 (BRCA1/2) inherited gene mutation have a higher risk of breast cancer. Breast cancer screening recommendations for transgender people with a BRCA1/2 inherited gene mutation are similar to recommendations for others with a BRCA1/2 mutation [77-78].
Breast cancer screening recommendations from the ACR are shown in the tables below. Talk with your health care provider about the breast cancer screening plan that’s right for you.
ACR breast cancer screening recommendations for |
||
Age, surgery and breast cancer risk |
||
Any age with top surgery (the removal of both breasts) and any level of breast cancer risk |
Not recommended |
Not recommended |
Ages 40 and older with breast reduction or no chest surgery and at average risk of breast cancer* |
Usually appropriate |
Not recommended |
Ages 30 and older with breast reduction or no chest surgery and a personal history of breast cancer, lobular carcinoma in situ (LCIS), atypical hyperplasia or a 15%-20% lifetime risk of breast cancer |
Usually appropriate |
Breast MRI may be appropriate Breast ultrasound may be appropriate |
Ages 25-30 with breast reduction or no chest surgery and a BRCA1 or BRCA2 inherited gene mutation |
Usually appropriate |
Breast MRI usually appropriate Breast ultrasound may be appropriate |
Adapted from American College of Radiology materials [77-78]. |
||
* Less than a 15% lifetime risk of breast cancer
ACR breast cancer screening recommendations for |
||
Age, use of gender-affirming hormone treatment and breast cancer risk |
||
Ages 40 and older, with past or current hormone use for 5 years or more and at average risk of breast cancer |
May be appropriate |
Not recommended |
Any age, with no hormone use or less than 5 years of hormone use and at average risk of breast cancer |
Not recommended |
Not recommended |
Ages 25-30, with past or current hormone use for 5 years or more and at higher risk of breast cancer |
Usually appropriate |
Not recommended |
Ages 25-30 with no hormone use or less than 5 years of hormone use and at higher risk of breast cancer |
May be appropriate |
Not recommended |
Adapted from American College of Radiology materials [77-78]. |
||
If you’re considering top surgery
Compared to a bilateral mastectomy (the removal of both breasts) used to treat or reduce the risk of breast cancer, top surgery removes less breast tissue. With top surgery, the nipple and areola are preserved, and some breast tissue remains. So, the cosmetic look tends to be better after top surgery than after bilateral mastectomy for breast cancer treatment or risk reduction (even when the nipple and areola are preserved).
If you’re considering top surgery and meet the criteria for genetic testing for inherited gene mutations related to breast cancer, the National Comprehensive Cancer Network (NCCN) recommends you get genetic testing before having top surgery [164]. This will help inform your surgery decisions (whether to have top surgery or a bilateral mastectomy for breast cancer risk reduction).
For those who do not meet the criteria for genetic testing, genetic testing before top surgery is not recommended.
Learn more about genetic testing.
Susan G. Komen® Support Resources |
|
Updated 07/22/24
