Are transgender people at risk for breast cancer?

People of all genders can get breast cancer, so it’s important for trans men and trans women to consider this 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.

Many factors influence your risk of breast cancer, including your own medical history, family history of breast cancer, whether or not you have certain genes that make breast cancer more likely, and whether or not you receive a gender-affirming treatment.

There are no official breast cancer screening guidelines specific to trans people yet. But the experts have general recommendations, detailed below.

You should discuss with your doctor what kind of screening you need, when to start, and how often. Of course, if you notice a lump or other unusual change in the breast, see your doctor to have it checked out. (“Screening” refers to routine checking for possible signs of breast cancer, not diagnosing the nature of a lump or other change.)

Breast cancer screening recommendations for trans women

Each person is unique. To assess the risk of breast cancer in trans women, one of the factors that doctors consider is whether they are on hormone therapy, their age, and for how long. This is in addition to any other breast cancer risk factors a person might have.

Trans women who take estrogen as part of hormone therapy: If you’re over 50, get a mammogram every 2 years after taking hormones for at least 5-10 years.

Not all trans women take gender-affirming hormone therapy. Those who do will develop breast tissue. Any breast tissue can develop breast cancer. And estrogen, which is part of this therapy, increases the risk of breast cancer.

If you start taking estrogen as an adult, it may not increase your risk as much as if you start taking it as a teenager, because over the course of your life you will be less exposed to estrogen. There hasn’t been much research in this area yet, so it’s unclear to what extent taking estrogen increases the risk for people of different ages.

Trans women with BRCA1 or BRCA2 genes and/or with a strong family history of breast cancer: These genes increase your risk of breast cancer. It is therefore very important that you discuss with your doctor how to manage this risk, for example with screenings or other preventive care. You may need to start having mammograms earlier – and have 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. At New York. “That’s why the decision to use hormones should be overseen by a healthcare provider, but many trans people don’t have access to a clinician and buy their hormones over the internet.”

If you are not undergoing gender affirmation therapy but are considering doing so, make sure your doctor knows you are BRCA positive.

“It’s not a formal recommendation, but there has been talk of testing trans women for BRCA before starting gender-affirming hormones,” Quinn says. “But a lot of people think gender-affirming hormones save lives and that it’s unreasonable to ask trans women to get tested first.”

If you have a doctor and want to get tested for BRCA genes — and other genes linked to breast cancer — your doctor can help you find out what’s involved.

Trans women who do not take hormones: Although there is no recommended screening time, be sure to see your doctor if you notice any breast lumps or changes – and tell them about anyone in your family who has had breast cancer. breast.

Trans women who have undergone breast augmentation: Some trans women choose to undergo breast augmentation surgery to create the appearance of breasts. This is done with implants, fat transferred from another location on 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 don’t show it increases breast cancer risk. Today’s breast implants also do not cause breast cancer. They have been linked to a low risk of a rare form of cancer called anaplastic large cell lymphoma (ALCL). There has not been much research on ALCL related to implants specifically in trans women. But in one study, researchers called it a “rare but serious” complication and recommended being aware of the risk and following up with follow-up care after receiving the implants.

Breast cancer screening recommendations for trans men

Some of the many factors that can affect your risk include whether you have had “upper breast surgery” to change the appearance of your breasts, whether you take testosterone, and whether you have certain genes that make breast cancer more likely.

Trans men who have not had top surgery or who have only had breast reduction: Have a mammogram every year or every two years starting at age 40.

If you did not have surgery, your risk of breast cancer is the same as before you transitioned. This is true whether or not you have had a hysterectomy (surgery to remove your uterus). Removal of the ovaries and uterus only slightly reduces the risk of breast cancer. Breast removal has the greatest impact on breast cancer risk.

Trans men who have had top surgery: You may not have enough breast tissue to put in a mammogram machine. Your doctor may therefore recommend that you do self-exams and have breast exams done by a doctor.

Not all trans men have surgery. But some do. Upper surgery reduces the risk of breast cancer, but not as much as a mastectomy to prevent or treat breast cancer.

With a mastectomy for breast cancer, the goal is to remove as much breast tissue as possible, including tissue under the arms and on the rib cage. With upper surgery, the goal is different: to change the appearance of the chest so that it is flatter. “The breast lump is removed, but we don’t go after every cell because there’s no need to do that to get the overall result we want,” Liang explains.

“How much surgery decreases [breast cancer] the risk depends on how much tissue is left, including the nipple, where there is also potential for cancer cells to develop,” says Quinn.

Men who are carriers of BRCA1 or BRCA2 gene mutations and who have undergone standard upper surgery (but not a complete preventive mastectomy): You may need annual breast cancer screenings. Since you probably won’t have enough breast tissue to put in a mammogram machine, a breast cancer specialist may need to give you a lung exam. It is important that your doctors know that you are BRCA+ so that they can establish a preventive screening plan for you based on the amount of breast tissue you have.

Trans men who take hormone therapy with testosterone: Testosterone suppresses estrogen. So if you take hormone therapy with testosterone consistently over time, your risk of breast cancer is likely to be somewhat lower. But if you don’t take testosterone — or if you only take it at a low dose or take it intermittently — you won’t get this protective benefit.

Whether or not you take testosterone therapy, there is always at least a risk of breast cancer. Your doctor can advise you on which screening you need.

Find Gender-Affirming Care

While experts can make recommendations on cancer screening for trans people, finding a gender-affirming healthcare provider is easier said than done in some places.

The World Professional Association for Transgender Health has an online directory of gender-affirming care providers. You can also simply call the doctors in your area and ask them about their experience caring for trans patients.

“If you can’t find a transgender health clinic near you, call the doctor first,” Liang says. “Ask about the provider’s experience with transgender preventive care. See how they respond to the question – if they have an understanding of what you need or if the question seems out of left field to them. Your health concerns – about breast cancer or anything else – should be taken seriously and treated with respect by your healthcare team.

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