Are transgender people at risk of breast cancer?
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Breast cancer can affect people of any gender, so it’s important that trans men and trans women consider it as part of their health care routine.
“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 things affect your risk of breast cancer, including your own medical history, a family history of breast cancer, whether you have certain genes that make breast cancer more likely, and whether you receive gender-affirming treatment.
There are still no official breast cancer screening guidelines specific to trans people. However, experts have general recommendations, which are listed below.
You should talk to your doctor about what screening you need, when to start, and how often. Of course, if you notice a lump or any other unusual breast change, see your doctor to have it checked out. (“Screening” refers to routine testing for possible signs of breast cancer, not diagnosing what a lump or other change might be.)
Breast cancer screening recommendations for trans women
Every human is unique. When assessing the breast cancer risk of trans women, doctors take into account, among other things, whether they are receiving hormone therapy, how old they are and for how long. This is on top of all the other risk factors for breast cancer a person might have.
Trans women taking estrogen as part of hormone therapy: If you are older than 50, have a mammogram every 2 years after taking hormones for at least 5 to 10 years.
Not all trans women receive gender-affirming hormone therapy. Those that do develop breast tissue. Any breast tissue can develop breast cancer. And estrogen, which is part of this therapy, increases the risk of breast cancer.
Starting estrogen as an adult may not increase your risk as much as starting as a teenager because you will have less exposure to estrogen over the course of your life. Not much research has been done in this area, so it’s not clear to what extent estrogen intake increases risk for people of different ages.
Trans women with the BRCA1 or BRCA2 genes and/or 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, e.g. B. through check-ups or other preventive measures. You may need to start mammograms sooner—and more 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 NYU Grossman School of Medicine in New York. “Therefore, the decision to use hormones should be overseen by a healthcare provider, but many trans people don’t have access to a doctor and buy their hormones online.”
If you’re not taking gender-affirming therapy but are considering it, make sure your doctor knows you’re BRCA positive.
“It’s not a formal recommendation, but there has been talk of testing trans women for BRCA before starting gender-affirming hormones,” says Quinn. “But many people feel that gender-affirming hormones are life-saving and that requiring trans women to get tested first is unreasonable.”
If you have a doctor and want to get tested for the BRCA genes — and other genes associated with breast cancer — your doctor can help you figure out what’s at stake.
Trans women not taking hormones: While there’s no recommended time for screening, be sure to see your doctor if you notice any lumps or changes in your breast — and tell them about someone in your family who has had breast cancer.
Trans women with breast augmentation: Some trans women choose breast augmentation surgery to create the appearance of breasts. This is done with implants, fat transferred from another part of the body, or a combination of these methods.
Fat transfer uses your own body fat from elsewhere on your body to form breasts, and studies don’t show that this increases the risk of breast cancer. 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 isn’t much research on implant-related ALCL specifically in trans women. However, in a review, researchers called this a “rare but serious” complication and recommended being aware of the risk and keeping up with follow-up care after receiving the implants.
Breast cancer screening recommendations for trans 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’re taking testosterone, and whether you have certain genes that make breast cancer more likely.
Trans men who have not had top surgery or only had breast reduction surgery: After the age of 40, have a mammogram every one to two years.
If you haven’t had top surgery, your risk of breast cancer is the same as before the switch. This is true whether you’ve had a hysterectomy (surgery to remove your uterus) or not. Removal of the ovaries and uterus only slightly reduces the risk of breast cancer. Removal of the breasts has the greatest impact on breast cancer risk.
Trans men who underwent top surgery: You may not have enough breast tissue to be placed in a mammography machine, so your doctor may recommend that you do self-exams and also have breast exams performed by a doctor.
Not every trans man gets top surgery. But some do. Top surgery lowers your risk of breast cancer, but not as much as a mastectomy, which you would get to prevent or treat breast cancer.
In a breast cancer mastectomy, the goal is to remove as much breast tissue as possible, including tissue under the arms and around the rib cage. With top surgery, the goal is different: to make the breast appear flatter. “The breast mass is removed, but we don’t go into every single cell because it’s not necessary to achieve the desired overall result,” says Liang.
“How much surgery brings down [breast cancer] The risk depends on how much tissue is left, including the nipple, where cancer cells can also develop,” says Quinn.
Trans men with BRCA1 or BRCA2 gene mutations who have had standard top surgery (but not a full preventive mastectomy): You may need annual breast cancer screenings. Because you probably don’t have enough breast tissue to fit into a mammography machine, a breast cancer specialist may need to examine you for a breast exam. It’s important for your doctors to know you are BRCA+ so they can create a screening plan for you based on your breast tissue.
Trans men taking hormone therapy with testosterone: Testosterone suppresses estrogen. So if you consistently take hormone therapy with testosterone over a longer period of time, your risk of breast cancer should be slightly lower. But if you’re not taking testosterone — or if you’re only taking a low dose or taking it intermittently — you don’t have that protective benefit.
Regardless of whether you are on testosterone therapy or not, there is still some risk of breast cancer. Your doctor can advise you on what screening you need.
Seek gender-affirming care
While experts can provide recommendations on cancer screening for trans people, in some places finding a gender-affirming healthcare provider is easier said than done.
The World Professional Association for Transgender Health has an online directory of gender-affirming care providers. You can also simply call doctors in your area and ask about their experiences caring for trans patients.
“If you can’t find a transgender health clinic in your area, call the doctor first,” Liang says. “Ask about the provider’s experience with transgender screening. See how they respond to the question — whether they understand what you need, or if the question seems to come out of left field for them.” Your health concerns — whether breast cancer or something else — should be taken seriously by your healthcare team and addressed be treated with respect.
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