As research builds for our transgender community, cancer screenings and preventative health must be encouraged. As hormonal therapy and surgery are often part of transitioning, trans people should be aware of their risk of developing certain cancers including breast cancer, reproductive cancers, or prostate cancer dependent on their individual treatment.
Risk of Breast Cancer in Trans Women
According to a Dutch study from 2019, for a trans female on hormonal therapy, the risk of developing breast cancer is slightly higher than in the cisgender male population, but still lower than the general cisgender female population.1 Just as hormonal replacement therapy has been shown to increase breast cancer risk in a post-menopausal cisgender female population, so it is for trans women.
Another Dutch study from 2013 noted that 60% of trans women whose records were reviewed in the study had dense or very dense breasts which is known to limit effectiveness of mammogram studies and puts someone at increased individual risk for breast cancer in all populations.2
Those with BRCA1/BRCA2 genetic mutations likely also have an increased risk of breast cancer, although more research is needed specifically for the transgender population. If someone has a BRCA mutation or significant family history of breast cancer, they should discuss screening options with their healthcare providers.
Risk of Breast Cancer in Trans Men
For trans men on hormonal therapy, the risk of developing breast cancer is lower than in the cisgender female population. Trans men also may choose to have top surgery which could include a breast reduction or removal of the breasts (bilateral mastectomy). The risk of developing breast cancer after mastectomy in this population is unknown at this time.1,3
Breast Cancer Screenings for the Trans Population
In the United States, some studies show that transgender people are less adherent to mammogram screening guidelines than cisgender people (often due to stigma or limited access to healthcare).4 However, it is important for these screenings to take place regularly as early detection of breast cancer can save lives.
Current guidelines for trans women who are age 50 or older and have been on hormonal therapy >5 years, a mammogram is recommended every 2 years.1
Trans men who have not had bilateral mastectomy or who only had a breast reduction should undergo an annual mammogram after age 40. After age 50, mammograms can be done every 2 years (but can be continued annually dependent on patient risk and preference). For trans men who have had bilateral mastectomy, chest wall examinations are recommended.3
Breast/Chest self-exams are recommended monthly for both transgender and cisgender populations to pick up early signs of cancer! To learn more about how to do a self-exam, see my previous post here.