Are Transgender People at Risk of Breast Cancer?
People of all genders can get breast cancer, so it’s important for trans men and trans women to consider that 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 things influence your breast cancer risk, including your own medical history, any family history of breast cancer, whether you have certain genes that make breast cancer more likely, and whether you get gender-affirming treatment.
There aren’t yet official breast cancer screening guidelines that are specific to trans people. But experts do have general recommendations, detailed below.
You should talk with your doctor about what screening you need, when to start, and how often. Of course, if you notice a lump or other unusual breast change, see your doctor to get it checked out. (“Screening” refers to routine checking for possible signs of breast cancer, not diagnosing what a lump or other change may be.)
Breast Cancer Screening Recommendations for Trans Women
Each person is unique. In gauging trans women’s breast cancer risk, one of the factors that doctors consider include whether they are taking hormone therapy, their age, and for how long. That’s on top of all the other breast cancer risk factors a person might have.
Trans women who take estrogen as part of hormone therapy: If you’re older than 50, get a mammogram every 2 years after you’ve been taking hormones for at least 5 to 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, does raise the risk for breast cancer.
If you start taking estrogen as an adult, it may not raise your risk as much as if you start taking it as a teen because over your lifetime, you’d have less exposure to estrogen. There hasn’t been a lot of research in this area yet, so it’s not clear how much taking estrogen raises risk for people of various ages.
Trans women with the BRCA1 or BRCA2 genes and/or a strong family history of breast cancer: These genes raise your risk of breast cancer. So it’s very important that you discuss with your doctor how to manage this risk, such as with screenings or other preventive care. You may need to start getting mammograms earlier – and get 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 in New York. “That’s why the decision to use hormones should be overseen by a health care provider, but many trans people don’t have access to a clinician and buy their hormones on the internet.”
If you aren’t taking gender-affirming therapy but are considering it, make sure your doctor knows that you are BRCA-positive.
“It’s not a formal recommendation, but there has been talk about testing trans women for BRCA before starting gender-affirming hormones,” Quinn says. “But a lot of people feel that gender-affirming hormones are lifesaving and that it’s unreasonable to ask that trans women get tested first.”
If you do have a doctor and want to get tested for the BRCA genes – and other genes linked to breast cancer – your doctor can help you find out about what’s involved.
Trans women who don’t take hormones: Although there’s no recommended screening timing, be sure to see your doctor if you notice any breast lumps or changes – and tell them about anyone in your family who’s had breast cancer.
Trans women who got breast augmentation: Some trans women choose to get breast augmentation surgery to create the look of breasts. This is done with implants, fat transferred from another place on the body, or a combination of those methods.
Fat transfer uses your own body fat from somewhere else on your body to create breasts, and studies don’t show that this raises breast cancer risk. Today’s breast implants don’t cause breast cancer, either. They have been linked to a low risk of a rare form of cancer called anaplastic large-cell lymphoma (ALCL). There hasn’t been a lot of research on implant-related ALCL specifically in trans women. But in one review, researchers called it a “rare but serious” complication and recommended being aware of the risk and keeping up with any follow-up care after getting 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 chest, 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: Get a mammogram every year or two starting at age 40.
If you haven’t had top surgery, your breast cancer risk is the same as it was before you transitioned. That’s true whether or not you’ve had a hysterectomy (surgery to remove your uterus). Removal of the ovaries and uterus only somewhat lowers breast cancer risk. Removing the breasts makes the biggest 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, so your doctor may recommend that you do self-exams and also get breast exams done by a doctor.
Not every trans man gets top surgery. But some do. Top surgery lowers breast cancer risk, but not as much as a mastectomy you’d get to prevent or treat breast cancer.
With a breast cancer mastectomy, the goal is to remove as much breast tissue as possible, including tissue under the arms and on the ribcage. With top surgery, the aim is different: to change the chest’s appearance to be flatter. “The breast mass is removed, but we don’t go after every single cell because it’s not necessary to do that in order to get the overall result that we want,” Liang says.
“How much surgery lowers [breast cancer] risk depends on how much tissue is left behind, including the nipple, where there’s also potential for cancer cells to develop,” Quinn says.
Trans men who have the BRCA1 or BRCA2 gene mutations and have had standard top surgery (but not a complete preventive mastectomy): You may need annual breast cancer screenings. Since you likely won’t have enough breast tissue to put into a mammogram machine, a breast cancer specialist may need to give you a chest exam. It’s important that your doctors know that you are BRCA+ so they can make a preventive screening plan for you based on how much 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 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 have that protective benefit.
Regardless of whether or not you take testosterone therapy, there is still at least some risk for breast cancer. Your doctor can advise you about what screening you need.
Finding Gender-Affirming Care
While experts can make recommendations about cancer screenings for trans people, finding a gender-affirming health care provider is easier said than done in some places.
The World Professional Association for Transgender Health has an online directory of providers of gender-affirming care. You may also simply call doctors in your area and ask about their experience with providing care to trans patients.
“If you can’t find a transgender health clinic near where you live, call the doctor beforehand,” Liang says. “Ask about the provider’s experience with transgender preventive care. See how they respond to the question – whether they have an understanding of what you need or whether the question seems to them to come out of left field.” Your health concerns – about breast cancer or anything else – should be taken seriously and treated with respect by your health care team.