Breast cancer in trans women: risks and screening recommendations

Until recently, the medical community did not have data on breast cancer rates in the transgender community. Transgender people have always faced large amounts of discrimination, and data was often not taken or recorded appropriately.

Discrimination and barriers to care still exist for the transgender community today, but substantial progress has been made. For example, for years it was assumed that transgender women had the same risk of breast cancer as cisgender men, but new data has shown that this is not the case.

Medical researchers now know that transgender women have an increased risk of breast cancer‌ compared to cisgender men, and they should follow breast cancer screening guidelines.

In this article, we will look at risk factors for breast cancer in transgender women and screening recommendations.

We still don’t have a lot of information about the exact risk of breast cancer in transgender women. However, the results of a Dutch study 2019 provided some valuable data.

The study looked for cases of breast cancer in transgender people on hormone therapy who received care at the Gender Clinic at the VU University Medical Center Amsterdam in the Netherlands between 1972 and 2016. The center was chosen because it is a major public health facility, where more than 95% of transgender people in the Netherlands receive care.

Researchers have found that transgender women who receive hormone therapy have an increased risk of breast cancer compared to cisgender men. The study data also shows that the risk increased after being treated with gender-affirming hormones for only a short time.

Additionally, data from the study indicated that transgender women who developed breast cancer often contracted it at a younger age than cisgender women.

The median age of breast cancer diagnosis among the transgender women in the study was 52. The average age of breast cancer diagnosis among cisgender women in the Netherlands is 61.

Further studies and information are still needed. However, this study shows that hormone therapy increases the risk of breast cancer in transgender women. Although the risk is considered lower than the risk for cisgender women, it is a significant enough risk that breast cancer screening and education for transgender women is very important.

The Dutch study proved that screening for breast cancer in transgender women is important. The exact screening recommendations for transgender women depend on your particular situation. Here are three general recommendations:

  1. If you’ve been taking feminizing hormones for at least 5 years, follow the breast cancer screening recommendations for cisgender women in your age range.
  2. If you’re 50 or older, follow breast cancer screening recommendations for cisgender women in your age group and get screened at least every 2 years. This applies no matter how long you have been on hormones.
  3. If you have a family history of breast cancer or know you have genetic mutations in the BRCA1 or BRCA2 gene, follow the screening instructions for high-risk cisgender women in your age group. This applies no matter how long you have been on hormones.

The doctor or clinic that prescribes your hormones may be able to advise you if you’re not sure when to start testing. You can tell them about any family history of breast cancer or any other concerns you may have. They can help you develop a screening schedule and plan.

They might also be able to recommend healthcare professionals and places to access breast cancer screening.

Breast cancer is easier to treat when detected at an early stage. This is why screening is so important, as well as knowing the symptoms of breast cancer.

The following symptoms do not always indicate cancer. However, if you notice any of them, it is best to see a medical professional as soon as possible.

Here are the signs to know:

  • a new lump in the breast tissue
  • an area of ​​breast tissue that looks different from the tissue around it
  • breast pain
  • breast swelling
  • an inverted nipple
  • red or discolored skin on the chest
  • peeling or peeling skin on the chest
  • nipple discharge
  • bloody discharge from the nipple
  • a sudden change in the size or appearance of the breasts
  • a painful lump or swelling in the armpit

What is the risk of breast cancer in transgender men?

Masculinizing hormones reduce the risk of breast cancer. Transgender men are less at risk of breast cancer than cisgender women.

However, unless they have had a mastectomy, it is recommended that transgender men continue to follow breast cancer screening recommendations for cisgender women in their age group.

Transgender men who take masculinizing hormones and who have had a mastectomy do not need to continue getting screened for breast cancer.

Should you stop taking feminizing hormones if you have other risk factors for breast cancer?

Talk to your doctor about your personal risk for breast cancer. Stopping feminizing hormones is usually not necessary. Although feminizing hormones increase your risk of breast cancer compared to a cisgender man’s risk, the risk is still lower than a cisgender woman’s.

This means that if breast cancer is a health concern for transgender women, the increased risk of it, even when other risk factors are present, is usually not enough to recommend stopping hormones. .

However, only you can decide if you are comfortable with your increased risk of breast cancer. If you are concerned, it may be helpful to contact a transgender-friendly healthcare professional who can help you understand your personal risk.

Are there other types of feminizing hormones that do not increase the risk of breast cancer?

Any type of feminizing hormone that provides gender-affirming results is likely to carry the same risk. Feminizing hormones cause breast tissue to grow. This will increase your risk of breast cancer. Keep in mind that the increased risk is small.

Can transgender women who have not changed their legal sex get screened for breast cancer?

You have the right to non-discrimination when receiving health care. There are national and state laws, as well as insurance regulations, that protect your right to access services such as breast cancer screening, whether or not you have officially changed your legal documents.

You can read a full list of your protected rights when accessing health care and see more resources by visiting the National Center for Transgender Equality.

Transgender women who take feminizing hormones have a higher risk of breast cancer than cisgender men. The increased risk is slight and the risk is lower than for cisgender women. However, the risk is considered significant enough to make it important for transgender women to be screened for breast cancer.

Currently, it is recommended that screenings for transgender women begin when you have been taking hormones for 5 years or when you reach the age of 50. At each stage, screening recommendations for cisgender women should be followed.

Higher-risk transgender‌ women, such as transgender women with the BRCA1 or BRCA2 gene mutation, are advised to get tested more frequently. It’s a good idea to talk with the doctor who prescribes your hormones about your personal risks and your screening schedule.

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