Are Transgender People at Risk of Breast Cancer?

People of all genders can get breast cancer, so it’s important that trans men and trans women consider it 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 affect your risk of breast cancer, including your own medical history, any family history of breast cancer, whether you have certain genes that increase your risk of breast cancer, and whether you are receiving gender-confirming treatment.

There are no official guidelines for breast cancer screening specific to transgender people yet. But experts do have general recommendations, which are described below.

You should talk to your doctor about what screening you need, when to start and how often. If you notice a lump or other unusual breast change, you should of course see your doctor to get it checked out. (“Screening” refers to routine checking for possible signs of breast cancer, not diagnosing what may be a lump or other change.)

Breast Cancer Screening Recommendations for Transwomen

Every person is unique. When measuring the risk of breast cancer in trans women, among the factors doctors consider is 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 may have.

Trans women using estrogen as part of hormone therapy: If you are over 50, have a mammogram every 2 years after taking hormones for at least 5 to 10 years.

Not all trans women take gender-affirming hormone therapy. Those that 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.

Starting to use estrogen as an adult may not increase your risk as much as if you started taking it as a teenager because you will be less exposed to estrogen over your lifetime. Not much research has been done in this area yet, so it’s not clear how much taking estrogen increases the risk for people of different ages.

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Trans women with the BRCA1 or BRCA2 genes and/or a strong family history of breast cancer: These genes increase the risk of breast cancer. So it is 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 sooner — and more often.

“There are other health issues, 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 transgender people do not have access to a doctor and buy their hormones on the Internet.”

If you are not taking gender confirmation 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 of testing trans women for BRCA before taking gender-confirming hormones,” Quinn says. “But many people believe that gender-affirming hormones are life-saving and that it is unreasonable to ask that trans women get tested first.”

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

Trans women who do not use hormones: While there is no recommended screening timing, if you notice breast lumps or changes, you should see your doctor — and tell them about anyone in your family who has had breast cancer.

Trans women who have undergone breast augmentation: Some trans women choose to undergo breast augmentation to create the appearance 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 elsewhere on your body to create breasts, and studies don’t show that it increases breast cancer risk. Current breast implants also do not cause breast cancer. They have been associated with a low risk of a rare cancer called anaplastic large cell lymphoma (ALCL). Not much research has been done on implant-related ALCL specifically in trans women. But in one review, researchers called it a “rare but serious” complication and advised being aware of the risk and keeping track of all follow-up care after getting the implants.

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Breast Cancer Screening Recommendations for Trans Men

Among the many factors that can affect your risk is whether you’ve had “top surgery” to change the appearance of your chest, whether you’re taking testosterone, and whether you have certain genes that increase your risk of breast cancer.

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

If you didn’t have top surgery, your breast cancer risk is the same as it was before you had surgery. That’s true whether or not you’ve had a hysterectomy (surgery to remove your uterus). Removing the ovaries and uterus only slightly lowers the risk of breast cancer. Removing the breasts has the greatest impact on breast cancer risk.

Transmen who have undergone 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 have breast exams done by a doctor.

Not every trans man gets top surgery. But some do. Top surgery lowers the risk of breast cancer, but not as much as a mastectomy 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 on the rib cage. In top surgery, the goal is different: to flatten the appearance of the chest. “The breast mass is removed, but we don’t go after every single cell because it’s not necessary to get the overall result we want,” says Liang.

“How Much Surgery Lowers” [breast cancer] the risk depends on how much tissue is left behind, including the nipple, where cancer cells can also develop,” says Quinn.

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Transmen who have the BRCA1 or BRCA2 gene mutations and have had top standard surgery (but not a full preventive mastectomy): You may need annual breast cancer screening. Since you probably don’t have enough breast tissue to put in a mammogram machine, a breast cancer specialist may need to give you a breast exam. It is important that your doctors know that you are BRCA+ so that they can create a preventive screening plan for you based on how much breast tissue you have.

Transmen receiving hormone therapy with testosterone: Testosterone suppresses estrogen. So if you consistently use testosterone hormone therapy over time, your breast cancer risk is likely to be slightly lower. But if you don’t take testosterone — or if you only take a low dose or intermittently — you won’t have that protective benefit.

Regardless of whether or not you take testosterone therapy, there is still some risk of breast cancer. Your doctor can advise you on what screening you need.

Finding Gender Confirming Care

While experts can make recommendations about cancer screening for transgender 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 address book of providers of gender-affirming care. You can also simply call doctors in your area and ask about their experience caring for trans patients.

“If you can’t find a transgender clinic near where you live, call the doctor ahead of time,” Liang says. “Ask about the healthcare provider’s experience with preventive transgender care. Watch how they respond to the question – whether they understand what you need or if the question seems to come from 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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