Breast cancer may affect anybody, so it’s crucial for trans men and trans women to take that into account when planning their medical treatment.
“Anyone who has breast tissue might theoretically or conceivably acquire breast cancer,” says Fan Liang, MD, the center’s medical director at Baltimore’s Johns Hopkins Medicine. Your personal medical history, any family history of breast cancer, whether you have specific genes that increase your chance of developing breast cancer, and whether you get gender-affirming therapy are just a few of the factors that might affect your risk of developing breast cancer.
Official transgender-specific breast cancer screening recommendations are still lacking. However, experts do offer some broad suggestions, which are included below. You should discuss what screenings you need when to begin them, and how often. Of course, you should visit your doctor to have any lumps or other unexpected breast changes examined. “Screening” refers to routinely looking for potential breast cancer symptoms rather than making a diagnosis of what a lump or other change could be.
Breast Cancer Recommendations for Trans Women Regarding Screening
Every individual is different. One of the criteria that physicians take into account when determining the risk of breast cancer in trans women is whether or not they are using hormone treatment, as well as their age and how long they have been using it. In addition to any other possible risk factors for breast cancer, this one is also present.
Transgender women who get hormone treatment and use estrogen: Get a mammogram every two years if you are over 50 and have been on hormones for at least five to ten years.
Not all trans women use hormone treatment that is gender-affirming. Breast tissue will form in those who do. Breast cancer may occur in any breast tissue. Additionally, this therapy’s use of estrogen does increase the risk of breast cancer.
Because you would be exposed to less estrogen over the course of your life if you started taking estrogen as an adult, it may not increase your risk as much as if you started taking it as a teen. It is unclear how much taking estrogen increases the risk for people of different ages since there hasn’t been much study in this area yet.
Trans women who have a significant family history of breast cancer and the BRCA1 or BRCA2 gene: Your risk of breast cancer is increased by these genes. Therefore, it’s crucial that you go through how to control this risk with your doctors, such as via screenings or other preventative treatments. You may need to begin having mammograms sooner and more often.
Gwendolyn Quinn, Ph.D., professor of obstetrics and gynecology at NYU Grossman School of Medicine in New York, states that “there are other health issues, not only cancer, that could not make you a suitable candidate for estrogen.” Because of this, a healthcare professional should supervise the choice to take hormones. However, many transgender people lack access to healthcare professionals and instead purchase their hormones online.
Make sure your doctor is aware of your BRCA positivity if you are seeking gender-affirming treatment but are not already receiving it.
It’s not an official prescription, but trans women might be tested for BRCA before beginning gender-affirming medications, according to Quinn. But many people think that gender-affirming hormones could save the life of a trans woman and that it is unfair to make them go through testing first. Your doctor can assist you in learning more if you have a doctor and decide to be tested for the BRCA genes and other genes related to breast cancer.
Transgender women who do not use hormones: Although there is no suggested time for screening, it is important to see your doctor if you feel any breast lumps or changes and to let them know about any family members who have had breast cancer.
Transgender breast augmentation: Some trans women elect to undergo breast augmentation surgery to give themselves the appearance of breasts. Using implants, fat that has been moved from another area of the body, or a combination of those procedures, this is accomplished. Studies reveal that fat transfer does not increase the risk of breast cancer since it utilizes your own body fat from another part of your body to build Breast Cancer. Additionally,
breast cancer is not brought on by modern breast implants. They have been associated with a low risk of anaplastic large-cell lymphoma, a rare type of cancer (ALCL). Research on implant-related ALCL in trans women hasn’t been studied too much. In one study, researchers called it a “rare but dangerous” problem. They said people should be aware of the risk and get any follow-up care they need after getting implants.
For Trans Men, There Are Two Breast Cancer Screening Recommendations
If you’ve had “top surgery” to alter the shape of your chest, if you use testosterone, and whether you have certain genes that increase your chance of breast cancer, these are just a few of the numerous variables that might impact your risk.
Trans males who have only had breast reduction surgery or have not had top surgery: Beginning at age 40, have a mammogram every year or two. Your chance of developing breast cancer remains the same if you haven’t had top surgery. No matter whether you’ve had a hysterectomy or not, it is true (surgery to remove your uterus). The risk of breast cancer is only marginally reduced by removing the uterus and ovaries. The breasts are removed, which has the highest effect on breast cancer risk.
transgender men who underwent top surgery: You may not have enough breast tissue to fit into a mammography machine, so your doctor may tell you to do self-exams in addition to getting a professional breast exam. Not all trans men get advanced surgery. But some do. Having a top operation reduces your chance of breast cancer, but not as much as having a mastectomy to cure or prevent breast cancer. The aim of a breast cancer mastectomy is to remove as much breast tissue as is practical, including tissue on the ribs and under the arms.
The goal of top surgery is different; it aims to make the chest seem flattered. The breast lump is gone, but Liang says that it is not necessary to take out every single cell to get the result that is wanted in the long run. According to Quinn, the amount of remaining tissue, especially in the nipple, where cancer cells may potentially form, determines how much surgery reduces [breast cancer risk].
Trans males who have had routine top surgery (but not a full prophylactic mastectomy) and have BRCA1 or BRCA2 gene variants: Annual breast cancer screenings can be necessary. A breast cancer expert may need to do a chest check on you since you probably won’t have enough breast tissue to put into a mammography machine. If you have BRCA+, you must tell your doctors so they can come up with a preventative screening plan for you based on how much breast tissue you have.
Transgender males who use testosterone-based hormone therapy: Estrogen is suppressed by testosterone. So, if you routinely take testosterone as part of hormone treatment over time, your risk of breast cancer is probably slightly decreased. However, you won’t experience this protective advantage if you don’t take testosterone, take it in little doses, or take it infrequently. There is still some risk of breast cancer regardless of whether you get testosterone treatment. Your doctor may provide you with advice on the appropriate screenings.
Breast Cancer Finding Care That Is Gender-Affirming
Finding a healthcare practitioner who is gender-affirming might be challenging in certain regions, despite the fact that professionals can advise against cancer testing for trans people. The World Professional Association for Transgender Health keeps an online list of care providers who are gender-affirming. You could also just call doctors in your area and ask if they have experience treating transgender people.
Call the doctor in advance if there isn’t a transgender health center close to where you live, advises Liang. “Ask the practitioner about their knowledge of transgender preventative care. Check their response to the inquiry to determine whether they comprehend what you require or if it appears to them that the question has come out of the left field. Your medical staff should respect you and take seriously any worries you have about your health, whether they are related to breast cancer or anything else.
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