While we tend to think of access to screening mammography as a woman’s issue the reality is more complex. Transgender patients – regardless if they were biologically or phenotypically male or female at birth – can also be at risk for the disease, and often lack access to mammographic breast cancer screening.
Medical professional theorize that male-to-female transgender patients who have been on feminizing hormones may face an increased risk of developing breast cancer. This is because androgen insensitivity and exposure to exogenous estrogen are risk factors for breast cancer in many other medical conditions. Female-to-male transgender patients who do not undergo mastectomies retain the same risk as women because their genotype is female. Furthermore, individual and hereditary risk factors may increase the likelihood of developing breast cancer in certain individuals.
While research to date – based on retrospective cohort studies – does not indicate that transgender patients have higher incidences of breast cancer than the general population of the natal sex – findings may be limited by study size and duration.
Current evidence suggests that male-to-female transgender patients tend to be diagnosed with later stage breast cancer that is ductal in origin, similar to male breast cancer in the general population. Meanwhile, female-to-male transgender patients who have had mastectomies and androgen supplementation are thought to have a reduced risk of breast cancer compared to the general female population.
Due to limited evidence and mixed results – at-risk transgender patients generally work with their physicians to pursue screening mammography based on the presence of breast tissue.
Current guidelines suggest screening mammography every two years starting at the age of 50 in transgender patients who have been exposed to exogenous hormones for five years or longer. Physicians are advised to assess additional risk factors such as a family history of breast cancer and high BMI when determining whether a transgender patient should pursue screening mammography.
As access to quality transgender healthcare improves, prospective studies are needed to determine best practices and guidelines for screening mammography.