What Transgender People Need to Know About Breast Cancer Screening

Contributor: Christin N. Collins, DO | Breast Surgical Oncology 

Every October, we get a reminder: every woman over the age of 40 needs a yearly mammogram to screen for breast cancer.

The guidelines, though, are targeted for cisgender women. With one in eight women developing breast cancer at some point in their life, mammograms are important to detect changes in breast health and identify breast cancer early, when it’s most treatable. And with 75% of women having no family history of breast cancer, yearly screenings like mammograms are essential for all women.

Unfortunately, for transgender men, transgender women and non-binary people, the traditional campaigns focused on women over 40 can be confusing by omission.

According to Christin Collins, DO, a breast surgical oncologist at MetroHealth, the lack of breast cancer screening campaigns that are inclusive of trans and non-binary people is the result of a domino effect.

“There is a glaring lack of data regarding trans and non-binary folks and breast cancer,” says Dr. Collins. “And that, in turn, means a lack of guidelines and education for providers.”

For Dr. Collins, the first step in combating breast cancer among the trans and non-binary community is creating a welcoming space for people to seek primary and specialty care.

“One of the biggest barriers to overall health—and breast health—among the trans community is a lack of trust in medical institutions,” says Dr. Collins.

Not that that lack of trust isn’t well-earned. Dr. Collins argues that while programs like the MetroHealth Pride Network are leading the way to make impactful changes, the healthcare system as a whole has overlooked caring for trans people. One example she gives is healthcare organizations not changing a patient’s records from their sex assigned at birth designation, which can lead to them being misgendered on documents and potentially denied by insurance for important screenings and procedures.

“The MetroHealth Pride Network pays attention to these crucial details and works to care for people without hassle and embarrassment,” says Dr. Collins. “We’re providing safety and access because of our training—and we can lead the charge for this type of change across all systems.”

Building trust is important, according to Dr. Collins, because determining the best screening plan for trans people relies on risk factors. That’s why sharing any risk factors openly with your provider is crucial. Risk factors for all cancers include tobacco use, excess drinking, obesity, family history and sexual history—since some cancers can be caused by sexually transmitted infections and diseases.

This type of open communication with your provider doesn’t just positively impact your health right now, but it may mean future generations can be healthier, too.

“If you’re willing to participate in research or disclose your personal health information to your provider, that data is crucial to developing guidelines in the future,” says Dr. Collins. “This is an important space that needs to expand in medicine.”

But, Dr. Collins says, healthcare providers and institutions must take the first step.

“We—providers and institutions—must take the first steps to create a safe and inclusive environment that fosters trust for people who largely have been abandoned or ignored in the past,” says Dr. Collins. “We know that even a small act such as a rainbow pin on a white coat, pronouns on your badge, or a pamphlet of patients’ rights and anti-discriminatory practices in the waiting room can help signify to patients a safe and welcoming space.”

While a transgender woman has less risk of breast cancer than a cisgender woman, gender-affirming therapy may increase your risk.

Estrogen—a common hormone used in gender-affirming therapy—can cause a person’s breast tissue to develop. And when breast tissue develops, it should be monitored for changes that could be potentially cancerous. Estrogen itself does not cause breast cancer, but if cancer develops, it can impact how the cancer cells grow.

With limited national guidelines to follow, many providers follow a consensus of general recommendations for cisgender women. A screening mammogram should be performed annually starting at 40, as well as after 5-10 years of feminizing hormone use. Additional lifestyle factors, high risk screening results, and genetic information should be taken into account when providers and patients are discussing breast cancer screening.

If you’ve chosen to have breast implants rather than—or alongside—estrogen, telling your provider is still important to make sure you get the right screening. Breast tissue may exist around the implants, which could call for additional screenings like ultrasounds or chest wall exams.

Without formal established guidelines, forming a personal relationship with a provider is essential to getting the right care. It can be uncomfortable for transgender and non-binary people to seek the care that’s right for them, especially for a traditionally cisgender woman-dominated experience like mammography and breast cancer screening.

“MetroHealth is working to become a welcoming, safe space for all people,” says Dr. Collins. “From having our pronouns on our badges to asking patients how they identify at the beginning of appointments, it all creates a safe space for people to navigate healthcare.”

The MetroHealth Pride Network is taking larger steps, too—like cross-departmental training with the MetroHealth Cancer Institute to demystify approaching gender and screening guidelines.

“Many providers outside of the Pride Network can feel uncomfortable because there’s no set of guidelines to help them navigate a space they traditionally don’t practice in,” says Dr. Collins. “By being a welcoming space for care, we can work together to develop those guidelines and save lives.”

The MetroHealth Pride Network offers primary care for adults and children and gender-affirming care for adults. While people in the LGBTQ+ community have similar routine healthcare needs as cisgender or heterosexual people, providers in the MetroHealth Pride Network have specialized training and experience related to sexuality and gender.

Contributor: