Trans Men + Women and Breast Cancer Risks

It's Breast Cancer Awareness Month, but stats (and images) don't often include Transgender Women or discuss the risks for Transgender Men. We decided to take a deeper dive into the information on breast cancer and transgender, genderqueer, and non-binary people.

When October rolls around, we see images everywhere that it's Breast Cancer Awareness Month. The iconic pink ribbon definitely reminds of someone we know - be it a mother, grandmother, friend, or even ourselves. But our transgender sisters aren't often included. And we definitely don't hear much about non-binary people or transgender men. If you're the latter, are there risks post transition, do you need to navigate the hell that is mammograms?

We also know that HRT (Hormone Replacement Therapy) raises the risks for cisgender menopausal women, so if you're a transgender woman who takes hormones, does this mean risks increase for you too?

I looked into a number of studies that I could find to research the risks for breast cancer and recommendations for transgender and nonbinary people (there aren't many). Here are your main takeaways:

For transgender woman taking gender-affirming hormones, your risk for breast cancer increases, though it is not as high as the average cisgender woman.

For transgender men taking gender-affirming hormones, your risk for breast cancer decreases, especially if you've had gender-affirming surgery, but you may still need to be screened.

All people (regardless of sex assigned at birth) have breast tissue and could get breast cancer. The risks are much higher for people assigned female at birth (1 in 8 women vs 1 in 800 men).

If you're not taking testosterone and haven't had any gender-affirming surgeries such as a mastectomy or top surgery to remove your breasts, or an oophorectomy (removal of the ovaries), you have the same risk for developing breast cancer as cisgender women.

Unfortunately, most of what we know of breast cancer and trans men is based on individual case reports rather than large studies. So, it's hard to say whether they can be generalized to the entire population, and we don't really know the frequency of breast cancer in trans men.

What does this mean? What about mammograms?

For transgender women, it's recommended you have screening mammograms every other year starting at age 50. It’s a good idea to talk to your doctor about your personal risk of breast cancer and develop a screening plan that is best for your unique situation.

For transgender men, AFAB nonbinary, or genderqueer people, the risk of breast cancer likely depends on several factors:

• Age

• Personal and family history of cancer

• Genetics

• History of childbirth and breastfeeding

• Hormone user

• Gender-affirming surgery

More research is needed on the relationship between gender-affirming testosterone therapy and breast cancer risk. It's difficult to compare since it's often given in different dosages and forms, and currently the research has focused on testosterone therapy for non-trans women/men.

If you are a transgender man taking hormones and have not had gender-affirming surgery, you should schedule screening mammograms every other year starting at age 50. It’s also a good idea to talk to your doctor about your personal risk of breast cancer and develop a screening plan that is best for your unique situation. If you have legally changed your sex, you may not receive automatic breast cancer screening invitations, so it is even more important to work with your doctor to develop a plan.

Work with your doctor on a personal screening plan

I know it can be difficult to find a healthcare provider who is respectful and informed. About 30% of transgender people have delayed or avoided seeking needed healthcare because of perceived discrimination and 15% of transgender people report they have been REFUSED healthcare because of their gender identity! But, it's important. Please check with your local advocacy organization, they may be able to help you find a trans-friendly healthcare provider if you don't have one already. I also love this guide to finding a trans-friendly OB/GYN at HelloClue.

Note: If you're a trans man or non-binary individual who binds, there is currently no relationship between binding and breast cancer.

References:

1. Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al (eds). SEER cancer statistics review, 1975-2015 Internet. Bethesda, MD: National Cancer Institute; 2018 April cited 2019 March 4. Available from: https://seer.cancer.gov/csr/1975_2015/

2. BMJ: "Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands"

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#nonbinary #trans #transgender #transhealth #breastcancerawareness