Skip to main content

Breast Cancer Risk and Screening in Transgender Persons: A Call for Inclusive Care

Abstract

The Society of Surgical Oncology is committed to reducing health disparities adversely affecting sexual and gender minorities. Transgender persons represent a socially disadvantaged group who frequently experience discrimination and receive disparate care, resulting in suboptimal cancer outcomes. The rate of breast cancer development in transgender individuals differs from rates observed in their cisgender counterparts, however there is little evidence to quantify these differences and guide evidence-based screening and prevention. There is no consensus for breast cancer screening guidelines in transgender patients. In this review, we discuss barriers to equitable breast cancer care, risk factors for breast cancer development, and existing data to support breast cancer screening in transgender men and women.

This is a preview of subscription content, access via your institution.

References

  1. Gates G. In US, More Adults Identifying as LGBT. Social & Policy Issues 2017. Retrieved from: https://news.gallup.com/poll/201731/lgbt-identification-rises.aspx

  2. Diamant AL, et al. Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Arch Fam Med. 2000;9(10):1043–51.

    CAS  Article  Google Scholar 

  3. Austin SB, et al. An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women. Cancer Causes Control. 2013;24(3):539–47.

    Article  Google Scholar 

  4. Blosnich JR, et al. Health inequalities among sexual minority adults: evidence from ten U.S. states, 2010. Am J Prev Med. 2014;46(4):337–49.

    Article  Google Scholar 

  5. Quinn GP, et al. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin. 2015;65(5):384–400.

    Article  Google Scholar 

  6. Burns ZT, et al. Clinical characteristics, experiences, and outcomes of transgender patients with cancer. JAMA Oncol. 2021;7(1):e205671.

    Article  Google Scholar 

  7. Hartley RL, Stone JP, Temple-Oberle C. Breast cancer in transgender patients: a systematic review. Part 1: male to female. Eur J Surg Oncol. 2018;44(10):1455–62.

    Article  Google Scholar 

  8. Stone JP, Hartley RL, Temple-Oberle C. Breast cancer in transgender patients: a systematic review. Part 2: female to male. Eur J Surg Oncol. 2018;44(10):1463–8.

    Article  Google Scholar 

  9. Fledderus AC, et al. Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening. Breast. 2020;53:92–100.

    Article  Google Scholar 

  10. Unger CA. Care of the transgender patient: a survey of gynecologists’ current knowledge and practice. J Womens Health (Larchmt). 2015;24(2):114–8.

    Article  Google Scholar 

  11. Bradford J, et al. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10):1820–9.

    Article  Google Scholar 

  12. Hughto JMW, Pachankis JE, Reisner SL. Healthcare Mistreatment and Avoidance in Trans Masculine Adults: The Mediating Role of Rejection Sensitivity. Psychol Sex Orientat Gend Divers. 2018;5(4):471–81.

    Article  Google Scholar 

  13. Socias ME, et al. Factors associated with healthcare avoidance among transgender women in Argentina. Int J Equity Health. 2014;13(1):81.

    Article  Google Scholar 

  14. Johnson CV, Mimiaga MJ, Bradford J. Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: Introduction. J Homosex. 2008;54(3):213–24.

    Article  Google Scholar 

  15. Griggs J, et al. American society of clinical oncology position statement: strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol. 2017;35(19):2203–8.

    Article  Google Scholar 

  16. Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat. 2015;149(1):191–8.

    Article  Google Scholar 

  17. Gooren LJ. Clinical practice. Care of transsexual persons. N Engl J Med. 2011;364(13):1251–7.

    CAS  Article  Google Scholar 

  18. Wierckx K, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641–51.

    CAS  Article  Google Scholar 

  19. de Blok CJM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652.

    Article  Google Scholar 

  20. Gooren LJ, et al. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10(12):3129–34.

    Article  Google Scholar 

  21. Burcombe RJ, et al. Breast cancer after bilateral subcutaneous mastectomy in a female-to-male trans-sexual. Breast. 2003;12(4):290–3.

    CAS  Article  Google Scholar 

  22. Nikolic DV, et al. Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy. World J Surg Oncol. 2012;10:280.

    Article  Google Scholar 

  23. Gooren L, et al. Five new cases of breast cancer in transsexual persons. Andrologia. 2015;47(10):1202–5.

    CAS  Article  Google Scholar 

  24. Katayama Y, et al. A very rare case of breast cancer in a female-to-male transsexual. Breast Cancer. 2016;23(6):939–44.

    Article  Google Scholar 

  25. Shao T, Grossbard ML, Klein P. Breast cancer in female-to-male transsexuals: two cases with a review of physiology and management. Clin Breast Cancer. 2011;11(6):417–9.

    Article  Google Scholar 

  26. Ray A, et al. Testosterone therapy and risk of breast cancer development: a systematic review. Curr Opin Urol. 2020;30(3):340–8.

    Article  Google Scholar 

  27. Parikh U, et al. Breast Imaging in Transgender Patients: What the Radiologist Should Know. Radiographics. 2020;40(1):13–27.

    Article  Google Scholar 

  28. Kiran T, et al. Cancer screening rates among transgender adults: cross-sectional analysis of primary care data. Can Fam Physician. 2019;65(1):e30–7.

    PubMed  PubMed Central  Google Scholar 

  29. Deutsch M. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2016. Available at: https://transcare.ucsf.edu/guidelines. Accessed 18 Jan 2021.

  30. Makadon HJ, Mayer KH, Potter J, Goldhammer H. Fenway guide to Lesbian, Gay, bisexual and transgender Health. 2nd ed. American College of Physicians; 2015.

  31. Transgender Breast Cancer Screenings. Available at: https://www.uhhospitals.org/services/cancer-services/breast-cancer/transgender-breast-screenings. Accessed 15 Jan 2021.

  32. Susan G. Komen Puget Sound Breast Health Toolkit for the LGBTQ Community. Available at: https://komenpugetsound.org/wp-content/uploads/2018/04/LGBTQ-Breast-Health-Toolkit-final.pdf. Accessed 16 Jan 2021.

  33. Canadian Cancer Society Screening in LGBTQ Communities. Available at: https://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/find-cancer-early/screening-in-lgbtq-communities/?region=on. Accessed 16 Jan 2021.

  34. Hembree WC, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Callisia N. Clarke MD, MS, FACS, FSSO.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Clarke, C.N., Cortina, C.S., Fayanju, O.M. et al. Breast Cancer Risk and Screening in Transgender Persons: A Call for Inclusive Care. Ann Surg Oncol 29, 2176–2180 (2022). https://doi.org/10.1245/s10434-021-10217-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-10217-5