Trans women also at greater risk of breast cancer

When it comes to early cancer detection, we don't always think of trans individuals. They often fall by the wayside in screening programs because there are no clear follow-up studies on the impact of their lifelong hormone treatment on the risk of various hormone-sensitive cancers. Trans persons, both men and women, must administer sex hormones to themselves for life, consistent with their gender identity. A trans woman, born male, takes estrogens for life and a trans man, born female, takes testosterone for life.

We know that estrogens increase the risk of breast cancer. How much this risk increases for trans women is difficult to quantify and depends, among other things, on the age at which they transitioned (the younger, the greater the risk) and what doses of hormones they need (which can vary individually). Moreover, trans persons often feel discriminated against and are themselves less likely to participate in cancer screening programs. Currently, there are hardly any science-based guidelines for cancer screening of trans persons, but this is gradually changing. More and more scientific research is happening on it. It shows that trans men (born female) who had both breasts surgically removed and are on testosterone therapy have a very low risk of breast cancer. Trans women, on the other hand, are at increased risk of breast cancer, although the risk is lower than for cis women. Reason enough to recommend biennial screening mammography also for trans women 50 and older who have been on hormone-affirming treatment for years.

What advice?

The Center for Cancer Screening is committed to the well-being of trans women and, with an eye toward breast cancer risk, provides the following advice based on available scientific research:

• Trans women who have used hormones for less than five years have a very low risk of breast cancer compared to cis men and do not need to be screened for breast cancer by mammography.

• Trans women who have been taking hormones for more than five years and are between the ages of 50 and 69 are best to have a mammogram every two years. Their risk of breast cancer is markedly increased compared to cis men.

• Trans women who have been taking hormones for more than five years and are younger than 50 or older than 69 should discuss screening with their doctor.