Trans Women Breast Cancer: Risks and Screening Recommendations

Until recently, the medical community didn’t have data on breast cancer rates in the transgender community. Transgender people have historically faced large amounts of discrimination, and data often wasn’t taken or recorded appropriately.

Discrimination and barriers to care still exist for the transgender community today, but there have been substantial steps forward. For instance, for years it was assumed that transgender women had the same risk of breast cancer as cisgender men, but new data has shown this isn’t the case.

Medical researchers now know that transgender women have an increased risk of breast‌ cancer compared with cisgender men, and they should follow breast cancer screening guidelines.

In this article, we’ll take a look at the breast cancer risk factors for transgender women and screening recommendations.

We still don’t have a lot of information about transgender women’s exact risk for breast cancer. However, the results of a 2019 Dutch study provided a few valuable pieces of data.

The study looked for cases of breast cancer among transgender people taking hormone therapy who received care at the gender clinic of the VU University Medical Centre Amsterdam in the Netherlands between 1972 and 2016. The Centre was chosen because it is a major public health facility, where more than 95 percent of transgender people in the Netherlands receive care.

Researchers found that transgender women who receive hormone therapy have an increased risk of breast cancer when compared with cisgender men. Data from the study also shows that the risk increased after being treated with gender affirming hormones for only a short time.

Additionally, data from the study indicated that transgender women who developed breast cancer often got it at a younger age than cisgender women.

The median age of breast cancer diagnosis for transgender women in the study was 52. The average age of breast cancer diagnosis for cisgender women in the Netherlands is 61.

More studies and information are still needed. However, this study shows that hormone therapy increases the risk of breast cancer for transgender women. Although the risk is considered to be below the risk for cisgender women, it is a significant enough risk that screening and breast cancer education for transgender women is very important.

The Dutch study proved that breast cancer screening for transgender women is important. The exact screening recommendations for transgender women depend on your specific circumstances. Here are three general recommendations:

  1. If you’ve been on feminizing hormones for at least 5 years, ‌follow the breast cancer screening recommendations for cisgender women in your age group.
  2. If you are age 50 or above, follow the breast cancer screening recommendations for cisgender women in your age group and have a screen at least every 2 years. This applies no matter how long you’ve been on hormones.
  3. If you have a family history of breast cancer or know you have genetic mutations on the BRCA1 or BRCA2 gene, follow the screening instructions for high risk cisgender women in your age group. This applies no matter how long you’ve been on hormones.

The doctor or clinic that prescribes your hormones might be able to advise you if you’re not sure exactly when to begin screenings. You can talk with them about any family history of breast cancer or any other concerns you might have. They can help you develop a timeline and screening plan.

They might also be able to recommend healthcare professionals and locations to access a breast cancer screening.

Breast cancer is most treatable when it’s detected in the early stages. That’s why screening is so important, as well as knowing the symptoms of breast cancer.

The following symptoms don’t always indicate cancer. However, if you notice any of them, it’s best to see a medical professional as soon as possible.

Here are the signs to know:

  • a new lump in breast tissue
  • an area of breast tissue that feels different from the tissue around it
  • breast pain
  • breast swelling
  • an inverted nipple
  • red or discolored skin on the breast
  • flaking or peeling skin on the breast
  • nipple discharge
  • bloody nipple discharge
  • a sudden change to the size or appearance of the breasts
  • a painful lump or swelling in the armpit

What’s the breast cancer risk for transgender men?

Masculinizing hormones decrease the risk for breast cancer. Transgender men are at less risk for breast cancer than cisgender women.

However, unless they’ve had a mastectomy, it’s recommended that transgender men continue to follow breast cancer screening recommendations for cisgender women in their age group.

Transgender men who take masculinizing hormones and have had a mastectomy do not need to continue having breast cancer screenings.

Should you stop taking feminizing hormones if you have other risk factors for breast cancer?

Talk with your doctor about your personal risk of breast cancer. Stopping feminizing hormones generally isn’t necessary. Although feminizing hormones increase your risk of breast cancer when compared with the risk of a cisgender man, the risk is still below that of a cisgender woman.

This means that while breast cancer is a health concern for transgender women, the increased risk of it, even when other risk factors are present, is not usually enough to recommend stopping hormones.

However, only you can decide if you’re comfortable with increasing your risk for breast cancer. If you’re worried, it can help to reach out to a transgender-friendly healthcare professional who can help you understand your personal risk.

Are there other types of feminizing hormones that don’t increase the risk of breast cancer?

Any type of feminizing hormone that provides gender affirming results is likely to carry the same risk. Feminizing hormones result in the growth of breast tissue. This will increase your risk for breast cancer. Keep in mind the increase in risk is small.

Can transgender women who haven’t changed their legal gender get a breast cancer screening?

You have the right to nondiscrimination when you receive healthcare. There are national and state laws, as well as insurance regulations, that protect your right to access services such as breast cancer screenings, regardless of whether you’ve officially changed your legal documents.

You can read a full list of your protected rights when accessing healthcare and see more resources by visiting the National Center for Transgender Equality.

Transgender women who take feminizing hormones have a higher risk of breast cancer than cisgender men do. The increase in risk is slight, and the risk is lower than cisgender women’s risk. However, the risk is considered significant enough that is important for transgender women to receive breast cancer screenings.

Currently, it’s recommended that screenings for transgender women start when you’ve been on hormones for 5 years or when you turn 50 years old. At either point, screening recommendations for cisgender women should be followed.

Transgender women who‌ are at a higher risk, such as transgender women who have the BRCA1 or BRCA2 gene mutation, are advised to get screenings more frequently. It’s a good idea to talk with the doctor who prescribes your hormones about your personal risks and about your screening timeline.

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