Breast cancer risk and breast screening for trans people: an integration of 3 systematic reviews

Abstract

rans" is an umbrella term for people with diverse gender identities and expressions that differ from stereotypical gender norms. 1,2 Recent estimates suggest that there were approximately 200 000 trans people in Canada in 2016. 3 Many trans people seek gender-affirming medical procedures or cross-sex hormone (CSH) therapy, or both, to align their physical appearance with their sense of self. 4 Cross-sex hormone therapy refers to the use of exogenous sex hormones that are opposite to those of a person's natal sex. 5 Breast cancer risk in trans people is hypothesized to be influenced by CSHs. 6 However, it is unclear whether the potential alteration in risk for breast cancer by CSH therapy should affect eligibility for breast screening. Trans people are medically underserved and face unique challenges in accessing appropriate care. 3,7 With respect to breast health, 25%-30% of trans people in Ontario with a perceived need for mammography were unable to access it. 8 In addition, trans people are less likely to pursue breast screening than are cisgender women (i.e., people assigned female sex at birth and who identify as female). 9 Although this shows a disparity in the approach to breast cancer detection when compared to

Breast Imaging for Transgender Individuals: Assessment of Current Practice and Needs

“…A second major finding was that only one-third of respondents had knowledge of mammographic screening recommendations for transgender women. Expert guidance for transgender breast cancer screening varies among organizations [5]; an accepted approach is summarized in Table 1. This guidance is informed by the experience of one large European study that demonstrated a 46-fold elevated risk for breast cancer in transgender women treated with estrogen compared with cisgender men, as well as a lower risk for breast cancer in transgender men compared with cisgender women [25].…”

“…Definitions relevant to the survey (ie, sex, gender identity, transgender, transition, cisgender, sexual orientation, and the "two-step" method for classifying sex) on the basis of relevant literature were provided to reduce confusion about terminology (Table 2) [10,15]. The "two-step" method was developed as a reliable means of accurately identifying Note: Recommendations are derived from a meta-analysis [5] and expert opinion [6][7][8].…”

“…The influence of such gender-affirming treatment on development of breast cancer is not well understood. It is widely acknowledged that there is insufficient evidence on which to base breast cancer screening guidelines for transgender women treated with feminizing hormones [5]. Despite the paucity of data, as shown in Table 1, some recommend that transgender women treated with feminizing hormones for at least 5 to 10 years consider mammographic screening every 1 to 2 years starting at 40 to 50 years of age [5][6][7][8].…”

“…It is widely acknowledged that there is insufficient evidence on which to base breast cancer screening guidelines for transgender women treated with feminizing hormones [5]. Despite the paucity of data, as shown in Table 1, some recommend that transgender women treated with feminizing hormones for at least 5 to 10 years consider mammographic screening every 1 to 2 years starting at 40 to 50 years of age [5][6][7][8]. Transgender men who have not had surgery should screen according to guidelines for cisgender women.…”

Culturally safe, high‐quality breast cancer screening for transgender people: A scoping review protocol

“…As with cis-gendered individuals--particularly women--due to breast cancer risks faced by transgender people, breast cancer screening is widely recommended (Meggetto et al, 2019). There are some suggestions that breast cancer screening guidelines (in the Netherlands) for cisgender people are adequate for transgender people using hormone treatment (de Blok et al, 2019).…”