Transgender people require better breast cancer guidance, study shows

Transgender people who have undergone top surgery require better breast cancer guidance, as despite the reduction in breast tissue, the risk still remains.

The research stressed that genetic and hereditary risk factors (such as BRCA mutations) still remain, meaning some patients may still need cancer screening after surgery.

Between 10 per cent and 20 per cent of breast cancer cases are caused by genetic factors, meaning if a family member has had it before, you may also be at risk.

“Every person – transgender or cisgender – deserves clear information” – lead researcher Kim Zayhowski on breast cancer guidance

Lead researcher Kim Zayhowski said in a news release: “Every person – transgender or cisgender – deserves clear information about their cancer risk and access to prevention.

“As it stands, trans people are diagnosed with cancer at later, more dangerous, stages than cisgender people.”

In the study, which involved 20 healthcare professionals, researchers found that assessing breast cancer risk often falls through the cracks for transgender patients due to the typical age of those who undergo top surgery.

When do screenings for breast cancer typically begin?

Researchers noted that top surgery is often performed in a person’s twenties, before the age when routine breast cancer screenings typically begin, around age 50.

One genetic counsellor said: “We’re talking about top surgery in the twenties. When should we get them tested for the BRCA? What is the plan there?”

Zayhowski stressed that:“Many healthcare professionals caring for transgender patients want to help, but there is currently no standardised conversation about breast/chest cancer risk (e.g. what screening looks like after surgery or whether they should consider having more tissue removed based on a genetic or familial risk for cancer).”

Transgender breast cancer case

One cancer surgeon described a case involving a transgender patient who was diagnosed with breast cancer after surgery: “[I had] a patient who had had top surgery elsewhere in a different state several years ago, but then came in with a palpable mass in the chest wall, which ended up being breast cancer.”

“And then I have had one or two who’ve had incidental cancers, which were really only found incidentally in the specimens having had top surgery,” they continued.

What is CHESTcare?

To advise relevant healthcare professionals and patients about these gaps, researchers are developing CHESTcare (Cancer & Hereditary Risk Education & Support for Transgender and nonbinary individuals).

CHESTcare provides transgender, nonbinary and gender-diverse individuals with clear, evidence-based information and support to help them understand and make informed decisions about chest cancer risk in relation to top surgery, testosterone use and hereditary cancer risks.

The service provides further information on screening after gender-affirming care.