All transgender people who have mammary glands must adhere to the breast cancer screening program under conditions very similar to those carried out by cisgender women (those who identify with the sex assigned at birth). But administrative gaps, insufficient training of health personnel and lack of awareness among those affected exclude them from the early detection system, thereby increasing the risk of tumor development.
As a sign of femininity and bodily identity, the treatment of the mammary gland takes on special relevance in both men and transgender women, who may be excluded from cancer screening during the process of transition and gender adjustment, specialists from the International Breast have warned. Cancer Center (IBCC), hyper-specialized center in breast cancer, based in Barcelona.
“It is no longer so uncommon to find a trans population that for some reason is outside the usual screening circuits,” explains Ignacio Miranda, head of radiology at the IBCC. “The last case – he specifies – was a Tans man who had not undergone a mastectomy, and despite being at the screening age (from 50 years for women) he was outside the program because he was registered as male. despite maintaining the mammary gland. The system does not identify you as a woman to undergo screening.”
This, transgender men who have not yet undergone a mastectomy for masculinization, although they have completed their gender reassignment administratively, is one of the two profiles that may be temporarily left out of early detection. The other is that of transgender women who have undergone hormonal treatments to develop breast tissue but have not yet completed the administrative procedure, so they remain administratively men.
Gender reassignment treatments (hormonal or surgical) affect the breast glandular tissue, a circumstance that can affect the risk of developing cancer. The baseline risk for trans women is similar to that of cis men, although an increase is added due to estrogen stimulation during hormonal treatment. For their part, trans men have a starting risk similar to that of cisgender women, modified in this case by hormonal treatment with testosterone.
Breast surgeries, both mastectomies and breast augmentation, could also alter the risk of developing cancer.
There is little scientific evidence on the incidence of breast tumors in the trans population receiving hormonal treatment and on the effects of early detection programs. The largest study, carried out in the Netherlands on a sample of 2,260 trans women and 1,229 trans men, indicates that the former have a greater risk (46 times) of cancer than cisgender men and that trans men are half as likely as women cis.
“With these data, it should be considered that transgender women enter breast cancer population screening programs, while transgender men undergoing masculinization surgery could be excluded,” says Miranda. The problem, she specifies, is that during the administrative and medical process, men who have not undergone a mastectomy are excluded.
A problem that is increasing. It is estimated that in 2017 the trans population in Spain was 10,000 individuals. But between 2017 and 2021, nearly 21,000 people were treated by units specialized in the treatment of gender identity, according to a report by Confluencia Movimiento Feminista.
Who should be included in screening programs? The US radiology and endocrinology societies have developed guidelines and indications in this regard. “For practical purposes, they are the same as in the population of cis women,” says Dr. Miranda: from the age of 50. Trans women who have been on hormonal treatment for at least 5 years and trans men who have not undergone a mastectomy.
