When it comes to getting a breast cancer diagnosis, most people only think about cisgender women. The association makes sense: It is the second most common cancer among cis women, and media depictions of this form of cancer, from fiction to PSAs, almost always center their experiences.
Although they are the demographic most impacted by breast cancer, cis women aren’t the only people susceptible to this illness. Everyone is born with some amount of breast tissue, and anyone who has breast tissue can technically be diagnosed with breast cancer. In fact, the National Foundation for Breast Cancer Awareness estimates that 2,190 cisgender men are diagnosed with this cancer each year.
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But what about transgender men who haven’t had top surgery, trans women whose breasts have grown due to hormone therapy, or nonbinary people who were assigned female at birth (AFAB)? There are an estimated 1.3 million trans adults living in the United States, yet their health and wellbeing is historically understudied and under-supported by our nation’s healthcare infrastructure.
In honor of Breast Cancer Awareness Month, SheKnows connected with experts on what trans and nonbinary people need to know about breast cancer — and here’s what we found.
Understand your risk factors
It bears repeating: Anyone with breast tissue can develop breast cancer regardless of their gender identity. That said, some people are more susceptible than others. Most breast cancer cases are diagnosed in people 50 years or older, so age is a factor. There also are a number of more specific risk factors that may be relevant to some trans men and AFAB nonbinary people, including genetic markers, like the BRCA gene, or a family history of breast or ovarian cancer.
Trans women or assigned-male-at-birth (AMAB) nonbinary people who have developed breasts by taking the hormone estrogen are more likely to develop breast cancer than cisgender men, according to some research. “It’s a common misconception that trans women don’t need screening,” Lola Pellegrino, Clinical Director of Women’s Health at Callen-Lorde Community Health Center, tells SheKnows.
The risk of breast cancer in trans men or AFAB nonbinary people who have had breast tissue removed via gender-affirming chest surgery, or top surgery, is understudied, although it is theoretically lower than those who have not. Screenings are generally not recommended for trans men post-top surgery, Pellegrino explains.
Since most clinical research on breast cancer in trans people is based on individual case reports, it is unclear if these findings can be generalized for the trans community at large. Additionally, most studies about breast cancer risk in trans women were conducted among trans women on premarin, an older, “much rougher” form of estrogen that is no longer in popular use. “We’re just kind of making guesses,” Pellegrino says.
Prioritize screenings, especially if you’re at a higher risk
Like most cancers, breast cancer is generally easier to treat if it is detected at an early stage. That’s why regular screenings are important.
For people at average risk of developing breast cancer, the American Cancer Society recommends annual screenings via mammograms for cisgender women ages 45–54. At 55, these screenings can be bumped down to once every two years. The same guidelines apply to people trans men who haven’t had top surgery, AFAB nonbinary people, and trans women on estrogen.
“We do recommend screening [for trans women], but not unless somebody is over the age of 50 and has been on hormones for at least five years,” Pellegrino says. Trans women are also “much more likely” to get false-positives on mammograms due to the density of their breast tissue, so they should request breast ultrasounds as an additional screening measure.
For those at higher risk, yearly mammograms are available to patients as young as 40 years old. Screenings are sometimes paired with clinical or self-administered breast exams, although these physical exams aren’t always effective, Pellegrino notes. Regardless of their gender identity, people who notice changes to how their breasts normally look and feel — including painless, hard lumps, skin dimpling, or nipple discharge — should consult with their healthcare provider as soon as possible.
Seek out trans-friendly healthcare providers
There is nothing more discouraging than seeking care from a medical provider, only to have them misgender you or invalidate your identity. Being treated by trans-affirming healthcare professionals — from your primary care provider to any specialists, including oncologists — can make a substantial difference in your overall experience as a patient. Breast health can be a vulnerable topic, especially for trans men or AFAB nonbinary people, but fear of discrimination at the doctor’s should never be a deterrent from seeking cancer-related care.
Don’t know where to start? The World Professional Association for Transgender Health (WPATH) maintains an online directory of trans-friendly providers around the world. Many major cities have LGBTQ-specific community health centers — for instance, Callen-Lorde is a go-to among LGBTQ New Yorkers. You can also try contacting your insurance provider directly, as some insurers keep lists of LGBTQ-affirming professionals on hand.
Additionally, consider checking in with other trans or nonbinary people in your area, who may be able to recommend local providers they trust.
If you’re diagnosed, find community
If you’re a trans or nonbinary person who has been diagnosed with breast cancer, know that you are not alone. There are other people in your shoes, and connecting with them can bring comfort and validation when facing a life-threatening diagnosis.
Consider contacting the National LGBT Cancer Network, a Rhode Island-based organizations that facilitates a number of identity-based virtual support groups for cancer patients and survivors, or similar groups in your area.
Before you go, check out these products patients and survivors of breast cancer can actually use:
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