Are Transgender Women At Risk for Breast Cancer?
By S. Behring
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.
What is the breast cancer risk in transgender women?
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 studyTrusted Source 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.
Additional risk factors for breast cancer
A number of other factors increase your risk of breast cancer. Many of these risks affect both transgender and cisgender women. Those risk factors include:
- Genetics. Having mutations on the BRCA1 or BRCA2 gene increases your risk for breast cancer. Transgender women can inherit these gene mutations.
- Family history. A family history of breast cancer puts you at a higher risk for breast cancer.
- Age. Your risk for breast cancer goes up as you age.
- Obesity. Obesity can change levels of hormones in your body and is linked to an increased risk of breast cancer.
- Limited physical activity. Having a non-active lifestyle can increase your risk for breast cancer.
- Alcohol. There’s a known link between drinking alcohol and an increased risk for breast cancer.
- Dense breast tissue. Dense breast tissue is more fibrous and harder to read on a mammogram. It can increase your risk for breast cancer. Dense breast tissue is common, and the breast growth that transgender women experience as a result of hormonal therapy can be dense breast tissue.
- Previous breast cancer. Having breast cancer once increases your risk of getting it again.
What are the breast cancer screening recommendations for transgender women?
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:
- 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.
- 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.
- 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.
Addressing barriers to healthcare
Unfortunately, transgender women often face barriers to healthcare, as suggested in 2017 researchTrusted Source, and discrimination in accessing medical services. This can be worse when trying to access traditionally gendered medical services such as breast cancer screenings.
Not all medical professionals are educated on inclusive care or on the medical needs of transgender women. Here are a few tips that can help you get the care you deserve and need:
- Research LGBT-friendly medical professionals in your area and read reviews. If you have transportation and your insurance allows it, it’s sometimes worth traveling 45 minutes or so to get to a location that will provide better care.
- Bring a friend or family member. You have the right to bring someone with you to medical appointments. Having someone you trust with you can help prevent discrimination.
- Come prepared with information. Don’t be afraid to come to appointments with notes and research. It can help you feel more confident when talking with your doctor.
What are the symptoms of breast cancer?
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
Breast cancer resources for transgender women
A breast cancer diagnosis can be overwhelming, frightening, and isolating. It’s important to have support and resources you can turn to. Fortunately, there are many helpful organizations for transgender women, including:
- Live Through This. Live Through This is an organization by and for LGBTQI+ people with all types of cancer. You can listen to their podcast, get recipes, read informative blogs, find resources, and more.
- Inclusive Community for Breast Health (ICBH). ICBH provides breast cancer support groups, resources, and information for LGBT people and their families.
- CancerCare. CancerCare offers online support groups led by an oncology social worker. Groups are specific to types of cancer and run in 15-week sessions.
- BreastCancerNow. You can call the free BreastCancerNow helpline for support at any time by dialing 808-800-6000.
Frequently asked questions about breast cancer in transgender people
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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- Blok C, et al. (2019). Breast cancer risk in transgender people receiving hormone treatment: Nationwide cohort study in the Netherlands.
- Feminizing hormones linked to higher breast cancer risk in trans women, but risk still lower than average woman's.
- Lifestyle-related breast cancer risk factors. (2021).
- Megetto O, et al. (2019). Breast cancer risk and breast screening for trans people: An integration of 3 systematic reviews.
- Safer JD, et al. (2016). Barriers to health care for transgender individuals.
- Sieberg R, et al. (2021). A rare case of breast cancer in a transgender woman.
- Sonnenblick EB, et al. (2018). Breast imaging of transgender individuals: A review.
Medically reviewed by Teresa Hagan Thomas PHD, BA, RN — Written by S. Behring on June 9, 2022
Posted in: Medical/Science, Transgender