Breast Cancer Risk and Screening in Transgender Individuals

There are over 1.4 million individuals who identify as transgender in the USA, and these individuals are frequently treated with cross-sex hormonal therapy (CSH) to acquire their desired phenotype. Simultaneously, breast cancer is one of the most common cancers in the USA, and there are mixed data on how CSH may influence breast cancer development in transgender individuals. Here, we review the barriers that exist to health access in this population, the current evidence of breast cancer risk in transgender individuals, and breast cancer screening guidelines for both transgender women and men. A large portion of the transgender population report barriers that exist to accessing appropriate healthcare, some of which are directly related to poor interactions with healthcare providers. From both systemic reviews and large retrospective studies, it appears that while transgender females have a lower rate of breast cancer development compared to cis-gender females, transgender males have a higher rate of breast cancer development compared to cis-gender males. While several organizations have released screening guidelines for transgender persons, there is a lack of consensus on optimal screening regimens. In addition, there are no formal recommendations by the American Cancer Society or the United States Preventative Task Force for breast cancer screening in transgender persons. The risk of breast cancer development in transgender individuals is different compared to that of the cis-gender population. Further prospective data are needed to appropriately quantify these risks and to assess what is the appropriate breast cancer screening recommendations for this population.