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Transgender individuals face breast care disparities. Guidelines for breast cancer screening in transgender women and men are proposed, but further research is needed for personalized care.

Keywords:
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Area of Science:

  • Medical Imaging
  • Oncology
  • Endocrinology

Background:

  • 1.4 million adults in the U.S. identify as transgender, yet face significant disparities in breast care access and outcomes.
  • Lack of evidence-based screening guidelines for transgender populations complicates breast care delivery.
  • Gender-affirming interventions impact breast imaging and cancer risk, necessitating radiologist familiarity.

Purpose of the Study:

  • To review current understanding of breast cancer risk and screening in transgender populations.
  • To provide guidance for breast imaging radiologists regarding gender-affirming interventions.
  • To highlight areas requiring further research in transgender breast health.

Main Methods:

  • Review of existing literature on breast cancer incidence in transgender individuals.
  • Analysis of the impact of hormonal and surgical gender-affirming treatments on breast health.
  • Synthesis of proposed screening recommendations based on current evidence.

Main Results:

  • Breast cancer incidence in transgender women is higher than in cisgender males but lower than in cisgender females, suggesting increased risk with estrogen therapy.
  • Presurgical transgender men have a breast cancer risk similar to cisgender females; risk decreases significantly after mastectomy.
  • Proposed screening: Transgender women with risk factors/hormone therapy >5 years follow cisgender female guidelines; transgender men with preserved tissue follow cisgender female guidelines or undergo annual chest/axillary exams post-mastectomy.

Conclusions:

  • Evidence-based screening guidelines are crucial for addressing breast health disparities in the transgender population.
  • Current proposals for transgender breast cancer screening require further research, especially for those with limited hormone therapy or no traditional risk factors.
  • Radiologists must be aware of imaging changes and risks associated with gender-affirming care to ensure appropriate patient management.