Contemporary Considerations for Breast Cancer Risk and Screening in Transgender, Nonbinary, and Gender-Diverse...

Breast cancer incidence, risk factors, and risk-reducing strategies are relatively well established for cisgender persons, but this information is limited in the transgender and gender-diverse (TGD) community. TGD persons have unique considerations that may affect risk, such as the need for gender-affirming hormone therapy or gender-affirming operations. This review outlines key literature informing our knowledge of breast cancer risk and summarizes screening recommendations for TGD persons.

Studies informing breast cancer risk in TGD persons have significant limitations. Generally, they suggest that transgender women have a higher incidence of developing breast cancer compared to cisgender men, but a much lower incidence compared to cisgender women; and that transgender men have higher rates of breast cancer compared to cisgender men, but lower rates compared to cisgender women. Screening guidelines put forth by professional societies are based on these retrospective cohort studies, expert consensus, and extrapolation from cisgender populations. The United States Preventive Services Task Force and American Cancer Society have not yet published guidelines.

Prospective data are needed to further define risk and best practices for breast cancer screening in the TGD community, an already marginalized population susceptible to worse oncologic outcomes.