Trans patients may struggle to access breast cancer screening

(Reuters Health) - At a time when a growing number of transgender Americans are getting gender-affirming treatments to make their bodies match their identity, breast imaging centers may not be changing to meet their needs.

Approximately 1.4 million U.S. adults identify as transgender today, double the number a decade ago, researchers note in the Journal of Breast Imaging. And while it’s still not clear how gender-affirming treatments like hormones or surgery might impact breast health, most doctors agree that transgender people have unique screening needs.

To see what transgender patients might learn on their own about where to go for breast imaging, researchers examined websites for top-ranked breast health centers nationwide and for a selection of top-rated centers in two cities, San Francisco and New York.

None of the websites included the term “transgender,” making it possible that people may come away empty handed when they search online for the right place to seek care.

“Transgender breast health is not established as a discrete area of radiology study,” said senior study author Dr. Miriam David, medical director of breast imaging services at Westchester Medical Center in Valhalla, New York.

“Additionally, screening guidelines for transgender patients are not evidence-based, which may discourage some radiologists from sharing service information more openly,” David said by email.

Screening guidelines generally focus on cisgender women, meaning their gender identity matches the sex they were assigned at birth. Over time, guidelines have urged cisgender women to start screening later, go less often and stop at younger ages to reduce potential harms.

Without any guidelines aimed at transgender men or women, they may not know whether they need screening or where to go to see providers who are good at caring for patients who take hormones or have surgery as part of gender-affirming treatment.

This could put transgender patients at higher risk for a delayed cancer diagnosis, and worse outcomes, David said.

Transgender women - people assigned male at birth but who identify as female - should consider mammograms after age 50 when they have been taking hormones for five to 10 years, according to primary care guidelines for transgender and gender nonbinary people from the University of California, San Francisco (

Transgender men, meanwhile, might need alternative imaging like MRIs or ultrasound to look for any signs of cancer in tissue left after breast reduction surgery, according to UCSF.

“Even with increased awareness among radiologists of special health needs of the trans community, without improved communication on the internet, access to care may remain compromised,” Dr. Emily Sonnenblick, an associate professor of radiology at Icahn School of Medicine and Mount Sinai Medical Center in New York City, said by email.

When transgender patients do get screenings, radiology centers can make them feel welcome by creating gender-neutral medical forms and encouraging clinicians and other workers to ask all patients for their preferred pronouns, experts say.

It’s also possible that the study didn’t find evidence of transgender imaging services even where it is available, said Dr. Justin Stowell, a radiologist at the Mayo Clinic in Jacksonville, Florida.

Updating faculty and staff profiles to emphasize any expertise in transgender health might be a good place to start, Stowell said by email. This could help “emphasize research and advocacy efforts for transgender patients that might not otherwise be broadcasted.”

SOURCE: Journal of Breast Imaging, online January 30, 2020.