Breast cancer risk for transgender women with inherited mutations
Full article: https://onlinelibrary.wiley.com/doi/10.1002/jgc4.1278
There has been little research on breast cancer risk for transgender women who are at high risk for breast cancer due to an inherited mutation. This review summarizes what we know. (Posted 11/29/23)
Este artículo está disponible en español.
Questions To Ask Your Health Care Provider
- What is my breast cancer risk?
- How might my gender-affirming care plan impact my breast cancer risk?
- I have never had genetic testing. Can you refer me to a genetics expert?
- Where can I get more information about breast cancer screening guidelines for transgender women?
Open Clinical Trials
The following organizations have cancer-related resources for members of the LGBTQ+ community.
Mutations in several genes increase the risk for breast/chest cancer, including BRCA1, BRCA2, ATM, BARD1, CDH1, CHEK2, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11, and TP53. Risk-reducing strategies differ by biological sex at birth.
Female sex assignment at birth
- Hormones: It is unknown whether gender-affirming testosterone therapy changes the risk of breast cancer.
- Genetic testing: For people with a personal or family history consistent with hereditary cancer, the NCCN recommends genetic testing before breast/chest surgery to inform the type of surgery.
- Surgery: Gender-affirming surgery, known as “top surgery,” involves removing some but typically not all breast tissue. People with an inherited mutation in a breast cancer gene may want to consider removing more tissue than top surgery typically does, like a risk-reducing mastectomy, that removes more than 95% of breast tissue. Nipple-sparing surgery can be safe but the resulting appearance may not be as good as top surgery, which retains some breast tissue. Transmen may want to discuss their chest profile options with a plastic surgeon.
- Screening: For transgender men with an inherited mutation (those who have had top surgery or no breast surgery), the NCCN recommends breast cancer screening may begin at an earlier age and may include mammography and breast MRI. Discuss gene-specific screening recommendations with your provider.
Male sex assignment at birth
- Hormones: Estrogens and anti-androgen hormone therapy increase breast tissue. Breast cancer among people receiving this therapy can develop at an earlier age than in the average population. However, even with an inherited mutation, breast cancer risk in people who were assigned male sex at birth is low, so while estrogen and anti-androgens may increase breast cancer risk, these hormones can be used.
- Screening: Because little is known about the benefit of chest/breast cancer screening for transgender women, it should be decided on a case-by-case basis, based on a person’s age, family history, duration of gender-affirming hormone therapy and the amount of breast tissue. For imaging, mammography and tomosynthesis are recommended rather than MRI. MRI without contrast can help monitor silicone breast implants for leaks but it does not detect cancer.
FORCE is a national nonprofit organization, established in 1999. Our mission is to improve the lives of individuals and families affected by adult hereditary cancers.