Breast cancer risk for transgender men with inherited mutations
Full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8747588/pdf/gox-10-e4012.pdf
There is little information related to the risks and treatment options for transgender men and nonbinary people who are at high-risk for breast cancer due to an inherited BRCA1 or BRCA2 mutation. We review an expert viewpoint on the implications of a BRCA mutation for transgender men undergoing breast removal as part of their gender-affirming care plan. (posted 5/19/22)
Yale NewHaven Health provides management and risk reduction options for transgender men with a BRCA1 or BRCA2 mutation, including the following:
- Ages 25-29: Yearly breast MRI (preferred) or mammogram and clinical breast exams every 6-12 months.
- Ages 30-75: Yearly breast MRI and mammogram spaced every 6 months. Clinical breast exam every 6-12 months.
- Chemoprevention with medications such as tamoxifen or raloxifene.
- Bilateral prophylactic surgery to remove healthy breast tissue.
The American College of Radiology has guidelines for breast cancer screening of transgender men with varying degrees of risk. For transgender men they recommend the following:
- Those at average risk may consider digital breast tomosynthesis or digital mammography screening after age 40.
- Those with an intermediate risk should have annual DBT or mammography after age 30 or an MRI if there is a previous breast cancer history.
- For those with a family history, screening should begin 10 years before the family member in question was diagnosed but not before age 30.
- Those with a genetic risk should be screened by DBT, digital mammography or MRI with contrast.
FORCE recommends that you speak with a genetics expert who can review your personal and family history of cancer and help you determine the best risk management and cancer screening plan for you.
Questions To Ask Your Health Care Provider
- Not every provider who offers gender-affirming care has experience with the medical concerns of people with a high risk of hereditary cancer, including those who have a BRCA1 or BRCA2 mutation. Likewise, not every surgeon who performs prophylactic mastectomies to address cancer risk is skilled in supporting trans and nonbinary people. Ask if your doctor is able to support you with both of these experiences.
- If you are uncomfortable with mammography, ask if ultrasound or MRI options are available. If you have already completed a gender-affirming top surgery, ask what screening options may be appropriate for your needs.
- Ask if your doctors are familiar with the literature and guidelines that exist for transgender and nonbinary people and cancer care.
Open Clinical Trials
The following studies are enrolling people from the LGBTQ+ community.
- PRIDE Study: The PRIDE Study is the first long-term national health study of LGBTQ+ people. The goal is to improve the long-term health and wellness of LGBTQ+ people.
Exploring Gender Diverse Experiences of Hereditary Cancer Risk: A Johns Hopkins genetic counseling student is conducting an interview study exploring gender-diverse folks’ experiences of hereditary cancer care, with the aim of better educating providers about LGBTQ+ needs and concerns. Interviews are held on the Zoom platform with individuals who qualify. If you are interested in participating, contact Sarah Roth at email@example.com.
Visit our Featured Research Page and Research Search and Enroll Tool to find additional studies enrolling people with, or at high risk for cancer. Note: Most of these trials are geared towards cisgender people.
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.