Frequently asked questions

My dysphoria with my chest before top surgery was intense. So, before I had the surgery I would’ve probably said, “Absolutely not” to screening. But I don’t really mind the idea now. I think it would be something that I would be open to. I mean, even men can get breast cancer. Right? –Rhys

Possibly.

Trans men who have had some types of top surgery (mastectomy) still have some risk of chest cancer because chest tissue remains after the surgery. Surgeries that leave more tissue — like those that leave the nipples intact — leave more possibility for chest cancer to develop. There are documented cases of chest cancer in trans men who have had top surgery. If you’ve had top surgery, get to know your new chest and talk to your healthcare provider about any changes or symptoms you experience.

At this time, there are no clear recommendations about regular chest cancer screening for trans men who have had top surgery. Talk to your healthcare provider about your personal risks and about the kind of screening that’s best for you.

Yes. If you’re between the ages of 50 and 69, you should be screened according to guidelines, whether or not you are or have ever been on testosterone or other gender-affirming hormones. If you’ve also had chest surgery, talk to your healthcare provider about the best way for you to be screened. You can talk to your healthcare provider about any risks associated with the hormones you take.

Yes. If you’re between the ages of 50 and 69, the Canadian Cancer Society recommends that you go for regular mammograms, whether or not you have ovaries. If you’ve also had chest surgery, talk to your healthcare provider about the best way for you to be screened.

There is some association between some types of short-term hormone therapy and increased cancer risk. Trans men who have had their ovaries removed surgically (oophorectomy) will likely experience menopause early and as a result may have used short-term hormone therapy to relieve menopausal symptoms. If you have used or are on hormone therapies, talk to your doctor about what this means for your risk.

It’s understandable to feel scared or worried if you have a positive test result. It can help to remember that abnormal results don’t necessarily mean you have cancer. Abnormal test results can often be the result of cysts (non-cancerous, fluid-filled sacs) or calcium deposits. If the mammogram does find cancer, finding it early means that you’ll have more treatment options that may be more effective than they would for cancer caught at a later stage.

If your test results show an abnormality, you’ll be called in for follow-up tests. Follow-up tests could include a:

• diagnostic mammogram. A diagnostic mammogram is more thorough than a screening mammogram. It focuses on areas where abnormalities have been detected, and takes more detailed images, viewed from different angles. Diagnostic mammography is usually done on both sides of your chest so that doctors can compare the tissue of the side that showed abnormalities to the side that did not.
• chest ultrasound. Sound waves are used to create an image of your chest tissue. This helps detect whether a lump is fluid-filled or solid.
• biopsy. This procedure involves removing a small sample of tissue from the area with cell abnormalities. The sample will then be examined under a microscope in a lab.

Depending on the results of the initial mammogram, you may need other types of testing as well. Your doctor or OBSP staff will let you know what further testing you’ll need.

Taking proactive steps like cancer screening takes a lot of courage, so it’s understandable if you feel scared or worried. It is important to remember that abnormal results don’t necessarily mean you have cancer. Abnormal test results can often be the result of benign fluid-filled sacs called cysts, or calcium deposits. If cancer is detected, finding it early means that you will have more treatment options that may be more effective than catching it at a later stage.

If your test results show an abnormality you will be called in for follow up tests. Follow up tests could include a:

diagnostic mammogram. Diagnostic mammograms are the most common follow-up test. It is more thorough than a screening mammogram and focuses on suspicious areas for more detailed images and views from different angles. Diagnostic mammography is usually done on both breasts so that doctors can compare the breast tissue of both breasts.

breast ultrasound. Sound waves are used to create an image of your breast. This helps detect whether a lump is fluid-filled or solid.

biopsy. This is a procedure that involves removing a small sample of tissue from the area with cell abnormalities. The sample will then be examined under a microscope in a lab.

Other types of testing may be required depending on the initial results from your mammogram. Your doctor or OBSP staff will let you know what further testing is necessary.

Magnetic resonance imaging (MRI) is a test that takes multiple, very detailed pictures of your chest tissue using a powerful magnetic field, radio pulses and a computer. MRIs can help doctors find signs of chest cancer in people at high risk. They are often done on people with a BRCA1 or BRCA2 genetic mutation. An MRI can take about 30 to 45 minutes. It does not use ionizing radiation.

Magnetic Resonance Imaging (MRI) is a test that takes a very detailed picture of your breast and can help doctors find signs of breast cancer in people at high risk. An MRI takes multiple images of your breast tissue by using a powerful magnetic field, radio pulses and a computer. An MRI does not use radiation. It can take about 30 45 minutes to do, and is often done on women with a BRCA1 or BRCA2 gene.

We know that screening can find cancer early, when treatment is more effective. In so doing, screening reduces the number of deaths from chest cancer.

But mammograms aren’t perfect. Knowing what risks are involved in getting a mammogram will help you make the right screening decisions for you. These risks include:

• increased exposure to radiation. While radiation doses in mammography are very low, repeated exposure to x-rays can increase the risk of developing cancer. The benefits of finding chest cancer outweigh the risk of repeated exposure to low-dose radiation.
• false positive test results. This means that a result shows cancer or precancerous conditions when there aren’t any. This can result in stress and unnecessary invasive procedures.
• false negative test results. This means that test results show that there are no signs of abnormal tissue even though chest cancer is present. It’s important to know your chest and to make sure you talk to your doctor about any changes, even if you are screened regularly and your mammograms come back normal.
• cancer developing between screening intervals: some cancers may develop in the interval between screens and therefore may not be detected immediately.
• over-diagnosis: some cancers that show up through screening would not have progressed to the point of having any symptoms that affect life expectancy or quality of life. This means that the treatment of precancerous conditions is sometimes unnecessary.

Research into chest cancer (and other cancers) is ongoing. The Canadian Cancer Society carefully reviews new research as it emerges in order to stay current and to provide Canadians with the best possible information and guidelines.

While some research studies may cast doubt on the value of screening mammography in preventing deaths, many other studies show that screening mammography does reduce chest cancer mortality. The effectiveness of mammography screening for people aged 50–69 has been well established by several large clinical trials. Of eight trials done so far, seven showed a benefit for mammography screening.

The chest cancer death rate among Canadian non-trans women has declined significantly — by 42% — since the mid-1980s. This improvement is the result of chest cancer screening programs, an increased awareness of the risk factors and early signs of chest cancer and improved treatments.

Canadian non-trans and trans women and trans men between the ages of 50 and 69 should continue to get screened for chest cancer according to the screening recommendations.

Yes. Even if you don’t have an OHIP card, you can still be screened through the OBSP. At the time of booking, please let the site know that you do not have an OHIP card. It's a good idea to call the site in advance and let them know that you don't have an OHIP card: they may ask you to bring other documents.

If your mammogram shows that you need follow-up tests, those tests may not be covered by provincial health insurance without an OHIP card.

For more information and a list of all OBSP sites in Ontario, click here.

Yes. Even if you don’t have an OHIP card, you can still be screened through the OBSP. When you arrive at the screening site, the staff will ask you to provide:

• evidence of landed immigration status
• an Ontario address where you live for at least six months of the year OR a letter from the government that states you’re on your three month waiting period for coverage

If you are not eligible for OHIP because you are new to the province, or you’re returning to the province and you’re in your three-month waiting period, you can still be screened through the Ontario Breast Screening Program (OBSP)

For a list of all OBSP sites in Ontario, click here.

Yes. The Canadian Cancer Society recommends that trans men between the ages of 50 and 69 should be screened for chest cancer every two years. While it’s important to take care of your health in the ways that feel good for you — including holistic, naturopathic, herbal or homeopathic medicines — it’s still important to get screened.

The Canadian Cancer Society recommends that every woman over 50 should be screened for breast cancer with a mammogram every two years. While it’s important to take care of your health in the ways that feel good for you, including holistic, naturopathic, herbal or homeopathic medicines, it is still important to get screened.

Yes. Most the time, you won’t need to remove nipple rings as long as they don’t interfere with viewing your breasts.

It is not necessary to remove nipple rings as long as they do not interfere with viewing your breasts.

Yes. Even if you don't have a lot of chest tissue, you can still get a mammogram. In some cases, if your chest is too flat, other screening tests such as an ultrasound or MRI might be recommended.

Dense chests have lots of connective tissue. It can be harder to read a mammogram of denser chests because it can be more difficult to tell the difference between cancerous tissue and healthy, connective tissue.

Some trans men report that their chest tissue becomes more dense after taking testosterone, but we currently don't have evidence to know conclusively if testosterone contributes to chest density. If you're on T, let the mammography technician know.

What we do know is that you should still go for mammograms even if you have dense chest tissue. After seeing your mammogram, your radiologist may recommend further testing, like a chest ultrasound, and/or more frequent screenings. The ultrasound uses sound waves to create an image of chest tissue and can zero in on any areas of concern identified in your mammogram.

Even if your breasts are small, you can still get a mammogram.

Yes, you can and if you’re over 50, it is recommended that you do. The OBSP program does not provide screening for women who have breast implants. Your family doctor can refer you for screening instead. When getting a mammogram, the implant is moved out of the way and breast tissue is pulled forward and into view. Sometimes, more than four pictures are taken to make sure as much of the breast tissue is examined as possible. Studies show that women with breast implants are diagnosed with breast cancer at a similar stage and have a similar prognosis as women who do not have breast implants.

A chest self-exam is when a person looks at and touches their own chest to get familiar with the look and feel of the tissue and to possibly detect any lumps or other abnormalities. The goal of the exam is to know how your chest normally looks and feels, and to report any changes to your doctor.

The Canadian Cancer Society does not recommend chest self-exams as a method of screening. Research shows that doing regular chest self-exam does not reduce mortality rates from chest cancer. Instead, the Canadian Cancer Society suggests getting to know what’s normal for you. Contact your healthcare provider about changes to your chest. If you’re between the ages of 50 and 69, get regular mammograms every two years.

Knowing your breasts is one of the most important parts of having healthy breasts. Getting to know what’s normal for you and contacting your doctor about changes, as well as getting regular mammograms, are key to early detection.

The best way to learn your breasts is by looking and feeling them. It is important to look and touch the whole area of your breast tissue up to the collarbone, under the armpits and including the nipples.

Lumpy and tender breasts are a normal part of a hormonal cycle. Often times, breasts can feel this way right before your period. Also, breast tissue changes with age, and so may look and feel different over time. If you notice any changes, especially ones that are possible signs and symptoms of breast cancer, then talk to your doctor.

A clinical breast exam (CBE) is a thorough examination of the chest by a trained healthcare professional to check for abnormalities. The Canadian Cancer Society no longer promotes CBE as a method of screening. However, some healthcare professionals will continue to use it as part of an overall chest health plan. If your healthcare professional suggests it, it’s up to you to decide whether you want to have the exam.

The best available scientific evidence shows us that mammography is most effective screening test and has been proven to reduce chest cancer deaths.

A clinical breast exam (CBE) is a thorough examination of the breast by a trained healthcare professional to check for abnormalities. If the healthcare provider is male, you may request a female staff person to sit in on the session.

The Canadian Cancer Society no longer promotes CBE as a method of screening. However, some healthcare professionals will continue to use it as part of an overall breast health plan.

The best available scientific evidence shows us that mammography is most effective screening test and has been proven to reduce breast cancer deaths.

There is usually no special preparation for a CBE. The woman removes her clothing from the waist up. A sheet or gown covers her while she is on the examination table.

First, the healthcare professional looks at the breasts. This should be done with the person sitting, and then when she is lying down. The healthcare professional looks for:

• changes or differences in the shape of the breasts
• areas of fullness or thickness in only one breast
• differences in skin colour, temperature and texture in the breasts, such as redness, increased warmth or dimpling of the skin
• rashes
• visible lumps or swelling
• nipple discharge (fluid leaking from the nipple)
• nipple changes, such as pointing inward (inverted) or scaling especially if these are new

Secondly, the healthcare professional feels (palpates) the breast and the nipple. This is done with you lying down, which flattens the breast tissue over the chest wall. The entire breast area is carefully examined using the fingers. The breast extends from the middle of the chest, into the armpit and up towards the collarbone. The entire area should be examined.

The healthcare professional feels for:

• lumps, including their size, shape and whether or not they move within the tissue
• hardening or thickening in the breast tissue
• tenderness or pain

There is no evidence that anti-perspirants (or, for that matter, bras, chest implants or abortion) increase rates of chest cancer. Learn more about some other cancer myths and controversies.

There is no evidence to suggest that wearing a binder will increase your risk of chest cancer. However, you should be aware of other risks involved in binding, such as skin irritation, difficulty breathing, and lymphatic flow issues if binders are worn too tightly. It’s helpful to take off your binder when you sleep so that your chest has some room to breathe.

There is no evidence that anti-perspirants, bras, breast implants or abortion increase rates of breast cancer. Learn more about some other cancer myths and controversies.

There is no evidence to suggest that wearing a binder will increase your risk of breast cancer. However, there are other risks to binder usage that you should be aware of, such as skin irritation, difficulty breathing, and lymphatic flow issues if binders are worn too tightly. It’s helpful to take your binder off when you sleep so that your chest has some room to breathe.

To find an LGBTQ-friendly healthcare provider, visit the Rainbow Health Ontario provider directory.