Breast/chest cancer screening information for trans men
Trans men at average risk of developing breast/chest cancer need to be screened according to the following information:
Trans clients who have not had gender-affirming top surgery (mastectomy):
- Clients between the ages of 40 and 49: Discuss individual risks of breast/chest cancer, along with the benefits and risks of mammography.
- Clients between the ages of 50 and 69 should have a screening mammogram every two years.
- Clients aged 70+: Discuss with clients whether and how they should be screened, according to individual risk factors.
Trans men who have had gender-affirming top surgery (mastectomy):
- At this time, we don’t have clear
recommendations about whether or how trans men who have had top surgery should
be screened regularly for breast cancer. Discuss individual cancer risk
factors, including the type of mastectomy and the amount of breast/chest tissue
remaining, to determine screening needs. Top surgery can significantly reduce —
but does not completely eliminate — trans men’s risk for developing breast/chest
cancer. Risks depend on:
- the amount of tissue removed during top surgery
- personal risk factors and history
- whether the client has had his ovaries removed
- whether the client is taking testosterone and other hormone therapies. Some studies show that excess testosterone in the body can be converted to estrogen, increasing the risk of breast cancer. More studies need to be conducted regarding the connection between testosterone and breast cancer.
- In some cases, mammography may not be possible following a mastectomy. Breast ultrasound or MRI may be a preferable method of screening.
Trans men at high risk of developing breast/chest cancer may need to be screened earlier and/or more often than trans men at average risk. People at high risk may have:
- a genetic mutation that puts them at a higher risk for breast/chest cancer
- a parent, sibling or child who has a genetic mutation that puts them at a higher risk for breast/chest cancer
- a family history that indicates a lifetime risk of breast/chest cancer that is equal to or greater than 25% confirmed through genetic assessment
- received radiation therapy to the chest before 30 years of age as treatment for another cancer or condition (for example, Hodgkin’s disease)
The Ontario Breast Screening Program: Barriers to screening for trans men
Trans men may change the gender designation on their health card from female/F to male/M. While this is an important and affirming practice for trans male clients, it can present barriers to cancer screening.
For example, currently only people with a female/F designation on their health card are eligible to participate in the Ontario Breast Screening Program (OBSP):
- Trans men with a male/M designation on their health cards are not eligible for OBSP screening and do not receive correspondence from the OBSP. They will need to get a referral for a mammogram from a primary health care provider. This can present a barrier to breast screening.
- Conversely, trans men with a female/F designation on the health cards may receive reminders from the OBSP that refer to them as women or as female. This mis-gendering correspondence can be upsetting and increase reluctance to get screened.
Talk to your trans male clients about these concerns and ask, where appropriate, whether they prefer to be screened by or outside the OBSP.
Clients who do not wish to receive correspondence from the OBSP can opt out here.
Tips for providing referrals for mammograms to trans men
If my doctor is sending me to a clinic he hasn’t sent trans people to before, he calls ahead and talks to someone fairly high up to say that he is sending a trans person and do they need some information on what that means? And that, coming from a physician, is very powerful. And then he used to actually write on the requisition that I’m a trans man. And some trans people would hate that but, in this situation, I really liked it because it means there’s a heads-up right away. –Fred
Intimate procedures that examine or expose the chest can be particularly challenging or risky for trans men. Here are some things that you as a healthcare provider can do to make the experience easier:
Many trans men prefer the term “chest” to “breasts.” Ask your client about his preferred terminology.
Where possible, requisition the mammogram at a clinic or hospital with experience in treating and sensitivity training for LGBTQ populations. If you’re not sure, telephone the clinic in advance and speak to the manager or director to let them know that you are referring a trans client for testing and to make sure they have appropriate training in place.
With your client’s consent, you can note in the file that he is trans, the name he prefers to be called (if different from the name on his health card) and his preferred gender pronouns (usually, he, him, his, they, their). Also note if your client would prefer that clinic staff and technicians use terms like “chest” rather than “breast(s).”
Ask your clients if they would like you to book them at the clinic at the beginning or end of the day, or when the clinic is least busy, so that they can avoid being in a room full of non-trans women.
Make sure that your client understands clearly:
- what will happen before, during and after the mammogram
- that the test is relatively short
- that it may be physically uncomfortable but that if it is outright painful he can request for the pressure to be lessened or the test stopped altogether
- how he will receive the results