Frequently asked questions

If you’re age 50 to 69, and you have been taking gender-affirming hormones (like estrogen) for more than five years, you should have a screening mammogram every two years. If you’re under age 50, get to know how your breasts look and feel and report any changes to your primary healthcare provider.

Yes. People with breast implants can still get mammograms.

Breast implants do not increase your cancer risk. If you’ve had implants, and you have also taken gender-affirming hormones for more than five years, then you need to be screened regularly between the ages of 50 and 69.

If you have implants, you’ll need a special type of mammogram, called a diagnostic mammogram. 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 that as much of the breast tissue is examined as possible. Studies show that people with breast implants are diagnosed with breast cancer at a similar stage and have a similar prognosis as people who do not have breast implants.

The Ontario Breast Screening Program does not provide screening for people who have breast implants. Your primary healthcare practitioner can refer you for screening instead.

Trans women tend to have denser-than-average breast tissue. Dense breasts have lots of connective tissue. It can be harder to read a mammogram of denser breasts because it can be more difficult to tell the difference between cancerous tissue and healthy, connective breast tissue.

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

Some trans women have injected silicon into their breast tissue as an immediate and relatively inexpensive way to enhance breast size and possibly ease gender dysphoria.

While silicon breast injections don't increase trans women's risk for breast cancer, they do pose other — very serious — threats to our health and can even endanger our lives. The silicon can migrate out of our chests and breast areas and create unsightly lumps. Silicon injections are also illegal.

Silicon breast injections may also interfere with the reading of a mammogram. For this reason, if you have injections, you may require a different test to screen for breast cancer, like an MRI. Talk to your healthcare provider about what’s most appropriate for you.

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 will 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 will 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 breasts so that doctors can compare the tissue that shows abnormalities with the tissue that does not.
• breast ultrasound. Sound waves are focused on the area of the breast where the abnormality was found. 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.

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.

Magnetic resonance imaging (MRI) is a test that takes multiple, very detailed pictures of your breast tissue using a powerful magnetic field, radio pulses and a computer. MRIs can help doctors find signs of breast cancer in people at high risk. It is 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.

We know that screening can find cancer early, when treatment is more effective. In so doing, screening reduces the number of deaths from breast 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 does increase the risk of developing cancer. The benefits of finding breast 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 breast tissue even though breast cancer is present. It’s important to know your breasts and 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 your quality of life. This means that the treating of precancerous conditions is sometimes unnecessary.

Research into breast 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 that show that screening mammography does reduce breast 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 breast cancer death rate among Canadian non-trans women has declined significantly — by 42% — since the mid-1980s. This improvement is the result of breast cancer screening programs, an increased awareness of the risk factors and early signs of breast 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 breast cancer according to the screening recommendations.

Yes. You can still get a mammogram if you don’t have an OHIP card. You may have to pay for it out of pocket or use third-party insurance.

If you’re eligible for screening through the Ontario Breast Screening Program (OBSP), you can also be screened through the OBSP without an OHIP card. If you are new to the province, or you’re returning to the province and you’re in your three-month waiting period you will need 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.

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

Yes. The Canadian Cancer Society recommends that trans women between the ages of 50 and 69 who have taken gender-affirming hormones for five years or more 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’s still important to get screened.

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

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

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

The Canadian Cancer Society does not recommend BSE as a method of screening. Research shows that dong regular BSE does not reduce mortality rates from breast cancer. Instead, the Canadian Cancer Society suggests getting to know what’s normal for you. Contact your healthcare provider about changes to your breast or chest. If you’re between the ages of 50 and 69 and you've taken gender-affirming hormones for more than five years, get regular mammograms every two years.

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. 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 breast cancer deaths.

There is no evidence that anti-perspirants or bras 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.