The screening test

Non-trans women, I’m guessing that they grow up learning about how to treat their bodies. They grow up learning that kind of stuff from their mothers, their sisters. But trans women don’t necessarily learn those things in the same way. That was my first mammogram, probably one of the first of a lot of things done to my new-and-improved body, and I didn’t know what to expect. Having some preparation, that would’ve been helpful. Debbie

Mammograms are the best tool for detecting breast cancer early, when it’s most treatable. A low-dose x-ray machine takes detailed images of breast tissue from different angles. A radiologist examines the images to check for any abnormalities in the breast tissue.

Lumps and other changes can be detected by a mammogram even if they are too small to be felt by a hand. That’s why it’s important to get screened regularly — screening means finding abnormalities early, when they are easiest to deal with.

Who should get screened?

Early detection helps fight breast cancer. It’s important to know your risk factors as well as when to get screened. The Canadian Cancer Society recommends the following breast cancer screening guidelines:

Your chances of getting breast cancer increase if you’ve taken gender-affirming hormones for more than five years, and as you get older. So, if you’re age 50 to 69 and have been on hormones for five years or more, don’t wait until you find a lump or have other symptoms: get screened for breast cancer by getting a mammogram every two years.

You can still get screened if you have breast implants.

No matter how old you are, whether you’re on hormones, or whether you have implants, it’s still a good idea to be familiar with your breasts and to talk to your healthcare professional if you notice any changes. Many people are alive and well today because their breast cancer was detected and treated early.

Do I need to do anything before the test?

When getting ready for your mammogram, do not apply any deodorant, lotions or talcum powder on the day of the test. The metals in these products can interfere with the x-ray. It’s also helpful not to wear anything that can get in the way of the test (for example, jewelry such as necklaces or clothing that is difficult to remove from the waist up).

What happens during the mammogram?

For most people, a mammogram takes less than 10 minutes.

Screening mammograms are done in a clinic or screening centre. Mammograms show detailed images and views of the breast taken from different angles.

If you don’t have breast implants (and you’ve been on gender-affirming hormones for more than five years) you’ll have a regular screening mammogram. When you have a mammogram, the breast is placed between two plastic plates. You’ll need to remove your clothing from the waist up for the test. The mammography unit will be adjusted to your height. A registered medical radiation technologist will place your breast on one plate. Then, the second plate will press down on your breast for a few seconds to spread out the breast tissue. Compressing the breast tissue helps make the images clearer while using as little radiation as possible. This will not harm your breast tissue.

Two x-rays are taken of each breast, one from the top and one from the side. The technologist will make sure that the pictures are good enough quality for the radiologist to read and will take more pictures if necessary. A radiologist examines the X-rays to see if there are any abnormal changes.

If you have breast implants, you will need to have a mammogram using diagnostic mammography equipment. This doesn’t mean that you have breast cancer; it’s just that the diagnostic equipment does a better job of screening around the implants. When getting a mammogram, the implant is moved out of the way and breast tissue is pulled forward and into view. The technician may need to take more than two images of each breast, and images may be taken from several different angles.

Does it hurt?

It was really uncomfortable. They squash that thing down, and the only thing that really got me through it was because I knew it was good for me. There’s a saying we have, like with my electrolysis: “It’s not what I do to you, it’s what I do for you.” It’s kind of like getting a tooth pulled, right? It’s not a lot of fun getting an infected tooth pulled, but you’re better off after they fix the tooth. –Debbie

You may have heard that getting a mammogram can be painful or uncomfortable. That’s because, to get the x-ray pictures, your breasts are placed between two compression plates, which flatten the tissue. This is done to make sure the images are clear and that the smallest amount of radiation possible is used when taking the x-rays.

Many trans women find the test painful. This can be because our breast tissue tends to be denser than average, and because trans women’s breast tissue may still be growing and can therefore be tender. You will feel some pressure on your breasts for just a few seconds — it feels a lot like a tight blood-pressure cuff. If this does feel uncomfortable or outright painful, it can help to know that the discomfort should last only a few seconds. If it lasts longer than that, you can tell the technician and they can adjust the compression.

How can I make a mammogram more comfortable physically?

• Avoid drinks and food such as cola, coffee and chocolate for 5-7 days before your mammogram or ultrasound. They contain caffeine and may cause added discomfort from fluid retention.
• If you get cold easily, or if you feel insecure or vulnerable in a hospital gown, you might want to bring a robe to put over the gown or to wear instead of it. Remember, you can keep on your pants or skirt — you need to remove clothing only from the waist up.
• If you think that you may be very anxious or tense before or during the mammogram, you can consider asking your doctor to prescribe an anti-anxiety medication to take as directed before the test.

How can I make a mammogram more comfortable emotionally?

I went to the mammogram, and they have a form. They want to know when I had my first period, about pregnancies and menstruation, and a bunch of questions you ask non-trans women. But they’re irrelevant questions to me, and so I found that to be a real barrier. I was uncomfortable and annoyed. I thought about walking out of the office, and then I decided, well, they sent me for this test, it must be important. So I took a couple copies of the form and stuck them in my bag, because I said I’m going to bring this back to my doctor and show him, like, they shouldn’t be asking these questions. There must be a better way to try to get this information. –Debbie

For some trans women, getting a mammogram is no big deal — just one more medical test in the grand scheme of things. In fact, some trans women may find that getting a mammogram is a positive experience: it affirms our gender identities and is a meaningful way of taking care of our bodies.

For other trans women, the idea of going for a mammogram or the test itself can be uncomfortable or upsetting. We may worry about experiencing transphobia or about passing. We may feel awkward in changing rooms or waiting areas. It can be difficult to have to come out repeatedly, or to have to explain our identity or appearance to people who aren’t familiar with trans folk.

Here are some suggestions for things you can do to prepare yourself for the test and to make getting a mammogram as emotionally comfortable as possible.

Call the clinic, and see if they’ve undergone any kind of sensitivity training or training on serving LGBTQ people. If you can’t find any place like that, tell them you’re trans, tell them that you’d like to come at the last appointment for that particular day. And if you have a fear with regards to the issue of proper pronouns, you can actually email them or send them or have them go to the Rainbow Health Ontario site, to see the terminology, how you address someone who’s trans. Educate them a little bit. –Shoshana

• If your family doctor or nurse practitioner has referred you for the mammogram, you can ask him or her to send you to a clinic that has experience in screening trans people and has a reputation for being trans-friendly.
• As the quote above suggest, intake forms for a mammogram tend to assume that you are non-trans. It may be helpful to call the clinic ahead of time and let them know that you are trans and would prefer a form that reflects that. (Even if the clinic doesn’t have one, at least you’ve taken a step toward getting them to think about trans inclusivity!)
• If you’re not already out to the healthcare provider who will perform the test, it can help to think about strategies for talking to that person about being trans. It can be helpful to come out in advance. You can call the clinic or healthcare provider’s office ahead of time to speak to a booking clerk, receptionist or technician about what practices are in place to make the reception area, changing room, waiting area and procedure as stress-free as possible for you.
  • A friendly phone call that says, “I’m coming in and I’m a trans person and I just want to be sure people aren’t surprised by that,” can often help make things more comfortable.
  • You can ask: Is there a private place to change? Is the waiting room welcoming to people of all genders? Do you have training or policies that address the needs of trans clients? You can also ask about how they will accommodate any of your access needs.
  • If the name on your health card isn’t the name you use, or your health card lists your gender as “male,” again, it can be helpful for you or your doctor to call the screening centre in advance to let them know the name and the gender pronouns you prefer them to use.
    • You can ask them to write your correct name and “Please use the pronouns ‘she, ‘her,’ ‘hers’” on the front of your file, rather than inside it: it’s too easy for a doctor or a receptionist to call out the wrong name, and then open the file and discover their mistake.

If somebody calls me sir, I’ll say “Excuse me. Do I look like a guy to you?” Like, how many guys have breasts and wear makeup and have their hair done, etc.? Excuse me? They’re supposed to ask, but they don’t always ask. So, I correct people. And if a person says, “Oh, I’m sorry, ma’am,” no problem. Like I went to the doctor and I’m standing right beside him and he “Sir’d” me once or twice, and he apologized. I accepted it. We laughed. The guy respects me, and he’s a good doctor. I’m not going to make an issue of it. Like for what? –Shoshana

• Clinics in larger urban centres may offer trans-friendly or LGBTQ+ screening times. You may be more comfortable booking an appointment during these hours. If you’re being screened somewhere that does not have queer- or trans-specific appointment times, or does not have private or gender-neutral change rooms and waiting rooms, you can ask for an appointment at the very beginning or the very end of the day, when waiting times may be shorter and there may be fewer people around. For a listing of trans-friendly clinics, contact Rainbow Health Ontario.
• If you use them, you can take anti-anxiety medications before the test, or consider asking your doctor to prescribe some to help make you more comfortable during the test.
• Have a supportive friend attend the appointment with you.
• Wear separates for your clothing, with a top and a bottom, so that you have to remove only your top for the screening.

The other thing I found somewhat socially uncomfortable was changing into the gown. I found that to be challenging because it doesn’t really close very well. So I was uncomfortable, or concerned, about … maybe less about me, but how the medical technician would respond to me if they noticed something askew, or something different about me. Maybe next time I’ll bring a robe. –Debbie

• Before the test, let the healthcare provider know what you will need in order to make your test more comfortable. For example, if it’s difficult for you to be touched in a certain place, or if you would like your body parts to be called by a different name, let them know. Remember, the more comfortable you are, the easier it is for the technician to do his or her job.
• Know what’s going to happen in advance. Read up on what will happen before you have the test.  You can ask the technician at the mammography clinic to describe the process of getting a mammogram before it starts. They can tell you what they will be doing step by step. Or, you may be someone who prefers just to be quiet.
• Plan to do something you enjoy immediately after your appointment, like going for a coffee with a friend, seeing a movie, going for a hike. During the test, you can focus on what you’ll be doing right after.
• Some trans women could experience increased gender dysphoria after the test. It can help to think through in advance what helps you deal best with gender dysphoria: exercise? Being alone in nature? Snuggling up with someone you love and trust?