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The screening test

At the mammogram, it seemed pretty immaterial really what I thought my gender was in that particular moment. It’s just screening a piece of body. That’s how I thought of it to myself and so I just managed to deal with it in that way. And they’re very gentle and they explained everything and you just do it. Alf

Mammograms are the best tool for detecting *chest cancer early, when it’s most treatable. A low-dose x-ray machine takes detailed images of chest tissue from different angles. A radiologist examines the images to check for any abnormalities in the 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?
Do I need to do anything before the test?
What happens during the mammogram?
Does it hurt?
How can I make a mammogram more comfortable physically?
How can I make a mammogram more comfortable emotionally?

Who should get screened?

Early detection helps fight chest cancer. Your chances of getting chest cancer increase once you’re 50. So, if you’re aged 50 to 69 and you haven't had top surgery, don’t wait until you find a lump or have other symptoms: get screened by getting a mammogram every two years.

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 chest cancer. Mammograms can still be done on the chest after top surgery, or you may need a different screening test, such as an ultrasound or MRI. If you’ve had top surgery, talk to your doctor about the type of surgery you’ve had, as well as any other risk factors, to figure out your screening needs.

No matter how old you are, or whether you’ve had top surgery, become familiar with your chest and talk to your healthcare professional if you notice any changes. Many people are alive and well today because their chest cancer was detected and treated early.

The Canadian Cancer Society recommends the following chest screening guidelines:

If you are: You should:
40 to 49

Talk to your doctor about your risk of chest cancer, along with the benefits and risks of mammography.

50 to 69 and have not had top surgery

Have a mammogram every two years.

50 to 69 and have had top surgery

Talk to your doctor about your individual risk factors, including the type of surgery you’ve had, to figure out your screening needs.

70 or older

Talk to your doctor about how often you should be checked for chest cancer.

Do I need to do anything before the test?

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, necklaces or clothing that is difficult to remove from the waist up). If you have nipple piercings, you don’t need to remove them.

What happens during the mammogram?

I’ve got the gender dysphoria thing going on. The discomfort of having breasts is a daily challenge. It’s always there and present in my awareness. So having a mammogram is really just an extension of that daily dysphoria I experience. And just being treated courteously and in a friendly way made all the difference. – Alf

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

Screening mammograms are done in a clinic or screening centre. In smaller communities, the Ontario Breast Screening Program (OBSP) conducts mammograms on a specially equipped bus that travels from community to community. Mammograms show detailed images and views of the chest taken from different angles.

You’ll need to remove your clothing from the waist up for the test. When you have a mammogram, each side of your chest is placed between two plastic plates. The mammography unit will be adjusted to your height. A registered medical radiation technologist will place each side of your chest on one plate, one at a time. Then, the second plate will press down on your chest for a few seconds to spread out the chest tissue. Compressing the chest tissue helps make the images clearer while using as little radiation as possible. This will not harm your chest tissue.

Two x-rays are taken of each side of your chest, one from the top and one from the side. The technologist will check the quality of the images and will take more pictures if necessary. A radiologist examines the x-rays to see if there are any abnormal changes.

Does it hurt?

No, the mammogram didn’t hurt. –Alf 

It hurt! It’s like when it squeezes it’s tight … youch! –Fred

You may have heard that getting a mammogram can be painful or uncomfortable. That’s because, to get the x-ray pictures, your chest tissue is 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.

As the quotes above suggest, some people find the test painful, while others don’t. You will feel some pressure on your chest 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?

  • If you bleed monthly, try to avoid scheduling your appointment 7-10 days before the start of your next cycle. Your chest area tends be more tender at this time.
  • 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.
  • 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?

Take some time to think through what’s going to make it the least stressful for you. And then be entitled to what you want. We’re not all the same and you’re not more trans or less trans or a better dude or whatever if you want this rather than that. –Fred

For some trans men, getting a mammogram is no big deal — just one more medical test in the grand scheme of things.

For many other trans guys, the idea of going for a mammogram or the test itself can be uncomfortable or upsetting. The test, or a focus on our chests, can trigger or worsen feelings of gender dysphoria. We may feel awkward or vulnerable 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:

  • 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.
  • Coming out as trans for a mammogram is a personal decision. If you do decide to be out (or if your gender presentation makes it difficult not to be out), it can be helpful to come out in advance. You or your doctor can call the screening centre 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 welcoming and stress-free as possible for you. Is there a private place to change? Is the waiting room welcoming to people of all genders? You can also ask about how they will accommodate any of your access needs.

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 trans people and do they need some information and blah, blah, blah? And that, coming from a physician, is very powerful. And then he used to actually write on the prescription 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

If you’re outside a major urban centre and you think you may be one of the first trans people going to this clinic, if your family doctor won’t do it, a very friendly phone call just saying, “I’m coming in and I’m a trans person and I just want to be sure people aren’t surprised by it,” or something very straightforward like that can ease the way a lot. And if you don’t feel up to doing that yourself maybe you have a family member or a good friend who would do that for you. And you should be able to tell by their response whether that clinic is a good fit. –Fred

  • If the name on your health card isn’t the name you use, again, it can be helpful for you or your doctor to call the screening centre in advance to let them know the name you prefer them to use. You can ask them to write your correct name 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.

Honestly, once you don’t use that old name that was given at birth any more, you don’t think of yourself as the person with that name. And if you’re already stressed about going through the procedure it’s the last thing you’re thinking about. And so it’s a shock if they call out that name. And then when you face that hurdle it’s more difficult. So phoning ahead and having somebody who you trust with you would help, and that’s what I’m going to do. –Alf

  • 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.
  • If you use them, you can your 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 or your partner attend the appointment with you.
  • You can ask the person doing the screening 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.
  • 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 (like “chest” rather than “breast”), let them know. Remember, the more comfortable you are, the easier it is for the technician to do his or her job.
  • Be prepared for the possibility that you might experience increased gender dysphoria or discomfort with your body after the test. It can help to think through in advance what helps you deal best with gender dysphoria: going to the gym? Being alone in nature? Snuggling up with someone you love and trust?
  • Plan to do something you enjoy immediately after your appointment, like going for a coffee with a friend, seeing a distracting movie, going for a hike. During the test, you can focus on what you’ll be doing right after. If you think the test will be particularly upsetting, you may want to make sure that you’ve got an appointment with a therapist or counsellor in the not-to-distant future.


*A note on terminology: In the trans men sections of this website, we refer to cancer in chest tissue as cancer of the chest, and to the tissue itself as chest tissue. This is because we recognize that many trans men and people on the transmasculine spectrum do not identify as having breasts, feel ambivalent about having breasts and prefer the term “chest” on its own. Although we use this terminology where appropriate, we also recognize the fact that some trans men do have breasts.

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