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:
|If you are:||You should:|
|40 to 49 and are taking gender-affirming hormones||
Talk to your doctor about your risk of breast cancer, along with the benefits and risks of mammography.
|50 to 69 and have taken gender-affirming hormones for more than five years||
Have a mammogram (or other screening test as appropriate) every two years.
|70 or older and have taken gender-affirming hormones for more than five years||
Talk to your doctor about how often you should be checked for breast cancer.
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.
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).
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.
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.
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 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
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