Breast Imaging in Transgender Patients: What the Radiologist Should Know

Abstract

Transgender is the umbrella term for individuals whose gender identity and/or gender expression differs from their assigned sex at birth. With the rise in patients undergoing gender-affirming hormone therapy and gender-affirming surgery, it is increasingly important for radiologists to be aware of breast imaging considerations for this population. While diagnostic imaging protocols for transgender individuals are generally similar to those for cisgender women, screening guidelines are more variable. Currently, several professional and institutional guidelines have been created to address breast cancer screening in the transgender population, specifically screening mammography in transfeminine individuals who undergo hormone therapy. This article defines appropriate terminology with respect to the transgender population, reviews evidence for breast cancer risk and screening in transgender individuals, considers diagnostic breast imaging approaches, and discusses special considerations and challenges with regard to health care access and public education for these individuals.

An Update on the General Features of Breast Cancer in Male Patients—A Literature Review

“…Even if diagnostic imaging methods and approaches for transgender individuals are similar to those for cisgender women, screening guidelines are different. Several professional and institutional guidelines have been developed to address breast cancer screening in the transgender population, particularly mammography screening in transfeminine individuals undergoing hormone therapy, as emphasized by Parikh [ 86 ].…”

Spectrum of imaging findings in gender-affirming genital surgery: Intraoperative photographs, normal post-operative anatomy, and common complications

“…Transgender women usually will have less lifetime exposure to estrogen and progesterone [21]. Therefore, evidence regarding breast cancer risk in transgender women is conflicting [22].…”

“…However, Brown and Jones performed a retrospective medical record review of 3566 transgender women, and found that the incidence of breast cancer was similar to that of cisgender women (incidence ratio of [24]. Most recommendations suggest annual or biennial mammographic screening [22]. According to the UCSF Center of Excellence for Transgender Health, "a multidisciplinary program consisting of experts in transgender medicine and surgery at UCSF Medical Center," the risk of breast cancer is thought to be less than or equal to the risk in cisgender women and likely greater than the risk in cisgender males.…”

“…Testosterone has been shown to reduce glandular and adipose breast tissue. However, the effect of testosterone on breast cancer risk is not well-established [22].…”

“…Many transmasculine individuals will undergo mastectomy. The amount of breast tissue removed varies from surgeon to surgeon and by operative technique [22]. Yearly clinical breast exams are recommended for all individuals who have had a mastectomy.…”