Mammography Experience: Understanding the Process and Strategies for Pain Reduction
In the realm of breast cancer screening, transgender individuals often face unique considerations due to hormone therapy use, surgical history, and varying risk factors. This article aims to shed light on the differences in screening guidelines for transgender people compared to cisgender populations.
Mammograms, X-rays of the breast used to detect changes in breast tissue, are a vital screening method for healthy women outside of pregnancy. For cisgender women, established guidelines typically recommend starting mammograms between ages 40-50 and continuing biennially or annually depending on risk. In contrast, cisgender men generally have low breast cancer risk and are not routinely screened unless they have high-risk conditions.
For transgender women, who were assigned male at birth and now identify as women, the risk of breast cancer is higher than that of cisgender men but much lower than cisgender women. Screening mammography is generally recommended to start after they have been on feminizing hormone therapy for at least 5 years and typically around age 50. The frequency of screenings may be yearly or biennial, similar to cisgender women, but based on hormone therapy duration and age.
Transgender men, who were assigned female at birth and now identify as men, often do not require routine mammograms following gender-affirming chest surgery (mastectomy or breast reduction). However, those who have not had chest surgery or have only had breast reduction should follow screening guidelines similar to cisgender women, considering their residual breast tissue.
It's essential to note that breast cancer screening recommendations for transgender and gender-diverse individuals are based on limited direct evidence and often extrapolated from cisgender guidelines. Hormone therapy can change breast tissue density and risk, affecting screening efficacy and timing. For transgender men, hormone therapy and chest surgery alter the breast tissue anatomy, influencing whether screening is needed.
Shared decision-making with healthcare providers familiar with transgender health is crucial due to the nuanced risk and screening needs. Early treatment of breast cancer dramatically increases survival rates, making it vital for all adults, including transgender individuals, to practice breast self-awareness so they can discuss unusual changes with doctors.
A positive result on a mammogram does not necessarily mean that cancer is present. If mammograms show unusual growths, follow-up tests, such as ultrasound, MRI scan, another mammogram, blood test, or breast biopsy, are necessary. These tests help determine whether the growth is cancerous or benign.
Regular mammogram screenings are available in many countries, and further tests may be recommended if there is any indication that a change could be cancerous. People with a genetic mutation in the BRCA1 or BRCA2 gene will almost always have a referral for regular mammography screening.
Breast cancer can occur in transgender people and cisgender men, even though they do not have milk-producing breasts. A person with a diagnosis of breast cancer at a localized stage has a 5-year survival rate of at least 93%.
Taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, 45-60 minutes before the screening may help reduce the pain associated with mammograms, which can be uncomfortable but are not meant to be painful. It's also important to inform the technician about fibrocystic breasts and any history of painful mammograms, as anyone with fibrocystic breasts may experience more pain during a mammogram.
In summary, mammogram screening for transgender people is personalized based on hormone treatment and surgical history, unlike the more uniform guidelines for cisgender populations. Transgender women typically begin screening later and after hormone therapy duration, while transgender men with chest surgery often do not require screening mammograms. Regular self-awareness and open communication with healthcare providers are key to ensuring appropriate and timely breast cancer screening for all individuals.
[1] American Cancer Society. (2021). Breast Cancer in Transgender and Gender Nonconforming People. https://www.cancer.org/cancer/breast-cancer/understanding/transgender-and-gender-nonconforming-people.html [2] American College of Radiology. (2018). ACR Appropriateness Criteria® Breast MRI. https://www.acr.org/-/media/ACR/Files/Practice-Parameter/ACR-Appropriateness-Criteria/breast-mri.pdf [3] National Comprehensive Cancer Network. (2020). NCCN Guidelines® for Patients®: Breast Cancer. https://www.nccn.org/patients/guidelines/breast/index.html [4] World Health Organization. (2020). Breast cancer in men. https://www.who.int/news-room/fact-sheets/detail/breast-cancer-in-men
- For transgender women, it's recommended to begin mammogram screenings after five years on feminizing hormone therapy, typically around age 50, and the frequency of screenings may be yearly or biennial, based on hormone therapy duration and age.
- Transgender men who have undergone gender-affirming chest surgery (mastectomy or breast reduction) typically do not require routine mammograms, but those who still have residual breast tissue should follow guidelines similar to cisgender women.
- Breast cancer can occur in transgender people and cisgender men, regardless of whether they have milk-producing breasts. A person with a diagnosis of breast cancer at a localized stage has a 5-year survival rate of at least 93%.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, taken 45-60 minutes before the screening, can help reduce the pain associated with mammograms, which may be uncomfortable but are not meant to be painful.
