Existing breast screening recommendations for trans men (review 3)
| Organization, year; population | Document type | Screening recommendations | |||
|---|---|---|---|---|---|
| Additional eligibility criteria | Modality | Interval | Additional recommendations | ||
| Without chest reconstruction* | |||||
| CCS, 2017 (24) | Position statement | 40–49 yr, at average risk | NR | NR | Discuss individual risk of breast cancer and benefits and risks of mammography |
| 50–69 yr, at average risk | Mammography | Every 2 yr | NR | ||
| ≥ 70 yr, at average risk | NR | NR | Discuss whether and how client should be screened according to individual risk factors | ||
| CETH, 2016 (26) | Guideline | NR | NR | NR | Follow guidelines for cisgender women |
| SHC, 2015 (28) | Guideline | NR | Clinical breast examination | Annual | Follow guidelines for cisgender women |
| 50–71 yr | Mammography | Every 2 yr | |||
| ACOG, 2011 (31) | Position statement | NR | NR | NR | Age-appropriate† screening |
| VCH, TTSES & CRHC, 2006 (4) | Guideline | With or without history of CSH use,‡§ with or without oophorectomy | Breast examination¶ | Annual | NR |
| Mammography | NR | Follow guidelines for natal females | |||
| With partial chest reconstruction* | |||||
| CCS, 2017 (24) | Position statement | NR | Ultrasonography or MRI** | NR | Discuss individual risk factors†† for breast cancer |
| CETH, 2016 (26) | Guideline | NR | Ultrasonography or MRI | NR | NR |
| SHC, 2015 (28) | Guideline | NR | Mammography | NR | Not required following chest reconstruction |
| VCH, TTSES & CRHC, 2006 (4) | Guideline | With or without history of CSH use,ठwith or without oophorectomy | Mammography | NR | Not necessary following chest reconstruction, but should be considered if only a reduction is performed |
| Trans men in general (i.e., chest reconstruction status not specified) | |||||
| CCS, 2017 (24) | Position statement | High risk‡‡ | NR | NR | May need to be screened at earlier age or more frequently than trans men at average risk, or both |
| IPPF, 2015 (27) | Position statement | With history of CSH useठ| NR | Periodic | Periodic cancer screening for those who retain their breast tissue |
| SHC, 2015 (28) | Guideline | Strong family history of breast cancer | Mammography | NR | Follow the same guidelines as for cisgender women regarding indications for referral to high-risk screening program/ genetic assessment |
| NHS, 2013 (30) | Guideline | With developed breast tissue | NR | NR | Breast screening |
Note: ACOG = American College of Obstetricians and Gynecologists, CBE = clinical breast examination, CCS = Canadian Cancer Society, CETH = Center of Excellence for Transgender Health, CRHC = Canadian Rainbow Health Coalition, CSH = cross-sex hormone, IPPF = International Planned Parenthood Federation, MRI = magnetic resonance imaging, NHS = National Health Service, NR = not reported, SHC = Sherbourne Health Centre, TTSES = Transcend Transgender Support & Education Society, VCH = Vancouver Coastal Health.
↵* Chest reconstruction was variably termed as mastectomy, gender-affirming chest surgery or chest surgery.
↵† Age range not specified.
↵‡ Cross-sex hormone use was variably termed as hormone use or testosterone.
↵§ Duration not specified.
↵¶ Document did not specify whether clinical breast examinations, breast self-examinations or both were recommended.
↵** Specific breast screening recommendations for trans men who have had partial chest reconstruction were not provided. However, it was noted that, in some cases, mammography may not be possible following chest reconstruction surgery, and breast ultrasonography or magnetic resonance imaging may be a preferable screening method.
↵†† Risk factors include the amount of breast tissue removed, personal risk factors and history, whether the client has had oophorectomy, and whether the client is taking testosterone and other hormones.
↵‡‡ Defined as a genetic mutation in oneself, or having a parent, sibling or child who has a genetic mutation that puts them at higher risk for breast cancer; a family history that indicates a lifetime risk of breast cancer of 25% or greater, confirmed through genetic assessment; or having received radiation therapy to the chest before 30 years of age as treatment for another cancer or condition.