Do transgender individuals need to get a mammogram?

Mammogram Screening for Transgender Individuals

Yes, transgender individuals need mammograms, but the specific recommendations depend on their assigned sex at birth, hormone therapy duration, surgical history, and individual risk factors.

Transgender Women (Assigned Male at Birth)

Standard Risk Screening

For transgender women aged 40 or older who have received at least 5 years of feminizing hormone therapy, screening mammography or digital breast tomosynthesis is appropriate. 1, 2

• Starting age 50 years is the most commonly recommended threshold, with either annual 1 or biennial 1 screening intervals depending on which guideline you follow
• The 5-year hormone exposure threshold is critical because feminizing hormones increase breast tissue development and cancer risk 1
• Transgender women without hormone therapy or with less than 5 years of exposure generally do not require routine screening 1

High-Risk Screening

For transgender women aged 25-30 or older with high-risk factors, screening mammography should begin earlier. 1

High-risk factors include: 1

• Personal history of breast cancer
• Chest irradiation between ages 10-30 years
• Genetic predisposition (BRCA mutations or other known genetic syndromes)
• First-degree relative with genetic predisposition to breast cancer
• 20% or greater lifetime breast cancer risk by established risk calculators

Important Context on Risk

Transgender women have substantially lower breast cancer risk than cisgender women (4.1 vs 155 per 100,000 person-years), but 46.7-fold higher risk than cisgender men. 1, 2 This intermediate risk profile justifies screening in those with prolonged hormone exposure.

Transgender Men (Assigned Female at Birth)

Without Chest Surgery

Transgender men who have not undergone total mastectomy should follow the same screening recommendations as cisgender women, regardless of testosterone therapy. 1, 3

• Standard screening begins at age 40 for average-risk individuals 1
• Testosterone therapy does not eliminate breast cancer risk 4, 3
• Breast cancer risk remains comparable to cisgender women 1, 3

After Chest Surgery (Mastectomy)

For transgender men who have undergone total mastectomy, routine screening mammography is not indicated. 1

• The American College of Radiology states all screening imaging modalities are "usually not appropriate" after total mastectomy 1
• However, yearly chest examinations may be considered to assess for any residual breast tissue 1
• Some guidelines suggest ultrasound or MRI may be appropriate after thorough discussion about risks, benefits, and lack of data, particularly if only breast reduction (not complete mastectomy) was performed 1

High-Risk Transgender Men

For transgender men with high-risk factors who have not undergone mastectomy, follow the same enhanced screening protocols as high-risk cisgender women. 1

• Begin screening 8 years after chest radiation but not before age 25 1
• For familial breast cancer risk, start screening 10 years earlier than the affected relative's age at diagnosis, but not before age 30 1
• Consider supplemental screening with breast ultrasound or MRI in addition to mammography 1

Critical Implementation Points

The Organ Inventory Approach

Use an organ inventory approach that accounts for natal anatomy and hormone-induced changes, rather than screening based solely on gender identity. 2, 3

This means: 2, 3

• Document what organs are present regardless of gender identity
• Consider both natal anatomy and effects of hormone therapy
• Adjust screening based on individual anatomy, not assumptions

Common Pitfalls to Avoid

• Do not assume transgender women without hormone therapy need screening—they have risk similar to cisgender men 1
• Do not skip screening for transgender men without chest surgery based on testosterone use—their risk remains comparable to cisgender women 1, 3
• Do not perform routine screening after complete mastectomy in transgender men—this is not indicated 1
• Do not overlook the need to clarify surgical history, as some patients may have had breast reduction rather than complete mastectomy 1

Barriers to Screening

Transgender individuals face significant barriers to appropriate screening: 5, 6, 7

• Only 36% of transgender individuals aged 50+ receive screening mammograms despite clear guidelines 7
• Discrimination, lack of provider knowledge, and socioeconomic barriers reduce screening uptake 6
• Transgender patients are less likely to undergo screening and may suffer poorer cancer-related outcomes 5

Creating Appropriate Care Environments

To improve screening rates: 8, 9, 6

• Ensure clinic environments are welcoming with inclusive language
• Train staff on accepted terminology and transgender health issues
• Allow patients to designate their gender identity and surgical history accurately
• Use trauma-informed approaches, particularly for examinations that may cause gender dysphoria