The Importance of Cancer Screening for Trans and Nonbinary Patients

Written by Jonathan Kipp | Sep 20, 2023 3:29:36 PM

Routine cancer screening has greatly contributed to the decrease in cancer mortality rates over the last 50 years. And though the World Professional Association of Transgender Health (WPATH) has created Standards of Care for transgender and gender-diverse (TGD) patients, there are no specific cancer screening guidelines.

When TGD-specific screening guidelines are not available, cisgender recommendations are suggested. This is true where organs remain in place or, in some cases, where there has been gender-confirmation surgery.

Breast Cancer Screening for the Transgender and Gender-Diverse Community

Transgender men may be at a higher risk of developing breast cancer compared to trans women and cisgender men. This may be a result of early exposure to estrogen or the lack of suppression treatment.

Unlike total mastectomies, chest reconstruction methods, such as keyhole and periareolar surgery, leave some breast tissue behind. In these cases, trans men who have had top surgery may still need breast cancer evaluation on an ongoing basis.

A clinical breast exam of the area behind the nipple or underarm region may be required as part of an assessment. You and your doctor should discuss when additional screening is advisable.

Recommendations for breast cancer screening for transgender men and nonbinary individuals are as follows:

Mammogram usually appropriate

Patients 25 - 30+ with a breast reduction or no chest surgery and a personal or family history of breast cancer.
Patients 40+ with a breast reduction or no chest surgery should discuss a yearly or biennial mammogram.

Mammogram not usually appropriate

Patients who have undergone a bilateral (double) mastectomy.

Recommendations for breast cancer screening for transgender women and nonbinary individuals are as follows:

Mammogram usually appropriate

Patients 25 – 30+ years with past or current use of hormones for 5+ years and a personal or family history of cancer.

Mammogram may be appropriate

Patients 25 – 30+ years with either no past use of hormones or hormone use for <5 years and a personal or family history of cancer.
Patients 40+ who have been receiving hormone therapy for 5+ years should discuss a yearly or biennial mammogram.

Mammogram not usually appropriate

Patients who have not had hormone therapy or who have had hormone therapy for <5 years.

Breast cancer screening recommendations are taken from The American College of Radiology and are based on sex assigned at birth, use of hormones, and risk factors.

Speak with your practitioner about what is appropriate for you.

Gynecologic Cancer and HPV Screening for the TGD Community

The American Cancer Society’s cervical cancer screening guidelines for transgender men and nonbinary individuals include the following:

Patients 25+ should begin screening for cervical cancer.
Patients between the ages of 25 – 65 should have a primary HPV test or co-test (HPV and Pap combined) every five years or a Pap test alone every three years.
Patients who have received the HPV vaccination should continue to follow guidelines for their age groups.
Patients who have had their uterus and cervix removed do not need to continue screening unless removal was due to cancer or a serious pre-cancer.

Gender-affirming hormone therapy (GAHT) does not increase the risk of cervical cancer. However, GAHT can cause cervical atrophy, which makes getting an accurate Pap result more difficult. Retesting may be required.

Transgender women who have had vaginoplasty do not need Pap smears. However, vaginal exams may be recommended to detect sexually transmitted infections, such as HPV, and address pelvic issues after surgery.

Data about cancer risk factors for transgender and nonbinary patients and their prevalence is limited. However, the link between HPV and certain types of cancer is well established. Screenings should continue, and any patient with a uterus or cervix should immediately inform their physician of any abnormal bleeding or discomfort.

Prostate Cancer Screening for the TGD Community

The incidence of prostate cancer in trans women is still being researched, but it does appear lower than that of cisgender men. This may result from androgen deprivation (suppression of hormones) combined with estrogen and progesterone therapy.

Still, anyone with a prostate gland can get prostate cancer. Even those who have undergone gender-confirming surgery will typically retain their prostate.

Prostate cancer risk for those assigned male at birth increases at age 50+ and even earlier for Black individuals or those with a family history of this disease.

The standard prostate screening for all patients born with a prostate may include:

A digital rectal exam (DRE) to determine an unusual prostate size or shape.
A PSA (prostate-specific androgen) test to measure PSA in the blood.
An MRI if a more complete view is recommended.

The prostate exam may vary if the patient has had gender-confirming surgery.

Who Performs Cancer Screening Tests?

Mission one is to remove barriers and provide the best care for transgender and gender-diverse patients. Finding a physician with whom you feel comfortable and who has demonstrated competency and sensitivity in TGD healthcare is essential. It’s also vital to share medical records detailing your surgical history and any development linked to gender-affirming hormones.

Being upfront about your medical history makes early detection of cancer easier, which means the outcomes of cancer treatment – if necessary – are likely to be better.

Comprehensive Cancer Care with Expert Oncologists in Portland-Vancouver

The oncologists and cancer care team at Compass Oncology in the Portland and Vancouver area are here to help. Our cancer doctors specialize in offering patients the latest cancer treatment options, including clinical trials based on each individual diagnosis. Compass Oncology is an inclusive practice that works with you to continually evaluate the most effective pathways for the best outcome for your health and care.

If you have been recently diagnosed with cancer, request an appointment with a cancer specialist at a Compass Oncology location near you.

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