Metastatic Breast Cancer in Transgender and Nonbinary People

Most people think of women when thinking about breast cancer. But anyone – of all gender identities – can develop breast cancer or metastatic breast cancer. The transgender and non-binary communities can have unique risks and experiences related to breast cancer. Understanding these risks can help you navigate a diagnosis for yourself or a loved one.¹

We use the following terms in this piece:^1-3

• Cisgender man (cis man) – assigned male at birth and identifies as a man.
• Cisgender woman (cis woman) – assigned female at birth and identifies as a woman.
• Nonbinary – a person’s gender identity does not align exclusively with being male or female. Nonbinary people may identify as a mix of both genders, as neither gender, or as a different gender altogether.
• Transgender man (trans man) – assigned female at birth and identifies as a man.
• Transgender woman (trans woman) – assigned male at birth and identifies as a woman.

Differences in breast cancer risk for transgender and nonbinary people

Hormones play a big role in breast cancer risk. Certain types of hormones, like estrogen and progesterone, are linked with an increased risk of developing breast cancer.¹

Research on breast cancer and transgender and nonbinary people is limited. For anyone, the risk of developing breast cancer can depend on several factors. These include age and family history of breast cancer.^2,4-7

For these communities, the risk of developing cancer can also be linked to the steps they take during transition. For example, surgical and hormonal transitions can each impact breast cancer risk.

Trans women have a higher risk for breast cancer than cis men. But this risk is not as high as the risk for cis women. The increase in risk for trans women is mostly due to gender-affirming hormone treatment.^2,4-6

Some trans men will choose to take hormones such as testosterone blockers or estrogen as part of their transition. Taking these hormones increases the risk of developing breast cancer.^2,4-6

On average, trans men have a lower risk for breast cancer than cis women. But they have a higher risk than cis men. Some trans men may have their breasts removed. This can be called top surgery, chest feminization surgery, or a double mastectomy. This surgery lowers the risk of developing breast cancer by about 90 percent.^2,4-6

Screening for breast cancer in trans people

The American College of Radiology has specific guidelines for screening transgender people for breast cancer. However, at this time, there is not enough research or data on breast cancer screening recommendations for nonbinary people.⁴

Here is what the American College of Radiology recommends for screening transgender people for breast cancer:⁴

For trans men

If you have had top surgery, breast cancer screening is not recommended. If you are older than 40 with no chest surgery, you should get regular mammograms to screen for breast cancer.⁴

You should also get regular mammograms if you are older than 25 with no chest surgery and have:⁴

• A history of breast cancer
• A BRCA1 or BRCA2 inherited gene mutation
• Other breast cancer risk

If you should be getting regular mammograms, your doctor may also recommend having MRI or ultrasound imaging of your breasts.⁴

For trans women

If you are any age and have not used hormones for more than 5 years, you should not need screening. If you are 25 to 30 or older, have a high risk of breast cancer, and have not used hormones, you should receive regular mammograms.⁴

You may also need regular mammograms if you:⁴

• Are 25 to 30 or older, have a high risk of breast cancer, and have used hormones.
• Are older than 40, have used hormones for over 5 years, and have an average risk of breast cancer.

Transgender and nonbinary people are typically less likely to receive breast cancer screenings than cis people. This can be harmful especially if you are at higher risk. A more inclusive approach is needed to break down barriers to healthcare for all populations. Talk with your doctor about what the best option for breast cancer screenings is for your needs and medical history.^4,6,7