A new study has found that healthcare professionals are not doing enough to screen trans patients who have had top surgery for breast cancer.
Published July 29 in the Breast Cancer Research and Treatment journal, the researchers emphasized the “dearth of available data” on cancer risk profiles of people who have had gender-affirming mastectomies, “including a lack of consistent guidelines that are infrequently implemented in practice.”
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The study explained that top surgery differs from a standard risk-reducing mastectomy performed on people who are genetically predisposed to develop breast cancer. Unlike the risk-reducing mastectomies, gender-affirming mastectomies do not remove all of the breast tissue but instead leave some tissue in place to “construct a masculine chest contour.”
As such, the researchers explain that while trans top surgery patients have a lower risk of breast cancer than cisgender women who have not had mastectomies, they are still at higher risk than cisgender men.
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They also recommend trans people undergo a “pre-surgical risk assessment” for breast cancer before receiving top surgery, the results of which “could inform surgery technique, providing a key avenue to close precision oncology care gaps” for trans people. A pilot study suggested that about 50% of patients will choose the full risk-reducing mastectomy over traditional gender-affirming top surgery if they are found to be at elevated risk for breast cancer.
The study also revealed a lack of education among patients on the importance of breast cancer screening after top surgery.
In addition, healthcare professionals reported “discomfort and limited knowledge” about breast cancer screening for trans people, as well as confusion over whose responsibility it is to conduct the risk assessment: “While a primary care provider noted reliance on surgeons for screening decisions, a surgical oncologist deferred to primary care to initiate risk assessment while acknowledging a need for dedicated attention.”
“Combined with conflicting guidelines for [Trans and gender diverse]-specific care, this discomfort may exacerbate care gaps in precision medicine in ways that specifically impact” trans people, the researchers wrote.
The study called for “coordinated structural initiatives that prioritize equity and precision.”
These findings are consistent with the overall lack of information and consistent guidelines on health care for trans men. For example, a first-of-its-kind study published in July in the journal Acta Obstetricia et Gynecologica Scandinavica found that pregnant trans men may be more likely to miscarry than pregnant cis women, with researchers emphasizing that much more data is needed to draw any strong conclusions.
Similar to the breast cancer study, the review concluded that pregnancy in transmasculine people is woefully understudied, and OBGYNs are also severely underprepared to treat transmasculine patients.
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