TalkBack: 11.06.15 – Transgender breast cancer concerns

TalkBack

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Dear Editor,

I was happy to see Jeff Taylor’s article exploring breast cancer risk and the transgender community [goqnotes.com/37781/]. He makes an important point that we all, cis- and trans- men and women, have breast tissue which extends to the clavicles (collar bones) and into the axillae (underarms) and is retained after mastectomies in cis-women and chest reconstructions in trans-men.

During ten years as a general surgeon, I coordinated the surgeries and oncological care for cis-women with breast cancer, as well as 3 cis-men with the disease. Now, as a cosmetic surgeon performing “Top Surgeries” for trans-men and women, I am often the first physician who discusses this issue with my clients. Likely because, as Mr. Taylor notes, there are no guidelines for their primary care physicians to follow.

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Given the current lack of research, I give my patients the following recommendations based on my own experience and our current knowledge of this disease:

• Trans-men who have not had chest reconstruction, and trans-women on HRT should follow the same guidelines for breast cancer screening as cis-women. These guidelines are evolving; but basically get your first mammogram at 40-50 years old and then annually. This may be continued annually, or reduced to every other year, after the age of 55.

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• Trans-women on HRT whose anatomy makes mammograms difficult should follow the guidelines above substituting MRIs for mammograms.

• Trans-men who have had chest reconstruction, cis-men, and trans-women who are not on HRT, should have an annual physical exam by a medical professional which includes palpation (careful feeling) of the chest and underarms beginning at 40-50 years old. A CT or MRI should be obtained if, on self-exam or professional physical exam, any lumps, tenderness, nipple discharge or other abnormalities are found. If there is a lump on palpation, CT, or MRI it should be further investigated by a needle or excisional biopsy.

Hope Sherie, MD, FACS
Charlotte, N.C.

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