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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.
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.
• 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