Skip to nav Skip to content

Knowing your cancer risks is an important part of remaining healthy. Feeling comfortable with your doctor is necessary to know what options are available.

While guidelines for breast cancer screening are regularly shared by many health institutions, guidelines specifically focusing on the transgender population are less prominent. Dr. Bethany Niell, section chief of Breast Imaging at Moffitt Cancer Center, hopes to change that.

The most important thing is that patients have the knowledge and information about their specific risk factors for cancer.
Dr. Bethany Niell, Section Chief, Breast Imaging

“The most important thing is that patients have the knowledge and information about their specific risk factors for cancer,” Niell said. “All of us have unique risk factors, but most of us haven’t explored them. This is especially true in the transgender community, which faces additional challenges in finding access to high quality health care.”

Breast cancer is treatable when caught early, regardless of that person’s gender identity.

Guidelines about screening in the transgender community will continue to evolve. The American College of Radiology has outlined breast cancer screening guidelines for transgender patients. Niell chaired one of the two American College of Radiology Appropriateness Criteria Breast Imaging panels, which create evidence-based guidelines for imaging examinations.

“Especially for transgender male-to-female patients, the risk of breast cancer is thought to be connected to the use of feminizing hormones,” Niell said. “Knowing and understanding that those hormones can be a risk factor can allow a patient to stay on top of their breast health. If something suspicious is present, have it evaluated promptly so it can be treated early, which leads to much better results.”

It’s also important for transgender female-to-male patients to understand that breast cancer risk drops dramatically if the breast tissue has been entirely removed.

“If there is no breast tissue remaining, then routine screening is not recommended,” Niell said. “That’s true for all patients who have had tissue removed, regardless of their gender identity.”

Screening regimens vary depending on each patient’s set of risk factors, but physicians now have a tool to help understand when a mammogram, digital breast tomosynthesis (3D mammography), breast ultrasound, breast MRI or other advanced imaging is recommended in a transgender patient.

“We engage medical professionals from other organizations to participate in creation of these guidelines, too,” Niell said. “The ACR appropriateness criteria can be used for clinical decision support to determine when advanced imaging is appropriate in our patients, including transgender individuals.”

Niell reiterates that knowledge is the best tool to combat breast cancer and that providing guidelines to all patient populations can help reduce the risks of cancer developing and improve access to earlier treatment options. There is an underutilization of the health care system and cancer screening in transgender patient populations, Niell said.

These guidelines are a positive first step, but Niell said there is still extensive progress to be made, and focused outreach and future research will help doctors and researchers better understand how to take care of this patient population.

“We continue to have very little data about how to best manage our LGBTQ patients in part because health care in general has not done a great job of building bridges between health care providers and these patients,” Niell said. “At Moffitt, we welcome all patients. We want to help you.”