Proposed French recommendations for breast cancer screening in the trans population

Abstract

Introduction

Transgender patients are increasingly able to assert their gender identity. Nevertheless, their access to care is still limited, mainly due to poorly trained and informed healthcare professionals. Because of a growing incidence of breast cancer (BC) and insufficient screening in France, it is vital to improve access for trans people. Therefore, we aim to produce the first French recommendations adapted to them.

Materials and methods

This work is based on the recommendations of the WPATH, the ACR, and a review of the literature.

Results

First, there is no excess risk of BC in the trans population. The risk for trans women is 0.3 times that of cis women, 47 times that of cis men, and twice that of trans men. The risk for trans men is 59 times that of cis men, and 0.2 times that of cis women (reduced by the use of testosterone and torsoplasty). The recommendations for BC screening are thus the same for trans men without torsoplasty, and for trans women after 5 years of gender-affirming hormone therapy, as for cis women. These should be adapted to the personal and family histories.

Discussion

The lack of inclusion of trans patients in studies makes it impossible to give recommendations that differ from those for cis women. The training of healthcare professionals and the provision of information to patients are vital to the screening and prevention of BC, which are mainly hormone-dependent, thus often contraindicating the gender-affirming hormone therapy essential for trans patients afterwards.