October is Breast Cancer Awareness Month, making it an important time of year to raise awareness for the need of screening and early detection, advocacy, support and ongoing research. Unfortunately, the reality is that breast cancer doesn’t care what month it is and doesn’t just go away until October. It’s vital that any person with breast or chest tissue, meaning everyone, understands that they may be at risk of developing breast cancer.
Women have an increased risk, not because of sexual orientation, but because of exposure to estrogen. LGBTQ-identifying women have higher rates of cancer due to other risk factors within the community, or late detection of cancer. Some of these risk factors include tobacco use, alcohol consumption, being overweight (especially after menopause), lack of insurance and lack of access to culturally competent healthcare. Those with first-degree family members with cancer are at higher risk — mothers, sisters, daughters, but let’s not forget that our fathers, brothers and sons can get breast cancer, too.
Knowing the family health history of our aunts, uncles and grandparents is an important factor in predicting the likelihood of getting cancer, too. The biggest risk factors are exposure to estrogen and older age.
Many LGBTQ patients have experienced discrimination leading up to healthcare appointments, or felt uncomfortable during a healthcare visit in the past. As a physician striving to provide open and inclusive healthcare to all, it is important to make every individual aware about their risks for all forms of cancers, but in a way that is easy to understand, in a safe, comfortable and inclusive environment.
The American Cancer Society recommends the following guidelines for breast cancer early detection for women at average risk:
• Women ages 40 to 44 have the choice to start annual breast cancer screening with mammograms if they wish to do so.
• Women ages 45 to 54 should get mammograms every year.
• Women ages 55 and older should switch to mammograms every 2 years, or can continue yearly screening, usually until age 75 (or life expectancy > 10 years).
• All women should be familiar with the known benefits, limitations and potential harms linked to breast cancer screening.
• Women should also be familiar with how their breasts normally look, and feel and report any changes to a health care provider right away. Many partners will notice changes before the patient.
• Some women at high risk for breast cancer — because of their family history, a genetic tendency or certain other factors — should be screened with MRIs along with mammograms. Talk with a health care provider about your breast cancer risk and the best screening plan for you.
There are many different societies with varying recommendations, so it is best to have a conversation with your health care provider.
It is important to note, too, that the screening recommendations for transgender women vary because there is no consensus on the recommendations for cisgender women. After a comprehensive review of all published recommendations, the Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco came up with some general recommendations. Here is a summary of those recommendations:
• Trans women on hormones may have an increased risk of breast/chest cancer after five years of taking hormone replacement. Trans-women whose hormone levels are not monitored and regulated by a medical provider may be at particularly high risk.
• Trans women should get their first mammogram at age 50 or after 5 to 10 years of hormone replacement therapy (whichever comes first), and then every 2 years through age 74. However, this should be discussed with their provider, with consideration to the length of hormone replacement therapy and the patient’s family history.
• Trans men ages 50 to 74 years, who have not undergone breast/chest reduction or bilateral mastectomy, should get a mammogram every 2 years. After mastectomy, they should continue to pay attention to tissue in that area to look for signs of abnormal tissue, because of the possibility of some tissue remaining after surgery.
Even if you have had top surgery, some breast tissue may remain. There is still some risk for developing cancer. We know that when the body receives too much testosterone that it cannot use, it turns that testosterone into estrogen. This means that trans men on hormones need to be monitored by their medical provider to ensure their testosterone levels are appropriate.
Screening for breast/chest cancer from your healthcare provider can reduce your risk. See your health care provider if you notice any changes to that tissue or the tissue under your arms, including, but not limited to: change in color, texture (dimpling/”orange peel,” sensation of your skin, lumps or bumps, swelling, warmth, sudden nipple discharge (especially if bloody, black or green in color).
Making healthy lifestyle choices by exercising, limiting alcohol intake and seeing a health care provider for regular check-ups is a great start to a healthier life.
Dr. Latonya Riddle-Jones is the Medical Director at Corktown Health Center, a full-service medical home for the LGBTQ community. Breast and cervical cancer screening is available by appointment, including those who are uninsured. Please visit corktownhealth.org for more information or to become a patient.