Breast Cancer Risk and Screening Rates in Female-to-Male Transgender Patients
Taylor J. Clegg*1, Andrea Hiller2, Destin Groff1, Jeffrey Fornadley2, Timothy S. Johnson2
1Penn State University College of Medicine, Hershey, PA; 2Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA
The number of individuals identifying as transgender in the U.S. is increasing. Unfortunately, evidence relating to breast cancers in this population is limited and insufficient to estimate cancer prevalence in female-to-male (FtM) individuals. Better data is needed to contribute to evidence-based screening guidelines. This study aims to evaluate breast cancer risk and current screening rates in FtM patients.
A retrospective cohort study was conducted using a multicenter electronic health record database to identify patients born female aged 40-75 years from January 2015-January 2023. Patients were split into two cohorts, cisgender females who had not undergone mastectomy and FtM patients, with the latter further divided based on gender-affirming mastectomy status. Patients with breast cancer genetic predisposition were excluded. Cohorts were propensity score matched on age, race, and ethnicity. Using ICD-10 codes, rates of breast cancer screening and diagnoses were identified.
6,132,901 cisgender females who had not undergone mastectomy, 7,742 FtM patients who had not undergone mastectomy, and 263 FtM patients who had undergone mastectomy were identified. Cisgender patients were twice as likely to receive breast cancer screening compared to FtM patients (24.19%vs12.12%, RR:1.995, p<0.0001). FtM patients were 3.2 times more likely to develop invasive breast cancer versus the cisgender group (3.67%vs1.14%, RR:0.312, p<0.0001). Following mastectomy, cancer screening rates decreased 2.2-fold in the FtM population (4.93%vs10.59%, RR:2.150, p<0.0288). No FtM patients developed invasive breast carcinoma after mastectomy (Table 1).
This study shows that FtM patients received breast cancer screening at much lower rates than cisgender females, regardless of similar recommendations. Furthermore, screening rates drop significantly following mastectomy, despite residual breast tissue posing a remaining cancer risk. This study highlights the current insufficiency in care of transgender patients and the need for interventions to improve outcomes of gender minorities in the U.S.
Table 1. Incidence of breast cancer screening/risk of developing cancer in cisgender vs FtM patients, and FtM patients with mastectomy
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