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A national multidisciplinary survey of current practice trends in breast cancer screening after gender affirming mastectomy: A call for inclusive care
Krishna Vyas*, Matthew A. DePamphilis*, Sasha Wood, Katya Remy, William G. Austen, Katherine Carruthers
Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
BackgroundGender-affirming mastectomy (GAM) may leave varying amounts of breast tissue conferring an unknown, nonzero risk of developing breast cancer. Current breast cancer screening guidelines provide minimal evidence-based direction tailored to this patient population. This study aimed to perform a multidisciplinary assessment of the current practices by plastic surgeons as well as breast surgeons when recommending breast cancer screening following GAM.
MethodsAn electronic survey was distributed to 5802 members of the American Society of Plastic Surgeons (ASPS) and 707 members of the American Society of Breast Surgeons (ASBrS) from 2024-2025. Survey items focused on (1) demographic and practice profiles; (2) familiarity with current screening guidelines; and (3) individual screening practices with corresponding confidence in those recommendations.
ResultsA total of 586 ASPS and 81 ASBrS members completed the survey. Among ASPS respondents, 25.8% perform GAM. Of the currently available breast screening recommendations for transgender individuals, a significantly greater proportion of ASPS members follow the WPATH Standards of Care (31.8% vs 9.9%, p<0.001) whereas a significantly greater proportion of ASBrS members follow the ACR Appropriateness Criteria (34.6% vs 12.6%, p<0.001). Only 1 in 4 plastic and breast surgeons express confidence in providing the appropriate recommendations. The overwhelming majority of plastic surgeons (93.9%) and breast surgeons (92.6%) support the development of more specific, evidence-based, and transgender-inclusive screening guidelines.
ConclusionThis is the first study to provide insight on multidisciplinary perspectives of the current screening guidelines for transgender individuals. Our findings reveal significant variability in practice among ASPS and ASBrS members. There is a critical need to generate improved guidelines in order to provide equitable breast cancer surveillance. Longitudinal research aimed at understanding breast cancer risk following GAM is needed to aid in the development of evidence-based screening protocols.
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