October is Breast Cancer Awareness Month – a month of pink ribbons, 5ks, and “save the ta-tas” campaigns. While well-intentioned, mainstream breast cancer campaigns exclude many LGBTQ+ people through marketing that targets feminine, cisgender – and often heterosexual – women. Graphics about breast cancer almost exclusively pink and depict women with long hair and short skirts. Where is the representation of genderqueer, non-binary, butch, trans masc, trans men, or trans women breast cancer survivors?
The lack of LGBTQ+ representation in the world of breast cancer awareness isn’t just a marketing issue; most medical information – both online and in doctor’s offices – constructs breast cancer as an illness which exclusively impacts cisgender women. Statistics like “1 and 8 women in the U.S. will develop breast cancer in their lifetime” begs many questions for the queer community: are trans women included in this statistic? If I am assigned female at birth but have made changes to my body, do I have similar risks as cisgender women? Where is the information about breast cancer within the non-binary community?
At Pride Center of Vermont, our Health & Wellness Program works to make information about breast and cervical cancer accessible to and inclusive of all queer people. My coworker, Taylor Small, and myself facilitate statewide training opportunities for medical providers and administrative staff in departments like mammography & gynecology to make cancer screenings & care inclusive to everyone who has breasts and/or a cervix.
This Breast Cancer Awareness Month, we’re queering the info about breast cancer by raising awareness on how it uniquely affects different members of our community. We hope you find the below information helpful, and, as always, medical providers are one of your best resources for guidance about your individual health. If you need help finding an LGBTQ+ safe and affirming provider, check out our Vermont Diversity Health Project.
Trans Men, Trans Masculine People and Breast Cancer
Medical research on breast cancer among trans men and trans masculine people is not nearly as exhaustive as the data we have for cisgender women. Despite that, there still appears to be consensus among peer-reviewed research about risks for trans men and trans masculine people developing breast cancer:
- Trans men and trans masculine people who have not had top surgery should follow the same screening guidelines that are recommend for cisgender women. (1, 2, 3) – to learn more about those guidelines, click here.
- Currently, there are no formal guidelines for breast cancer screening for people who have undergone top surgery. While the risk of breast cancer in trans men who have had top surgery has not yet been formally researched, the risk is suspected to be lower than those who have not had top surgery. It is important to note that gender-affirming top surgery is a slightly different procedure than a mastectomy to treat breast cancer. Gender-affirming top surgery often has the goal of changing someone’s appearance for their well-being. Because of that, this type of top surgery might leave behind certain tissue on which cancer could possibly form. (1, 4, 5)
- Trans men who have been taking testosterone may have a significant reduction in breast glandular tissue, however there may also be an increase in connective tissue, which could pose an increased risk of breast cancer, as dense breast tissue makes it harder to detect cancer in the earlier stages. (1)
- Trans men who are taking HRT and have had gender-affirming top surgery are at a lower risk of developing breast cancer. However, they are still at a higher risk than cisgender men for developing breast cancer. (2, 5, 6, 7)
- People who can’t receive a mammogram due to the removal of breast tissue can access alternative methods of screening, such as via an ultrasound or MRI. (3)
Trans Women and Breast Cancer
Similar to medical research on trans men and trans masucline people’s risk for developing breast cancer, the research on breast cancer risks for trans women is not nearly as exhaustive as it should be. That said, peer-reviewed research and medical providers do offer some consensus on specific factors which could impact the development of breast cancer in trans women:
- Trans women who are taking estrogen are at a higher risk of developing breast cancer than trans men, but are potentially at a lower risk than cisgender women. (1, 6, 7)
- In the current screening guidelines for transgender women, those with no family history of breast cancer but who have been receiving estrogen for at least 5 years, should be screened regularly starting at age 50. (1)
- Trans women who do have family history or genetic predisposition for breast cancer should consider additional screening approaches based on their history and professional recommendations. (1)
- Both trans women and men are at a higher risk than cisgender men for developing breast cancer, and at a lower risk than cisgender women. (7)
Cisgender LGBQ Women and Breast Cancer
While cisgender LBGQ women have access to more information than the trans community about their risk for developing breast cancer, there are still certain factors that increase this population’s risk of developing breast cancer that aren’t widely known:
- Cisgender LGBQ women are at a higher risk of developing breast cancer than cisgender, heterosexual women, as they often have higher rates of cancer risk behaviors, such as cigarette smoking and alcohol consumption (8, 9)
- Cisgender women who do not have biological children are also at a higher risk of developing breast cancer, and LGBQ women are less likely to give birth to a biological child. (8, 9)
- One study found that lesbian, gay, and bisexual women reported having less access to post-cancer healthcare, which is crucial in preventing the cancer from returning, detecting early threats, and monitor for long-term effects of the cancer treatment. (9)
LGBTQ+ People and Breast Cancer
No matter the identity you hold, there are some common risk factors which affect all LGBTQ+ people and their health:
- Barriers such as discrimination, lack of trust, financial circumstances, lack of insurance coverage, and past negative experiences can all make it more difficult for LGBTQ+ people to seek out and receive quality health care. As early detection is often key for breast cancer treatment, if someone is not connected to health care or does not visit a doctor regularly, there is an increased chance that breast cancer could go undetected for longer which could make the cancer harder to treat once it is detected. (8, 9, 10, 11)
You deserve safe, informed, judgement-free health care. If you’re feeling dysphoric or uncomfortable accessing breast cancer screenings or care, we completely understand and are here to help. Reach out to our Health & Wellness Team to find out how we can make accessing health care a safer, more affirming experience. Additionally, it is important to find a doctor who understands the specific health care needs of the LGBTQ+ community. To find an LGBTQ+ safe and affirming doctor, click here.
Pride Center of Vermont partners with You First, a program which offers personalized support to pay for and connect eligible Vermonters to breast, cervical and heart screenings, heart health checkups (blood pressure, cholesterol and blood sugar testing), diagnostic tests and heart-healthy lifestyle programs. Members can get free memberships to WW® (Weight Watchers), TOPS® and local gyms, farmers’ market coupons, state park passes and more. Check your eligibility for free health services here or reach out to our team at email@example.com to discuss eligibility.
Research conducted by Glow intern, Keira Hawkes.