Mammogram Screening for Transgender Individuals

Screening Recommendations

• The American College of Radiology recommends that transgender women aged 40 or older who have received at least 5 years of feminizing hormone therapy undergo screening mammography or digital breast tomosynthesis [@1 Adler, 1@, 2, 3]
• The American College of Radiology states that transgender women without hormone therapy or with less than 5 years of exposure generally do not require routine screening 2
• The Mayo Clinic recommends that transgender women with high-risk factors, such as personal history of breast cancer, chest irradiation, genetic predisposition, or first-degree relative with genetic predisposition, undergo screening mammography starting at age 25-30 2, 5
• High-risk factors for transgender women include personal history of breast cancer, chest irradiation between ages 10-30, genetic predisposition, first-degree relative with genetic predisposition, or 20% or greater lifetime breast cancer risk 5
• The American College of Radiology recommends that transgender men who have not undergone total mastectomy follow the same screening recommendations as cisgender women, regardless of testosterone therapy 5, 6, 7
• The Mayo Clinic states that transgender men who have undergone total mastectomy do not require routine screening mammography, but may require yearly chest examinations to assess for residual breast tissue 5, 6
• The American College of Radiology suggests that transgender men with high-risk factors who have not undergone mastectomy follow the same enhanced screening protocols as high-risk cisgender women, starting screening 8 years after chest radiation but not before age 25 5

Organ Inventory Approach

• The American College of Radiology recommends using an organ inventory approach that accounts for natal anatomy and hormone-induced changes, rather than screening based solely on gender identity 3, 7
• This approach involves documenting present organs, considering both natal anatomy and effects of hormone therapy, and adjusting screening based on individual anatomy 3, 7

Critical Implementation Points

• The Mayo Clinic recommends training staff on accepted terminology and transgender health issues to improve screening rates 1
• The American College of Radiology suggests using trauma-informed approaches, particularly for examinations that may cause gender dysphoria 7