Preventive Care Screening for Transgender Women

Breast Cancer Screening

The American College of Radiology recommends that transgender women aged 40+ with ≥5 years of hormone exposure may undergo screening mammography or digital breast tomosynthesis, with a strength of evidence based on expert consensus 3, 4
Transgender women who have received 5 or more years of feminizing hormone therapy should undergo screening mammography starting at age 50 years, either annually or biennially, as recommended by Fenway Health and UCSF guidelines 1, 2
The Endocrine Society recommends that transgender women follow the same screening schedule as cisgender women without specifying hormone duration requirements, based on low-quality evidence 1, 2
Transgender women have substantially lower breast cancer risk than cisgender women (4.1 per 100,000 person-years vs. 155 per 100,000 person-years), but significantly higher risk than cisgender men (46.7-fold increased risk), according to observational studies 3, 5, 6

Transgender women on estrogen therapy have significantly elevated cardiovascular risk compared to both cisgender women and cisgender men, requiring more aggressive cardiovascular screening, based on moderate-quality evidence 7
Transgender women on estrogen therapy are at increased risk of venous thromboembolism, ischemic stroke, and myocardial infarction compared to cisgender women, according to observational studies 7

Transgender women on long-term estrogen therapy may have compromised bone structure, requiring individualized bone density assessment, based on expert opinion 7
Bone density screening should follow guidelines similar to cisgender women, with consideration for additional risk factors related to hormone therapy duration and dosing, based on low-quality evidence 7

The American College of Radiology and other guideline societies recommend an organ inventory approach that accounts for both natal anatomy and hormone-induced changes, based on expert consensus 8
Transgender women should undergo screening based on their individual organ inventory and hormone therapy duration, rather than solely on gender identity, based on moderate-quality evidence 1, 2, 8