Table 7:

Existing breast screening recommendations for trans women (review 3)

Organization, year; populationDocument typeScreening recommendations
Additional eligibility criteriaModalityIntervalAdditional recommendations
History of CSH use*
CCS, 201725Position statement40–49 yr, at average risk, CSH use > 5 yrNRNRDiscuss individual risks of breast cancer and benefits and risks of mammography
50–69 yr, at average risk, CSH use > 5 yr, without breast implantsMammography†Every 2 yrNR
50–69 yr, at average risk, CSH use > 5 yr, with breast implantsDiagnostic mammography†Every 2 yrNR
≥ 70 yr, at average risk, CSH use > 5 yrNRNRDiscuss how often client should be screened for breast cancer
CSH use < 5 yrNANABreast screening not recommended
CETH, 201626Guideline≥ 50 yr,‡ CSH use 5–10 yrMammographyEvery 2 yrClinicians may choose to reduce age at onset of screening, number of years of female hormone exposure or frequency of screening in clients with significant family risk factors
Any age, CSH use > 5 yr
IPPF, 201527Position statementCurrent CSH use§NRPeriodicNR
SHC, 201528Guideline50–71 yr, CSH use > 5 yrMammographyEvery 2 yrNR
< 50 yr, additional risk factorsMammographyNROwing to lack of consensus on screening for younger trans women, emphasis may be placed on client preference following counselling on risks and benefits of screening
CDC, 201329Position statementPast or current CSH use,§ meet all NBCCEDP eligibility requirements**NRNRProviders should discuss benefits and harms of screening and individual risk factors to determine whether screening is medically indicated
VCH, TTSES, & CRHC, 20064Guideline> 50 yr,‡ additional risk factors, past (but not current) CSH use, breast growth, no orchiectomyMammographyNRNR
> 50 yr,‡ additional risk factors, current CSH use,†† no orchiectomyMammographyNRNR
> 50 yr,‡ additional risk factors, past or current CSH use, postorchiectomyMammographyNRNR
NRClinical breast examinationAnnualNot recommended
NRBreast self-examinationPeriodicNot recommended
No history of CSH use*
VCH, TTSES, & CRHC, 20064GuidelineNo orchiectomyNANARoutine screening not recommended
Trans women in general (i.e., female CSH use not specified)
SHC, 201528Guideline30–69 yr, family history suggestive of hereditary breast cancerMRIAnnualConsider obtaining expert opinion regarding need for annual MRI
Breast implantsDiagnostic mammographyNRNR
THIP, 20155GuidelineDeveloped breast tissueNRNRScreening
NHS, 201330GuidelineDeveloped breast tissueNRNRScreening
ACOG, 201131Position statementNRNRNRAge-appropriate screening
ES, 200932GuidelineNo known increased risk of breast cancerNRNRFollow screening guidelines for cisgender women

  • Note: ACOG = American College of Obstetricians and Gynecologists, CCS = Canadian Cancer Society, CDC = Centers for Disease Control and Prevention, CETH = Center of Excellence for Transgender Health, CRHC = Canadian Rainbow Health Coalition, CSH = cross-sex hormone, IPPF = International Planned Parenthood Federation, MRI = magnetic resonance imaging, NA = not applicable, NBCCEDP = National Breast and Cervical Cancer Early Detection Program, NHS = National Health Service, NR = not reported, SHC = Sherbourne Health Centre, ES = Endocrine Society, THIP = Transgender Health Information Program, TTSES = Transcend Transgender Support & Education Society, VCH = Vancouver Coastal Health.

  • ↵* Cross-sex hormone use was variably termed as hormone use, feminizing hormone use, gender-affirming hormone, estrogen or progestin.

  • ↵† Or other screening test (not specified) as appropriate.

  • ↵‡ Upper age limit not reported.

  • ↵§ Duration not reported.

  • ↵ Include estrogen plus progestin use for more than 5 years, family history of breast cancer, body mass index greater than 35.

  • ↵** Specific eligibility requirements not reported.

  • ↵†† Cross-sex hormone regimen that includes estrogen.