October is Breast Cancer Awareness Month. This blog post provides an overview of some of the key information that trans men, non-binary and gender non-conforming individuals need to be aware of.
The breast screening programme in the UK for everyone registered as female, without family risk, runs from the age of 47 until the age of 73 and it involves undergoing a mammogram (an X-ray picture of the breast) every three years.
Legally registered males who were assigned female at birth, even if they had no top surgery, will not receive an automated letter to attend a screening mammogram, and will have to contact their GP to arrange for one.
Non-binary identities are not legally recognised in the UK as such those assigned female at birth will receive a breast screening appointment at the appropriate age.
Risk of breast cancer
Breast cancer prevalence in the cis female UK population is around 12%. There are 55,000 new cases every year and the lifetime risk for a cis female is one in eight. Breast cancer prevalence in cis males in the UK is 0.12% or one in 833.
Mammogram vs clinical examination prior to top surgery
Everyone above the age of 40 should have a mammogram prior to top surgery to exclude the need for a different operative approach in case of the discovery of an asymptomatic breast cancer. In such cases, where a patient is younger than 40 years old, a clinical examination is enough to determine whether further investigations are needed or not. Large research studies have found that, in the absence of any lumps, the risk of cancer in young individuals (without significant family history) is extremely rare.
Breast cancer in those requesting top surgery
Top surgery and surgery for treating breast cancer are not mutually exclusive. Patients should make their case to the oncoplastic surgeon and make a request for input from a gender affirming surgeon if needed. The same applies for those who are seeking preventative mastectomies due to their personal risk. For more information check out this episode of the Top Surgery podcast, in which Mr Ntanos chats with one patient about their personal experience of navigating both top surgery and cancer.
Risk of cancer after top surgery
The intention in any type of top surgery is to achieve a full mastectomy. No glandular breast tissue should be intentionally left behind. Cells or a cluster of cells are likely to stay, especially towards the armpit area, although the exact volume is impossible to calculate. For some surgical techniques, for example with dermal flaps, the remaining tissue volume may be significantly higher. It is impossible to calculate a lifetime risk for someone that has had top surgery, although evidence suggests that it should be close to that of a cis male. An “It’s rare, but it’s there” approach is realistic in this scenario. Being on testosterone does not seem to add any risk.
Screening after top surgery
There is no routine screening for those who have had top surgery (bilateral mastectomies and chest wall reconstruction), but as the risk will never be zero, individuals should remain chest aware for the rest of their lives. In practice this means a self-examination every 2-3 months, within the same guidance that exists for cis males. Any future lumps or changes should be thoroughly investigated.
Self-examination after top surgery
The following infographic was created by Ben Haseen and is presented here with his permission.