Why transgendered women's breast cancer risk is still a mystery

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Why transgendered women’s breast cancer risk is still a mystery

When a man takes hormones and has surgery to become a woman, does she suddenly develop an increased risk of breast cancer? Estrogen creates a slightly increased risk of breast cancer, and obviously after someone takes enough hormones to develop breasts, there’s more breast tissue, but it’s still unclear whether transgendered women have the same breast cancer risk as biologically born women.

Last week, Beth Scott won her battle to get her insurance carrier to cover her mammogram, after they refused to because she’s transgender. Scott’s doctor had recommended the screening, but when it comes to figuring out their actual risk of breast cancer, transgender women (and men) face a frustrating lack of information. According to Dr. Maddie Deutsch, director of the transgender health program at the LA Gay & Lesbian Center the risk of breast cancer for trans women like Scott is relatively low. It’s likely “much lower,” she says, than the risk for cisgender (that is, non-trans) women. And trans men have surgery to remove their breasts, a small amount of breast tissue can remain, but the reduced amount translates to a significant reduction in risk.

However, she also noted that there’s a serious lack of research in this area. It’s not clear, for instance, whether developing breasts as part of gender transition actually raises a person’s cancer risk — that is, whether transgender women are more likely to get breast cancer than men who never grow breasts. Most funding for trans-related health issues has focused on HIV, mental health, or substance abuse — there’s been almost no research into general health concerns like breast cancer.

The reason, according to JoAnne Keatley, director of the Center of Excellence for Transgender Health at UCSF, is that people who control research money still think of transgender health as a political hot potato. So federal grants for trans health research aren’t available, and private donors shy away too. Keatley says, “there’s no private foundation that I’m aware of that is willing to provide money” to study breast cancer in trans women. A 1988 case study looked at one trans woman who developed cancer 10 years after her transition, and mentioned two previous cases, but according to Keatley, no large-scale research whatsoever into the incidence of breast cancer in transgender people has been done.

When trans men have surgery to remove their breasts, a small amount of breast tissue can remain, but the reduced amount translates to a significant reduction in risk. And Deutsch says there’s some evidence that the testosterone some trans men take can cause remaining breast tissue to “involute,” becoming smaller and less functional. This, she says, could further reduce the risk of cancer.

Via