Key points
- Discuss breast screening and breast cancer risk with transgender patients.
- Male-to-female transgender patients on endocrine therapy should be enrolled with BreastScreen Aotearoa for screening mammograms.
- Discuss breast awareness and breast cancer risks with female-to-male transgender patients.
Breast cancer risk in transgender patients
There is limited evidence that male-to-female transgender patients on endocrine therapy have the same risk of developing breast cancer as a cisgender woman. GPs should discuss breast screening with these patients. They can be enrolled in the national screening programme through BreastScreen Aotearoa.
Female-to-male transgender patients remain at risk of developing breast cancer, particularly if they have not had gender reassignment surgery to remove their breasts or are not on endocrine therapy. The risk level of transgender men who are on endocrine therapy is unclear, however men can also develop breast cancer. Discuss with patients about remaining breast aware and breast screening.
Breast screening guidelines for transgender patients
Male-to-female patients:
If the patient is recorded under their NHI record as ‘male’, they will need to request a gender change for this record in order to book an appointment with BreastScreen Aotearoa. This process of recording the patient as a female will not interact with NHI data, but ensures the service has her recorded as ‘female’ which guarantees she is offered her two-yearly mammogram. Patients can request to change their gender on their NHI through their GP.
Transgender women are eligible for mammograms through BreastScreen Aotearoa if they have undergone gender reassignment surgery and endocrine therapy, resulting in breast tissue. If a patient has had breast implants, but has not undergone the above treatments, they are not eligible for mammograms through the national screening service.\
Female-to-male patients:
Transgender men will need to remain ‘female’ in BreastScreen Aotearoa’s system, irrespective of their gender identity. This ensures they remain active in the national screening programme and are able to book appointments through BreastScreen Aotearoa. Changing their identity to ‘male’ in the system will render them ineligible for mammograms through BSA.
If the patient still has breasts, they are eligible to attend screening mammograms through the screening programme. Patients are not eligible for mammograms if they have had gender reassignment surgery, as no breast tissue will remain on which to perform a mammogram.
