Questions about breast and chest cancer screening from LGBTQ community

I have breast implants. Can I still get a mammogram?

Yes. People with breast implants can still get mammograms. If you have breast implants, the technologist will make sure that as much breast tissue as possible is seen on the mammogram. Special techniques (called implant displacement techniques) are used to move the implant out of the way and pull the breast tissue forward so it can be in the image. Additional views may need to be taken to examine as much of the breast tissue as possible.

Extra care is taken when compressing the breasts to avoid rupturing the implant. Studies show that women with breast implants are diagnosed with breast cancer at a similar stage and have a similar prognosis as women who do not have breast implants.

Does binding increase my chances of getting breast cancer?
There is no evidence to suggest that wearing a binder will increase your risk of breast cancer. However, there are other risks to binder usage that you should be aware of, such as skin irritation, difficulty breathing, and lymphatic flow issues if binders are worn too tightly. It’s helpful to take your binder off when you sleep so that your chest has some room to breathe.
I have injected silicon into my breast tissue. Am I at increased risk for breast cancer?

Some trans women have injected silicon into their breast tissue as an immediate and relatively inexpensive way to enhance breast size and possibly ease gender dysphoria. 

While silicon breast injections don't increase trans women's risk for breast cancer, they do pose other — very serious — threats to health. The silicon can migrate out of our chests and breast areas and create unsightly lumps. Silicon injections are also illegal.

Silicon breast injections may also interfere with the reading of a mammogram. For this reason, if you have injections, you may require a different test to screen for breast cancer, like an MRI. Talk to your healthcare provider about what’s most appropriate for you.

I'm taking hormones. Should I get a mammogram?
If you’re age 50 to 69, and you have been taking gender-affirming hormones (like estrogen) for more than five years, you should have a screening mammogram every two years. If you’re under age 50, get to know how your breasts look and feel and report any changes to your primary healthcare provider.
I'm told I have very dense chest tissue. What does this mean and should I still get a mammogram?

Dense chests have lots of connective tissue. It can be harder to read a mammogram of denser chests because it can be more difficult to tell the difference between cancerous tissue and healthy, connective tissue.

Trans women tend to have denser than average breast tissue. Some trans men also report that their chest tissue becomes more dense after taking testosterone, but we currently don't have evidence to know conclusively if testosterone contributes to chest density. If you're on T, let the mammography technician know.

You should still go for mammograms even if you have dense breast tissue. After seeing your mammogram, your radiologist may recommend further testing, like a breast ultrasound, and/or more frequent screenings. The ultrasound uses sound waves to create an image of breast tissue and can zero in on any areas of concern identified in your mammogram.

I've had top surgery. Do I still need a mammogram?

Possibly. Trans men who have had some types of top surgery (mastectomy) still have some risk of chest cancer because chest tissue remains after the surgery. Surgeries that leave more tissue — like those that leave the nipples intact — leave more possibility for chest cancer to develop. There are documented cases of chest cancer in trans men who have had top surgery. If you’ve had top surgery, get to know your new chest and talk to your healthcare provider about any changes or symptoms you experience.

At this time, there are no clear recommendations about regular chest cancer screening for trans men who have had top surgery. Talk to your healthcare provider about your personal risks and about the kind of screening that’s best for you.

I'm on T. Should I still get screened?
Yes. If you’re between the ages of 50 and 69, you should be screened according to guidelines, whether or not you are or have ever been on testosterone or other gender-affirming hormones. If you’ve also had chest surgery, talk to your healthcare provider about the best way for you to be screened. You can talk to your healthcare provider about any risks associated with the hormones you take.
I've had my ovaries removed. Do I still need to get mammograms?

Yes. If you’re between the ages of 50 and 69, the Canadian Cancer Society recommends that you go for regular mammograms, whether or not you have ovaries. If you’ve also had chest surgery, talk to your healthcare provider about the best way for you to be screened.

There is some association between some types of short-term hormone therapy and increased cancer risk. Trans men who have had their ovaries removed surgically (oophorectomy) will likely experience menopause early and as a result may have used short-term hormone therapy to relieve menopausal symptoms. If you have used or are on hormone therapies, talk to your doctor about what this means for your risk.

I don't have a lot of chest tissue. Can I still get a mammogram?
Yes. Even if you don't have a lot of chest tissue, you can still get a mammogram. In some cases, if your chest is too flat, other screening tests such as an ultrasound or MRI might be recommended.