Transgender men are delaying mammograms — or not getting them at all

NEW HAVEN, Conn. (WTNH) – Reia Massaro often calls imaging centers before her patients arrive for their mammogram appointments.

“We often in our referrals, we’ll think about or talk with a patient about how explicit we’re going to be in our naming and gendering of the patient,” said Massaro, a family nurse practitioner with Anchor Health, an LGBTQ-focused health center with offices in Hamden and Stamford. “So, to say, ‘This is a 45-year-old transgender man who uses he/him pronouns who needs initial screening’ – mammogram, for instance – may hopefully help answer some of those questions before they arrive at the screening location.”

Massaro said that campaigns encouraging people to “think pink” during October for Breast Cancer Awareness Month, along with treatment often being conducted in facilities labeled as “women’s health centers,” can create barriers for transgender patients who are trying to access services.

“And then they’re driving farther for care, where they’re deferring the care that they may need,” she said.

Although there’s scant research on the topic, the existing data is clear – patients in the LGBTQ community, and especially those who are transgender, are not getting the breast cancer screenings they need.

The general recommendation is for people who are assigned female at birth, and are between the ages of 40 and 74, should get a mammogram every two years. Those assigned female at birth who are between the ages of 25 to 39 are told to undergo a clinical breast exam, where a medical examiner manually examines the breasts, every one to three years.

A study published in November 2023 refers to the cancer risk among transgender adults as “a growing population with unmet needs.” The same study also found that a “significant proportion” of transgender patients were refused health care due to their identity. Overall, transgender patients were more likely to be diagnosed with cancer at later stages, less likely to receive treatment and more likely to have worse outcomes compared to people who are not transgender.

Around .2% of the population over the age of 50 identifies as a transgender man or woman, according to the Pew Research Center. Between those aged 30 to 49, .3% identify as a transgender man or woman, and another 1.3% identify as nonbinary. Among those between the ages of 18 and 29, 2% identify as a transgender man or woman, and 3% identify as nonbinary.

For transgender and nonbinary adults aging into needing those screenings, the care isn’t always available or accessible.

Massaro said those screenings can make people anxious, especially for those who are transgender and were assigned female at birth.

“That can be a really dysphoria-inducing kind of experience, and they can be really vulnerable to discrimination and transphobia in those moments, both when they go to seek care from their primary care provider, but also when they go for the actual mammography itself,” she said.

The OUT National Cancer Survey found that the decrease in screenings could be due to a lack of “culturally competent” health care providers. There’s also difficulties after cancer is detected. And once people sought care, 8% of people who are gender nonconforming reported that there was an unwelcoming atmosphere at their cancer treatment center.

Those factors are impacting medical outcomes. Research published in the JAMA Oncology medical journal found that LGBTQ patients diagnosed with breast cancer are three times more likely to have it return, compared to people who are heterosexual and cisgender.

However, the American Cancer Society found that when health care providers knew their patient’s sexual orientation and gender identity, they were more likely to encourage them to receive cancer screenings. It also recommends that providers ask patients what organs they have, instead of making assumptions.

Massaro said those screening reminders might not pop up in a patient’s health records if a patient has “male” listed as their sex or gender. But, if a patient has breast tissue, then they need a mammogram, even if they’ve had chest reconstruction surgery (also known as “top surgery”).

Top surgery, Massaro stressed, is not a true mastectomy, although it’s a common misconception.

“Most providers refer to it as a mastectomy, and kind of think, ‘OK, we’re removing the breast tissue,’” Massaro said. “But, it’s not, because some of it’s used for that kind of masculinizing contouring in the surgical approach. And even the surgical technique matters in how much tissue is taken out, and how much is left behind.”

One solution to bridge the gap is improving communication. When a patient feels comfortable talking to their provider, they’re more likely to get the proper screenings faster.

“To a certain extent, if you’re not comfortable telling your health provider things, then it might be time to find a new provider,” Massaro said.

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