What Cancer Screenings do Trans People Need?

My doctor suggested a mammogram. That caused me to dig into the research.

Photo by National Cancer Institute on Unsplash

I am Not a Doctor!

I’m not a doctor, so while I try to summarize guidelines and research here, ultimately you should have this conversation with your medical provider, who, unlike me, has had years of training!

Some Notes on Terminology

In presenting what I find, I’m going to use the medical words for our body parts. I understand that many in the trans community may use other words for these body parts, but in the interest of clarity I’m going to use the names an anatomy textbook might use. I’m going to use words like testicles, prostate, cervix, and breasts. I understand these words are highly gendered in common usage, and do not intend to convey any gendered meaning to them.

Screen The Body Parts You Have

When searching for recommendations, it was clear that there are many unanswered questions still. But one thing everyone seems to agree on is that if you have a body part that is relevant to cancer screenings, you should screen it. That is:

  • AFAB people who have not had their cervix removed (it is sometimes, but not always, removed as part of a hystorectomy or transgender genital surgery) have a cervix, while AMAB people (even if they have had surgeries) do not.
  • AMAB people who have not had vulvaplasty, vaginoplasty, or an orchiectomy will have testicles. AFAB people may have prosthetics, but do not have testicles.
  • All AFAB and AMAB people have varying degrees of breast tissue unless the tissue has been completely removed. Top surgery for AFAB trans people may not remove all breast tissue, as some may be left and scuplted into a male chest (indeed cis men have breast tissue as well).

Looking at the Parts

Prostate Cancer Screening (For AMAB People)

AMAB people may be at risk of prostate cancer, even if they’ve had “bottom surgery” or have been on hormones.

Cervical Cancer Screening (For AFAB People with a Cervix)

If you have a cervix, it is recommended that you be screened for cervical cancer periodically. I couldn’t find good evidence of cervical cancer incidence among trans people on HRT, although some older studies indicated that testosterone (some of which may be converted to estrogen in the body) may slightly increase the risk of some cervical cancers.

Testicular Cancer Screening (For AMAB People with Testicles)

Routine screening for testicle cancer is not recommended for cisgender men. There is no evidence I could find that trans people would be at higher risk or benefit from routine screening, although at least one paper (a case study on a trans woman who developed testicular cancer 15 months after starting HRT) postulates (without testing this theory) that estrogen may increase testicular cancer incidence in trans women. However, it’s also postulated that anti-androgens may lower this risk. It certainly does not seem to be common for trans AMAB people.

Endometrial (Uterus) and Ovarian Cancer (For AFAB People with a Uterus and/or Ovaries)

Routine screening, in the absence of other issues, is not recommended. However, this same paper suggests that testosterone may theoretically increase the risk of endometrial cancer, but there is no data that supports this.

Vaginal Cancer (For both AFAB and AMAB People with Vaginas)

For AFAB people (cis or trans), this is not routinely screened for. However, these types of cancers may be noticed during pelvic exams or a cervical cancer test. I could find no evidence of higher or lower incidence of vaginal cancer in AFAB people.

Breast Cancer (For both AFAB and AMAB)

This brings us back to my initial question: should I get screened for breast cancer?

Other Screenings (EVERYONE!)

Of course don’t neglect other screenings, such as colon cancer screenings or routine physical exams. Being trans doesn’t exempt us from other health problems.

So, What Did I Do?

While I am not yet 50, my doctor suggests starting mammograms for people after age 40 with breasts. In addition, due to another factor, she suggested that a mammogram might be appropriate at this time in my life. That fits the guidelines I found while researching this.

Programmer (🦋, 🐪, & 🐍), Gender Traitor & Shape Shifter ⚧, Geek 📚, Christian ✝, Motorcycle Rider 🏍️ , Puppy Parent 🐾, Wife 👩‍❤️‍💋‍👩.

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