Breast cancer screening

• When a person with breast tissue, within the screening age group 50 -69 has NOT had a mammography within the past two years, screening is considered not up to date, and mammography is recommended regardless of legal gender registration.
   
• When a person with breast tissue, who is within the screening age group 50 -69, has had a mammography within the past two years, screening status is considered up to date. In this case, it is recommended to continue having a mammography every two years, unless your healthcare provider advises a different schedule.

Because screening reduces but does not eliminate risk, it is important to be aware of changes in the chest area and seek care promptly if new symptoms arise between screening rounds.

Outside the age group 50-69, screening is not routinely offered:

• Below 50 years, screening may be considered on a case-by-case basis, in consultation with an healthcare provider, in the presence of elevated risk, such as significant family history of breast cancer or known genetic predisposition.
   
• Above 69 years, continued mammography surveillance may also be considered on a case-by-case basis, in consultation with an healthcare provider, depending on overall health status and risk profile.

By “absence of breast tissue,” we refer to the absence or near absence of glandular tissue (glands capable of milk production).

This situation is typical in individuals whose chest did not develop during puberty and who have not received estrogen-based gender-affirming hormone therapy (e.g. a transfeminine person who has used estrogen for ≥5 years, which can induce development of glandular tissue).

If glandular tissue has never developed - either during puberty or as a result of prolonged estrogen exposure - routine breast cancer screening is generally not indicated.

This does not mean that risk is zero, but available evidence suggests a very low risk in this situation. Additional evaluation by an healthcare provider may be appropriate in the presence of strong family history or known genetic risk factors (e.g., BRCA mutations).

If breast tissue was removed surgically, please refer to “Gender-affirming top surgery.”

For people who have undergone bilateral chest surgery (removal of most breast tissue) for gender affirmation or for other non-oncologic medical reasons, routine breast cancer screening is generally not recommended.

However, it is recommended that a thorough breast cancer risk assessment is performed by a healthcare provider, either before or after surgery, to help determine whether occasional imaging tests are needed. This assessment may consider personal and family history of breast cancer, any known genetic risk factors, and details of the surgical technique used.

Why? Surgery greatly reduces the risk of breast cancer, but it does not remove the risk completely, because a small amount of breast tissue may remain depending on the surgical technique used.

Breast cancer after this type of surgery is very rare, but it has been reported. For this reason, it’s important to stay aware of any changes in the chest area and to share them with your provider as soon as possible.

Evidence indicates that individuals who develop breast tissue after at least five years of estrogen therapy have a breast cancer risk that is closer to that of people who developed breast tissue during puberty, although it generally remains somewhat lower.

For this reason, breast cancer screening is recommended for all individuals with breast tissue, regardless of whether that tissue was developed during puberty or following estrogen therapy.

Breast implants placed for cosmetic reasons are usually inserted underneath the existing glandular tissue (whether that tissue developed during puberty or through estrogen use) and do not reduce the amount of breast tissue present. For this reason, people with implants can follow the usual breast cancer screening recommendations appropriate for their age and level of breast tissue.

The presence of breast implants does not contraindicate mammography. It is important that the radiology provider is informed about the presence and type of implant so that specific imaging techniques can be used.

People with a prior diagnosis of breast cancer usually follow a personalized surveillance plan with their specialist, rather than surveillance within the organized screening program, in the first 10 years after diagnosis. This approach allows appropriate follow-up in light of prior medical treatments, radiotherapy or surgery.

After 10 years of remission, people with residual breast tissue may resume standard mammography surveillance (typically every two years between ages 50 and 69), unless your healthcare provider advises a different schedule.

Read more here.