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Resources for transgender community for preventative cancer screenings

June 07, 2022

Cancer Primary Care
Cancer screening guidelines

Finding a health care provider that you can have an open trusting conversation with is important. Riverside provides a safe, non-judgmental, and welcoming environment for all patients, and is committed to helping everyone attain their full health potential.

If you or a loved one is a member of the transgender community, you may need to have cancer screenings for the gender assigned at birth. It is important to be open with your health care provider to have the conversation about which screenings are best for you and at what age each screening should begin, based on your personal risk factors and family history. 

Your assigned gender at birth, surgeries, or hormones you take, can determine the types of preventative cancer screenings you should have. Screening tests help find cancer early, before you have any signs or symptoms, when it may be easier to treat.

As the National LGBTQIA+ Education Center says “if you have it, check it”.  

For the transgender community, seeking care for certain screenings may create an increased sense of body dysphoria- the feeling like you are not in the correct body which can lead to anxiety, depression, or a reluctance to have the screening. Research regarding cancer risk and treatment within the transgender community is limited, but growing.

The Riverside Cancer Care Network recommends following the cancer screening guidelines:

Transgender Male/ Assigned Female At Birth (AFAB)

Breast Cancer

  • Annual screening mammogram beginning 40 years of age. 
  • Clinical breast exam every 3 years beginning age 21, then yearly beginning age 40.
  • Report to your health care provider if you notice any changes so you may be assessed. Changes to look for would include: a lump in the breast or under the arm, skin changes including a dimple, redness, or thickening, change in breast shape or size, nipple discharge, scaling or redness of the nipple and or areola, nipple retraction or deviation or new breast pain.
  • For those people who have had top surgery or chest reconstruction, your health care provider may recommend you have a Breast MRI, as well as a clinical exam every three years beginning age 21 and yearly beginning age 40, as top surgery doesn’t completely eliminate the risk of microscopic breast tissue cells.

Cervical Cancer

  • Pap Smear beginning age 25 with a Pap Smear and HPV co-testing
  • Repeat Pap Smear with HPV co-testing every 5 years OR Pap Smear without co-testing every 3 years.
  • Ages 65 & older with a history of abnormal Pap Smears or other abnormal cervical conditions should talk with their health care provider about the recommended screening interval.
  • It is important to let your healthcare provider know if you are taking testosterone, because testosterone can lead to changes to your cervix that may appear as early cancer changes. If your health care provider notices changes, further testing may be recommended such viewing your cervix with a colposcope.
  • If a Pap Smear is highly traumatic, a hysterectomy may be a consideration to discuss with your health care provider. Unless you have a hysterectomy with removal of the cervix, the risk for cervical cancer remains.

Transgender Female/ Assigned Male At Birth (AMAB)

Prostate Cancer

  • Transgender women who have undergone genital surgery often still have a prostate and should be screened, beginning age 50 for those at average risk.
  • Age 45 for those at high risk – this includes African Americans and those who have a first-degree relative diagnosed with prostate cancer at an early age (younger than 65).
  • Age 40 for those at even higher risk – this includes those with more than one first degree relative who had prostate cancer at an early age.

Breast Cancer

  • Transgender women who take feminizing hormone therapy may have a higher risk of breast cancer. Talk with your health care provider about the recommended breast cancer screening method, starting age, and frequency.

Cervical Cancer

  • Transgender women who have not had a vaginoplasty (surgical creation of a vagina) do not have a cervix, so there is no risk for cervical cancer.

Cancer screening guidelines for everyone

Lung Cancer

Current or former smokers ages 50-80 should be screened with an annual Low Dose CT screening (LDCT) to detect lung cancer sooner, when it is more treatable. 

You should have a LDCT if: 

  • You have smoked an average of one pack a day for 20 years AND 
  • You currently smoke or quit less than 15 years ago OR 
  • You currently smoke and have other risk factors for lung cancer

Colorectal Cancer

Screening is important, no matter which screening method you choose: 

  • Colonoscopy every 10 years – as the gold standard for screening, this is the only screening that allows your health care provider to see the entire length of your colon 
  • At-home stool-based DNA test (Cologuard) every three years 
  • At-home Fecal Immunochemical Test (FIT) every year

Head & Neck Cancer

Have a yearly preventative oral exam & dental cleaning. Talk with your health care provider if: 

  • You notice changes in your voice or hoarseness, a lump in your neck, persistent sore throat, difficulty swallowing or moving your jaw, mouth or lip sores that do not heal, white or red patches, pain in the ear or unexplained weight loss
  • You notice changes during a monthly self-screening of your mouth and tongue, especially if you use tobacco or drink alcohol 
  • If you have been exposed to Human Papilloma Virus (HPV) as you may be at higher risk for head & neck cancers

Skin Cancer

Self-screen monthly and know how your skin normally looks and feels. Notify your health care provider if you notice any changes such as: 

  • Asymmetry: One half is unlike the other half 
  • Borders: Irregular or poorly defined border 
  • Color: Varied from one area to another (shades of tan or brown, black, red, white, or blue) 
  • Diameter: Diameter greater than 6mm 
  • Evolution: Changing in size, color or shape

Hormone therapy and cancer risk

It is important to discuss with your health care provider the hormones you have taken or currently take, to determine if there is any heightened risk of cancer.

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