Routine Breast and Bone Screening for Transgender and Gender Diverse Adults

By Jennifer Footit-Tank RN BSN, quality care coordinator at Network Health

According to the Centers for Disease Control and Prevention (CDC) nearly one million people identify as transgender. But data to provide formal guidelines for screening protocol remains insufficient for transgender and gender diverse individuals (TGD). This makes it more important than ever to have a personal doctor who is well versed in your medical needs to ensure that you are receiving the correct routine screening at the correct time.

LGBT Breast Cancer Screening Guidelines

Breast cancer remains the second most common cancer among women in the United States per the Center for Disease Control (CDC). Regular screening and early detection for changes are your best defense. Early diagnosis coupled with treatment offers the best chance for a positive outcome. Below are recommendations for average risk women.

• Transgender women (male-to-female) 50 or older and have had at least 5 years of feminizing hormones should have a mammogram every 2 years.
• Transgender men (female-to-male) without a bilateral mastectomy (top surgery) should follow breast cancer screening recommendations for the general population. If you are 40-44 years old, discuss with your personal doctor when to start screening. Ages 45-54 should have a yearly mammogram. Recommendations for 55 years and older is a mammogram every other year.
• Transgender men (female-to-male) with a bilateral mastectomy have significantly reduced breast cancer risk. It is recommended you ask your personal doctor if you need to have a mammogram.

LGBT Osteoporosis Screening Guidelines

Bones are living tissue which continuously generates new bone as old bone is reabsorbed. As you age, the ability to create new bone falls short of the amount that is lost. This leads to a disease called osteoporosis.

Osteoporosis is often referred to as the “silent disease” because you don’t know that your bones are weakening until you sustain a fracture. Sometimes the first clue is that you are losing height or developing a curve at the top of your spine. Discussion with your personal doctor about when to start screening is the best way to preserve your bone strength and health.

The current standards used to guide recommendations for osteoporosis for TGD individuals (regardless of sex assigned at birth) come from the University of California, San Francisco Transgender Care as follows.

• Have your first bone mineral density (BMD) screening beginning at age 65.
• If you have risk factors for osteoporosis, then BMD screening should be considered between ages 50-64.
• Regardless of your current age, if you have undergone a gonadectomy and have not had at least 5 years of hormone replacement therapy, you should have a BMD regardless of sex assigned at birth.