by KYLE P. CHRISTIASON, MD, CPE, FAAFP
​
Unfortunately, breast cancer remains one of the most common cancers in the Unites States. Therefore, screening for breast cancer remains
vitally important. Breast cancer screening means testing for cancer even when a person doesn’t have any worrisome symptoms. Remember,
screening doesn’t prevent cancer; rather, it may help detect cancer at an early stage, making it easier to treat.

Transgender, and gender-expansive folks should actively talk with their health provider about a plan for breast cancer screen. “Breast cancer
does not discriminate; regardless of gender.”

Regarding cancer risk and screening for transgender and gender-expansive folks, there remains a large opportunity for further research.

​However, there a few principles to help guide us:
1) If one has a particular body part or organ and otherwise meets criteria for screening, screening should proceed regardless of hormone use.
(Eur J Endocrinol Eur Fed Endocr Soc. 2013 Oct;169(4):471-8)
2) Transgender men and gender-expansive folks who have not had mastectomy, or who have only undergone breast reduction, should
screen according to current guidelines for non-transgender women.(WPATH 2022)
3) Gender-expansive folks who have had mastectomy should review their individual risk with their healthcare provider; there are no good
data on pros/cons of mammography after mastectomy. However, if risk is high, one may consider other screening techniques, like
ultrasound or MRI.
4) Transgender women could consider screening mammography every 2 years, once the age of 50 and have completed 5-10 years of gender-affirming feminizing hormone. Once again, there are few data on breast cancer risk for trans-women, but it appears to be lower than
for non-transgender women. (https://transcare.ucsf.edu/guidelines/breast-cancer-women), (BJOG: An International Journal of Obstetrics
and Gynaecology, 125(12), 1505–1512)

As always, please share any questions you have with your healthcare provider to establish the best cancer screen plan for you.

By Dr. Meghna Krishnan, M.D. 
Breast imaging fellowship trained radiologist practicing at Wheaton Franciscan Healthcare - Iowa

Breast cancer continues to be the most common cancer in women. Two thirds of new breast cancers are diagnosed in women without a family history of breast cancer. Having a mammogram that can detect cancer in its earliest, most treatable stage decreases the chance that a woman will need extensive treatment and/or die from breast cancer.

The death rate from breast cancer has declined steadily by over 30% since 1990, when women started obtaining annual screening mammograms. Breast tomosynthesis produces a threedimensional view of the breast tissue that helps radiologists identify and characterize individual breast structures without the confusion of overlapping tissue.

This type of state of the art imaging benefits all screening and diagnostic mammography patients. Breast cancer screening with tomosynthesis, when combined with a conventional 2D mammography, has a 40% higher invasive cancer detection rate than conventional 2D mammography alone. Tomosynthesis technology gives radiologists increased confidence with up to a 40% reduction in recall rates. With breast tomosynthesis digital mammography, there is a better chance to diagnose breast cancers at earlier and more treatable stages. In the fall of 2014,

3D mammography (tomosynthesis) came to the Cedar Valley. At these facilities, given cutting edge technology, there is no increased radiation to the breasts from 3D mammography and the radiation dose is equal to that of having a conventional 2D digital mammogram. At these facilities, merely less than 5 percent of women are asked to return following an inconclusive screening mammogram, thanks to the cutting edge technology of 3D mammography and experienced breast radiologists.

The majority of these recalled women simply get another mammogram and/or ultrasound for clarification. Only 1 to 2 percent of these women proceed to have a needle biopsy. Short-term anxiety from test results is shown to have no lasting effects and does not outweigh the over 30 percent reduction in breast cancer deaths and thousands of lives saved each year by mammography screening.

The NAPBC accredited Covenant Comprehensive Breast Center and the Covenant Cancer Treatment Center have a strong Breast Program Leadership team and a highly engaged Cancer Committee that is comprised of breast surgeons, breast radiologists, pathologists, medical oncologists, radiation oncologists, and many trained breast health professionals who concur with American College of Radiology guidelines for breast cancer screening for women with average risk.
These include:
• Annual screening mammography starting at age 40
• Monthly self-breast exam
• Clinical breast exam (at least annual)

​