Study, sex expert split on mammo regimen for transsexual women

Breast screening habits for transsexual women shouldn’t differ from those of biological women, according to a recent European study. However, a human sexuality expert disagrees, saying screening for transsexual women should depend on when the patient started estrogen therapy and not age alone.

Reports of transsexual women developing cancer are scarce, but there may be some underreporting. The study sought to remedy this problem and examined 50 women post–sex-reassignment surgery (EJR 2010;74:508-513).

The researchers found mammography and breast sonography were technically feasible in the women. No gross anomalies were detected. In addition, 98% of the patients intended to come back for screening.

“It is not unlikely that in transsexual women, who receive life-long estrogen therapy, the risk of developing breast cancer will prove to be higher than for their male counterparts,” said study author Dr. Steven Weyers from the gynecology department at Ghent University Hospital in Ghent, Belgium.

The study recommended a normal screening regimen for transsexual women. The mean age of study subjects was 43 ± 10.5 years.

Not everyone agrees with the study’s conclusions, however.

The pathophysiology of breast cancer suggests that risk is largely related to years of estrogen exposure, according to Dr. Jamie Feldman, an associate professor in the human sexuality program at the University of Minnesota.

“It really makes no sense to screen a 40- or even 50-year-old transwoman who just started estrogen therapy two weeks ago,” she said.

Given the estrogen exposure factor, using the screening schedule developed for biological women is not cost-effective and exposes transsexual women with a low risk of cancer to unnecessary x-rays, false positives, anxiety, and possible biopsies, she said.

Instead, Feldman suggests screening mammography for transsexual women start at age 50 provided they have had five years of hormone therapy. High-risk patients should begin sooner, Feldman said.