Despite Years of Breast Cancer Research, Questions Remain for Transgender Men, Women

Research into breast cancer is extensive, but it is still severely lacking when it comes to transgender men and women. In spite of the fact that we know more about breast cancer now than ever before, we know little about how it affects the transgender community.

It has left those individuals wondering about their risk of developing breast cancer with more questions than answers.

JoAnne Keatley, director of the Center of Excellence for Transgender Health at the University of California, San Francisco, told BuzzFeed (bzfd.it/1QRdg2t) back in 2012 that this is primarily due to the people who control research money thinking transgender health issues are a political hot potato. Federal grants are unavailable as a result and even private donors shy away.

While some progress has been made socially in the past few years, with an overall increase in transgender awareness, things have not progressed scientifically at the same rate.

The American Cancer Society recognizes and outlines the issue with their Transgendered and Transsexual Individuals Access to Care and Cancer Disparity Fact Sheet (bit.ly/1OPByw).

They point out that there have not been any studies looking into the incidence of breast cancer in transgender individuals.

There have only been three documented cases of breast cancer among this population, but, they note, "that is likely a significant underestimate, given the hesitance of many transgendered individuals to reveal their transsexualism to their physicians."

The Women's Health Initiative published a large study in 2002 that suggested a connection between Hormone Replacement Therapy (HRT) in cisgender (that is, non-trans) women and an increased breast cancer risk. Consequently, many assume there is an increased risk among male to female transgender women who begining hormone therapy.

Female to male transgender men undergoing HRT may also face an increased risk, as excessive testosterone can be converted into estrogen. Additionally, transgender men may be uncomfortable with the idea of getting a breast exam or self administering one. Many are also likely unaware that even after chest reconstruction surgery, some of the breast tissue cells may remain.

Putting this information in the hands of those about to begin HRT would be a step in the right direction, as many are never informed of the potential for increased risk.

Justine Matlock, a 23-year-old trans rights activist living in Charlotte, N.C., said she was aware of the increased risk of breast cancer, but only as a result of her own research.

"I was aware, but only because I had to be," Matlock said. "Being trans, most people inherently ascribe political aspects to my identity, and being who I am, I got pissed. I feel like an exception to the rule, because in order to get people to fundamentally understand me, I spent two years of my life being a hardcore activist.

"At the very beginning of my transition? I had no idea," Matlock continues. "I didn't even know how to get hormones, much less [was I aware of the increased risk for] breast cancer."

Transgender men and women also face substandard care more often than their cis counterparts. Many physicians aren't adequately educated on transgender identity and health issues. Bad experiences in the past may cause a transgender person to avoid going to the doctor in the future, which makes early detection of cancers or other health problems less likely.

According to The American Cancer Society, female to male transgender individuals who have undergone HRT are also at a higher risk for ovarian cancer due to the amount of testosterone ingested. Transgender men may also feel uncomfortable with screenings looking for ovarian cancer.

Meanwhile, male to female transgender women may be at an increased risk of prostate cancer due to reduced levels of testosterone and, again, some increased potential for hesitancy to consent to screenings.

Of course, other factors, both genetic and environmental, play a role in the risk for developing breast cancer. Quitting or not starting smoking, maintaining a healthy weight, getting regular exercise, and getting screenings, especially as one gets older, are all important steps to take in order to decrease the risks.

But individual action can only go so far.

A concerted effort to educate physicians, transgender individuals, and the wider public about these issues would go a long way to help address the issue. Well-funded research studies would also provide the possibility for illuminating this issue at long last and getting some answers on how transgender men and women are affected by breast cancer, as well as other cancers.

Until that happens, there will remain a cloud of confusion, ignorance and denial on these important health concerns for a community that is all too often ignored.