Mammography and Breast Imaging in Transgender Patients: The Current State of Practice

Steven Marks

^*President, MedCom Consultants, Inc, Potomac MD

Address correspondence to: Steven Marks, MedCom Consultants Inc, 1311 Fallsmead Way, Potomac, MD 20854. E-mail: steven.marks52@gmail.com.

Disclosure statement: Steven Marks reports having no financial or advisory relationship with any corporate, medical, or political organization doing work related to this paper or other business activity at MedCom Consultants, Inc.

This course meets the Oregon Board of Medical Imaging (OBMI) cultural competency CE requirement under OAR: 337-010-0085(2)

ABSTRACT

Transgender men and women are people whose gender identity differs from their sex assigned at birth. Although the true prevalence of transgender people in the United States (US) and around the world is unknown due to biases in reporting, poor surveillance, and misapprehension of the myriad aspects of gender identification and expression, estimates suggest the total population ranges from 8 to 25 million globally, with about 12% to 15% living in the US. Transgender and nonbinary people are often subjected to discrimination and harassment from the public. Physical abuse is also common. Even within the healthcare system, transgender patients commonly face prejudice and exclusion. Medical care is often denied to transgender people because of their gender identity, healthcare providers are frequently ignorant of the issues and concerns pressing on this cohort, and healthcare facilities are often unwelcoming and insensitive. As a result, many transgender patients postpone essential medical care, delay diagnostic examinations, and often do not return for necessary follow-up care. These delays can be problematic, as transgender people have unique health-related needs due to their transitioning, which often involve gender-affirming hormone therapy, surgical reconstruction, and augmentation. During this process, breast imaging is an important component in the delivery of care. While diagnostic-imaging protocols for transgender patients are, in the main, similar to those for cisgender women, the screening guidelines promulgated by various professional societies differ. Emerging evidence suggests that transgender women taking hormone therapy may have an elevated risk of breast cancer. All members of the radiology care team must be aware of the breast-imaging considerations of this special population and the need to show compassion, respect, and inclusivity during all phases of the imaging examination.

This course will explore the current place of mammography and breast imaging in caring for transgender patients. After delineating the recommended terminology to be used in addressing the transgender population, the need for heightened cultural sensitivity, and the importance of clear healthcare-provider and patient communication, factors related to medical hormone therapy, surgery, and breast development in transgender men and women will be discussed. Imaging characteristics and appearances will be described, as will a summary of the several professional society recommendations, focusing in particular on the American College of Radiology (ACR) Appropriateness Criteria for the use of mammography and other breast imaging. Special diagnostic considerations for transgender patients will also be discussed. An overview of current challenges, including barriers to care and the need to improve imaging-center performance will also be addressed.

Disclaimer
The terminology used to describe members of the LGBTQ+ community in this Continuing Education (CE) course have been vetted and peer reviewed by members of the medical and radiologic imaging community prior to publication. The terminology included here is primarily derived from the medical literature available at the time of publication, and as recommended by LGBTQ+ support organizations, as appropriate for this course. Kindly note that that individual patients may prefer to use different terminology to self-identify.