Over 1.4 million Americans identify as transgender. The term transgender refers to individuals whose gender identity or expression differs from their sex assigned at birth. Transgender patients are at particular risk for cancer disparities. They face additional barriers to care, including lack of physician compliance or understanding of patient gender identity, stigmatization, psychosocial trauma when undergoing procedures related to sex assigned at birth that contradict gender identity, possible increased cancer risk related to endocrine therapies often prescribed during gender-affirming care (GAC), and lack of insurance coverage for necessary tests or procedures based only on sex assigned at birth.

Transgender women often receive gender-affirming hormones (sex steroids) to reduce psychological distress and to induce desired physical changes, such as change in voice pitch and a feminized body composition. Feminizing cross-sex hormonal (CSH) therapies typically include the use of exogenous estrogens and antiandrogens. Prolonged estrogen exposure due to CSH therapies may increase the risk of developing breast cancer in transgender females when compared with rates observed in cisgender males.

Transgender women have been shown to have nearly a 46-fold higher incidence of breast cancer when compared with cisgender men, but a much lower incidence when compared with cisgender women.

Other studies have shown a similar trend, with a fourfold increased risk of breast cancer development in transgender females undergoing CSH therapy when compared with cisgender males.

The sex (male or female) assigned to a child at birth, most often based on the child’s external anatomy. Also referred to as birth sex, natal sex, biological sex or sex.

A person’s inner sense of being a boy/man/male, girl/woman/female, another gender or no gender.

The ways (e.g., feminine, masculine, androgynous) in which a person communicates their gender to the world through their clothing, speech, behavior, etc. Gender expression is fluid and is separate from assigned sex at birth or gender identify.

Transgender is an umbrella term for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth. Not everyone whose appearance or behavior is gender-nonconforming will identify as a transgender person. Transgender people can receive hormone treatment and/or other medical care to induce desired physical changes.

Gender-affirming breast surgeries can include breast reduction surgery, also known as reduction mammaplasty. This is a procedure used to remove excess fat, tissue and skin from the breasts. If you have large breasts, you might choose to have breast reduction surgery to ease discomfort or to achieve a breast size proportionate to your body. Breast reduction surgery might also help improve your self-image and your ability to participate in physical activities.

Top surgery is a procedure to remove breast or chest tissue (subcutaneous mastectomy). It’s also called masculinizing chest surgery. It’s a type of female-to-male (FTM) gender-affirming surgery.

In this procedure, the nipple and areola and their nerve structures are often retained with this procedure, though this is up to the patient. This technique leaves breast tissue which prevents the side concavity and leaves some tissue that fills out the shadow in that area.

With a total mastectomy, all the breast tissue is removed, from the latissimus to the armpits inframammary fold, all the way up to the clavicle. The technique levels thinner skin flaps and a con cavity on the lateral chest and can mean the total removal of the areola.