A new study published July 29 in Breast Cancer Research and Treatment finds that healthcare providers aren't doing enough to screen trans patients for breast cancer after gender-affirming top surgery, pointing to what researchers call a "dearth of available data" on cancer risk for this population.
What the Study Found
Gender-affirming mastectomies are built differently than the risk-reducing surgeries offered to people with a genetic predisposition to breast cancer. Top surgery is designed to "construct a masculine chest contour," which means some breast tissue is intentionally left behind. That tissue doesn't disappear, and neither does the cancer risk attached to it, even though it's lower than the risk cisgender women without mastectomies carry.
The researchers recommend a pre-surgical risk assessment before top surgery, arguing the results could shape surgical technique itself and help close what they call precision oncology care gaps for trans patients. In a pilot study cited in the research, about half of patients found to be at elevated risk chose to have the full risk-reducing mastectomy instead of standard top surgery once they had that information.
Confusion Between Providers
The study also found patients often aren't educated about the need for screening after surgery, and providers themselves report discomfort and limited knowledge about how to screen trans patients at all. Nobody seems clear on whose job it is.
While a primary care provider noted reliance on surgeons for screening decisions, a surgical oncologist deferred to primary care to initiate risk assessment while acknowledging a need for dedicated attention.
That gap isn't hypothetical. Fenway Health, a major LGBTQ+ health center, currently recommends yearly chest exams for post-top-surgery patients simply because reliable evidence is lacking, while the Endocrine Society offers no specific screening recommendation at all for this group. Two respected sources, two very different answers, and a patient stuck in the middle.
More Context
Part of the problem is structural: medical systems weren't built to track transgender status in the first place, so the data needed to write solid guidelines simply hasn't accumulated. Testosterone therapy's effect on estrogen receptor-positive breast cancer risk remains unaccounted for in current screening frameworks, and the actual rate of residual tissue left after top surgery, and what that tissue means for cancer risk, is still unstudied. Researchers say high-risk patients should at least discuss pathology review of removed tissue with their surgeons, though that conversation is far from standardized.
Why It Matters
This fits a broader pattern: trans health research is thin across the board, from breast cancer to pregnancy. A separate July study found pregnant trans men may face higher miscarriage risk than cisgender women, with authors again stressing how understudied transmasculine care remains and how unprepared many OB-GYNs are to provide it. The throughline is the same. When medicine treats trans bodies as an afterthought, patients and their doctors are left guessing at decisions that shouldn't be guesswork. This study is a real step toward better answers, but it's also proof of how far behind the baseline still is.
Source: LGBTQ Nation
Cover photo: cottonbro studio / Pexels
