Transgender and gender-diverse people and breast cancer

It’s normal for people of all gender identities to have questions and concerns about breast cancer and breast health.

We use the terms “breasts” and “chest” throughout this information. However, you may have other ways of referring to this area of your body.

We also use the terms:

• Cisgender – your gender identity matches the sex you were assigned at birth
• Transgender – there’s a difference in your sex assigned at birth and your gender identity
• Non-binary – you do not identify with the discrete categories of male and female

Everyone has breast tissue, so it’s important to check your breasts or chest to get to know your normal.

Signs and symptoms of breast cancer include: 

1. A lump or swelling in the breast, upper chest or armpit
2. A change to the skin, such as puckering or dimpling
3. A change in the colour of the breast or chest – the breast or chest may look darker, red or inflamed
4. A nipple change, for example it has become pulled in (inverted)
5. Rash or crusting around the nipple
6. Unusual liquid (discharge) from either nipple
7. Changes in size or shape of the breast or chest

Some of these symptoms may appear differently on different skin tones.

On its own, pain in the breasts or chest is not usually a sign of breast cancer. But look out for pain in your breast, chest or armpit that’s there all or almost all the time.

Chest checking after top surgery

If you’ve had top surgery (bilateral mastectomy with masculine chest reconstruction), you will need to get to know how your new normal feels once your chest has healed.

Although your top surgery will have removed most of your breast tissue, it’s still important to check for changes.

Check your whole chest area, including up to your collarbone (upper chest) and armpits.

Checking when you have breast implants

If you’ve had breast implants, you’ll need to get to know your new normal. You should check your whole breast area, including up to your collarbone (upper chest) and armpits.

Breast implants and cancer

Having breast implants does not increase your risk of breast cancer.

But 2 very rare types of cancer have been found in a very small number of people with breast implants. These are called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-associated squamous cell carcinoma (BIA-SCC).

If you develop a lump or a swelling around your implant, regardless of how many years later, contact your GP or treatment team so you can get your symptoms checked out.

In most cases BIA-ALCL and BIA-SCC can be treated successfully by removing the implant.

If you’re considering having implants, your treatment team will talk to you about the risks of BIA-ALCL and BIA-SCC. 

Checking when you’re experiencing gender dysphoria

You may not want to touch your breasts or chest if you’re experiencing gender dysphoria (a sense of distress or discomfort related to a mismatch between sex assigned at birth and gender identity). However, it’s important to regularly check your breasts or chest for signs and symptoms of breast cancer.

If you’re feeling dysphoric, it might be easier to check under a top or without looking in a mirror.

Breast screening uses a breast x-ray, called a mammogram, to look for cancer that may be too small to see or feel.

The sooner breast cancer is diagnosed, the more effective treatment is likely to be. Screening can pick up breast cancer before there are any signs or symptoms.

How breast screening invitations work

In the UK, you may be invited for a mammogram every 3 years from the age of 50 until your 71st birthday.

Whether you’re invited for breast screening depends on how your gender is recorded on your GP record.

Who is invited for breast screening?

You will usually be invited automatically if you’re within screening age and your GP record shows your gender as female.

You are not usually invited automatically if your GP record shows your gender as male.

Who can have breast screening?

You may benefit from breast screening if you’re within screening age and you have breast tissue.

This may be the case if:

• You were assigned female at birth and you still have breast tissue (you have not had mastectomies or top surgery)
• You were assigned male at birth and have been taking feminising hormones

If you are not invited automatically

If you’re not automatically invited but think you may benefit from routine breast screening, you can ask your GP to refer you for screening.

If screening is arranged this way, you can usually continue to have screening every 3 years, as long as you remain eligible.

OUTpatients has more information on breast screening for transgender and gender-diverse people on its website.

Other important information

Having a Gender Recognition Certificate does not change whether you are invited for breast screening.

You can change the gender recorded on your GP record. The OUTpatients website has information on changing the gender on your NHS records.

If you’re not automatically invited, you may not receive written information about screening unless you ask.

If you’re not sure whether breast screening is right for you, your GP can help you decide.

Breast cancer is uncommon in transgender and gender-diverse people.

Your risk depends on things like:

• The type of hormone therapy you take
• How long you have taken hormones
• Whether you have had chest or breast surgery

If you take feminising hormones (such as oestrogen)

If you were assigned male at birth and take oestrogen:

• Your risk of breast cancer is low
• The risk may increase the longer you take oestrogen
• Even after many years, the risk is still lower than in cisgender women

Having breast implants or fat transfer surgery does not increase your risk of breast cancer.

If you take masculinising hormones (such as testosterone)

If you were assigned female at birth and take testosterone:

• Your risk of breast cancer is lower than in cisgender women
• The risk is still slightly higher than in cisgender men

If you have had chest (top) surgery, most breast tissue will have been removed. This lowers your risk further, but it’s still important to be aware of changes in your chest.

There’s no evidence that chest binding increases your risk of developing breast cancer.

Breast and chest changes during hormone therapy

Many transgender women take oestrogen-based hormone therapy. This can lead to the development of breast tissue over time.

You may notice:

• Small, firm areas (called breast buds) under or around the nipple after around 3 to 6 months
• Tenderness or discomfort in the breast or chest area
• Gradual changes in the size and shape of your breasts

Breast development usually continues for 2 to 3 years. Changes then tend to slow or stop.

It’s normal for breasts to feel smooth in some areas and lumpy in others, particularly while they’re developing.

Lumps that appear during breast growth are almost always due to normal changes in breast tissue. A lump may also be caused by a benign (not cancer) breast condition.

If you find a lump in your breast, see your GP. Although it’s very unlikely there’s anything wrong, your GP will check it out and can refer you to a breast clinic for further assessment.

The organisations below offer support for transgender and non-binary people who are affected by cancer or breast health conditions:

OUTpatients

OUTpatients is the UK’s only LGBTIQ+ cancer charity.

CoppaFeel!

CoppaFeel! has information on breast checking during transition.

LGBT Foundation

LGBT Foundation are a national charity with LGBTQ+ health and wellbeing at the heart of everything they do.

TransPlus

TransPlus’s UK Cancer and Transition Service (UCATS) is a service for trans and non-binary people who have a cancer diagnosis.