Assessing the current landscape of breast cancer screening guidelines for transmasculine and gender diverse patients: a scoping review

Background: Breast cancer remains the most common malignancy among women worldwide, with established screening protocols for cisgender populations. Screening guidelines for transmasculine patients, however, remain poorly defined. Factors such as gender-affirming hormone therapy (GAHT), variable surgical techniques, and inconsistent documentation of residual breast tissue contribute to uncertainty regarding appropriate screening strategies. Given the lack of a singular screening guideline, this scoping review aims to explore current breast cancer screening (BCS) guidelines for transmasculine and gender diverse patients.

Methods:

Results: Sixty-five studies were included, encompassing cohort analyses, reviews, surveys, and policy evaluations. Breast cancer incidence among transmasculine individuals ranged from 4–6 per 100,000 person-years, lower than in cisgender women but higher than in cisgender men. Gender-affirming mastectomy reduced risk by approximately 90%, though a residual risk persisted. Testosterone therapy was not associated with increased cancer incidence. Existing screening recommendations largely extrapolate from cisgender data, with recent American College of Radiology (ACR) and National Comprehensive Cancer Network (NCCN) guidelines advocating anatomy-, hormone-, and surgery-specific approaches. Despite these frameworks, screening adherence remains low, hindered by limited provider education, inadequate insurance inclusivity, and psychosocial barriers. Provider surveys revealed persistent gaps in guideline awareness and training, while variable surgical practices further complicate standardized follow-up and pathology assessment.

Conclusions: Transmasculine patients retain a measurable risk of breast cancer despite gender-affirming interventions. Persistent disparities in screening access and knowledge highlight the need for evidence-based, anatomy-specific guidelines. A multidisciplinary, patient-centered framework involving primary care physicians, oncologists, surgeons, endocrinologists, genetic counselors, and mental health professionals is essential to ensure equitable care and improve screening compliance in this population.