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

Introduction

Breast cancer is associated with the highest incidence and overall mortality amongst all cancers affecting women globally, with 319,750 new cases of breast cancer reported in 2025 and 99% of cases occurring in female patients (1). In the United States, studies of cisgender individuals have estimated that 1 in 8 women will be diagnosed with invasive breast cancer (2). A 2020 review of cancer screening in the transgender and gender-diverse population postulates that in transmasculine people, the overall risk of developing invasive breast cancer is 20/100,000 patient years, but also reports a decreased risk of breast cancer in transmasculine people compared to cis-women (3).

Breast cancer screening (BCS) is a well-established and routine practice for cisgender women to successfully detect breast cancer and potentially reduce morbidity and mortality. For patients with an average risk of breast cancer and normal breast density, several professional societies, including the American Society of Breast Surgeons (ASBrS), the American College of Radiology and Society of Breast Imaging recommend annual screening mammography starting at the age of 40 yearly BCS through 3-dimensional mammography should begin at age 40 with no need for supplemental imaging, according to the ASBrS as well as the American College of Radiology and Society of Breast Imaging (4). The U.S. Preventative Task Force (USPTF) recommends biennial screening mammography for women aged 40 to 70 years old (5). For those at higher-than-average risk due to genetic predisposition, previous chest-wall irradiation, or a predicted lifetime risk greater than 20%, an annual magnetic resonance imaging (MRI) can be offered (4). These recommendations, however, are often based solely on research involving cisgender women despite their terminology indicating applicability to all women.

Despite the robust evidence base supporting BCS guidelines in cisgender women, BCS recommendations for transmasculine patients assigned female at birth (AFAB) have historically remained unclear, with no universal understanding on proper screening protocols. The applicability of existing screening paradigms is complicated by factors unique to this population, including the use of gender-affirming hormone therapy and variability in gender-affirming chest surgery techniques, which may alter residual breast tissue volume and oncologic risk. These considerations thus add uncertainty for both clinicians and patients with regard to the best practices to follow. Given that these unique factors may have an impact on the lack of discrete steps for BCS, disparities faced by transmasculine people present an important gap in current medical practice that should be explored and remedied.

The objective of this scoping review is twofold: (I) to synthesize existing BCS guidelines and recommendations relevant to transmasculine and gender-diverse individuals, and (II) to identify patient-, provider-, and system-level factors that limit effective screening implementation. By clarifying current evidence and highlighting gaps in practice, this review aims to inform future research directions and support more equitable, evidence-informed approaches to BCS in a historically marginalized population. We present this article in accordance with the PRISMA-ScR reporting checklist (available at https://abs.amegroups.com/article/view/10.21037/abs-2025-1-61/rc) (6).

Methods

The protocol for this scoping review was pre-registered on the Open Science Framework (OSF) and can be accessed at: https://osf.io/qtcf7/overview.

Search strategy

Our team searched Embase, PubMed, Web of Science, Cochrane Central Register, and Scopus as these databases provided the largest pool of published research. Terms and searches were tested for accuracy and precision. Search terms included: "transgender persons”, “transgender”, and “trans men”, to identify the population of interest, while terms, such as “breast cancer” and “breast neoplasm”, were used to identify research regarding breast cancer in transmasculine and gender diverse (TGD) individuals. Terms, including “screening” and “surveillance”, were used to properly isolate studies focused on screening suggestions for this population. The full electronic search strategy for PubMed is provided in Table S1 in accordance with PRISMA-ScR reporting guidance. The search was conducted on September 24, 2025 using the following Boolean string: (“transgender persons” OR transgender OR “trans men” OR “female-to-male” OR “gender diverse”) AND (“breast neoplasms” OR “breast cancer” OR “breast neoplasm”) AND (“screening” OR “early detection” OR “surveillance”).

Filters applied included English language, human subjects, and publication date from inception to September 24, 2025. No additional field restrictions or controlled vocabulary limitations were applied beyond PubMed’s default automatic term mapping. A full summary and report of yields from each database is included in Table S1.

Inclusion and exclusion criteria

Clinical studies regarding breast cancer and BCS in the TGD population were included. Studies that were in the adult population and published in English were included. Editorials, commentary reports, abstracts, and letters to the editor were excluded. Additionally, studies in animals and cadaveric studies were omitted. The full eligibility criteria are accessible on OSF (https://osf.io/qtcf7/overview).

Study selection

The search results were uploaded into the online systematic review program Covidence to select studies. Two independent investigators performed a two-stage screening process for study selection. First, article titles and abstracts were screened independently. Following this, full texts were requested and reviewed in a similar manner. During the review of the articles included in the full-text stage, articles were further excluded if they did not directly address BCS practices and guidelines in TGD patients, had no extractable data regarding screening/guidelines, and were commentaries or editorials. Given the limited availability of studies specific to TGD populations, select articles that did not stratify transgender participants by gender identity were included given the provision of relevant data on BCS access, healthcare system barriers, or policy considerations applicable to TGD individuals. Given substantial variation in international screening frameworks and health system structures, this review focused on studies and guidelines applicable to clinical practice in the United States and those studies carried out exclusively within non-United States screening frameworks were excluded. Conflicts were resolved by a third investigator.

Data extraction

Two independent investigators (A.K. and S.A.) used a predesigned template to collect information from the included studies. The data extracted included first author, year of publication, country where study was performed, study type, methods, summary of results if applicable, and author conclusions and recommendations. Consistent with PRISMA-ScR guidance, a formal critical appraisal (risk-of-bias assessment) was not performed, and the scoping review was designed to map and characterize the available literature rather than synthesize effect estimates. Accordingly, our objective was to describe the scope, nature, and gaps in the evidence base rather than evaluate methodological quality using structured appraisal tools.

Data synthesis

Extracted data was synthesized narratively. Due to the heterogeneity of included studies, analysis was limited to comparison of means and a qualitative synthesis.

Results

Following application of the search strategy, 133 full-text articles were assessed for eligibility. Studies ultimately meeting inclusion criteria were published between 2014 and 2025. These articles consisted primarily of reviews, surveys, cohort analyses and policy evaluations related to BCS in transgender (TGD) and gender diverse TGD individuals of which 65 ultimately met inclusion criteria for this scoping review (Figure 1). The full list and narrative synthesis is available in Table S2. The included articles were assessed to identify the following to comprehensively meet the primary aims established (Table 1):

• Epidemiology and risk of breast cancer in TGD males.
• Effect of gender-affirming hormone therapy (GAHT) on the risk of developing BC.
• The impact of surgical decision making for breast cancer risk and screening.
• Existing screening guidelines.
• Provider knowledge.
• Patient knowledge.
• Policy and systemic barriers to BCS.
• Genetic risk and counseling.
• Existing gaps in screening guidelines.

Figure 1 PRISMA 2020 flow diagram summarizing study selection. A total of 133 full-text articles were assessed, of which 65 met inclusion criteria for this scoping review.

Across multiple cohorts, the incidence of breast cancer ranged between 4–6 per 100,000 person-years; an incidence lower than that for cis-women, though still higher when compared to cis-men. Those who underwent mastectomy for gender-affirming reasons experienced a 90% reduced risk of developing BC, though a residual risk still exists (7-13). Testosterone therapy in TGD males was associated with epithelial and stromal involution across multiple cohort studies, with no clear evidence of testosterone exposure linked to increased risk of developing BC. Those patients who did develop breast cancer following use of GAHT had ductal tumors with ER/PR receptor positivity most commonly (14-18).

Current screening guidelines and recommendations for TGD males are often extrapolated from data for cis-women, though newer models have encouraged adoption of approaches that account for hormonal exposures, surgical history, and anatomy, while the Gail and American College of Radiology (ACR) models have implemented a risk-stratified approach in their recommendations (19-22). BRCA1/2 and TP53 carrier management now explicitly include guidance for transgender patients though overall genetic counseling prior to gender-affirming surgery (GAS) has not yet been established as standard of care (20,23). Provider knowledge and comfort with TGD-specific screening were limited, although training exposure improved confidence (24,25). Patient-level barriers included stigma, gender dysphoria, and lack of inclusive clinical environments, while policy barriers stemmed from non-inclusive insurance language and electronic health record limitation (26-29). Multiple studies highlight substantial gaps within existing BCS guidelines, largely stemming from the absence of prospective, longitudinal data in trans-inclusive databases.

Summary of existing BCS guidelines

Tables 2,3 summarizes the current BCS recommendations for TGD patients according to various organizations dedicated to providing screening guidelines. Recommendations for screening for each society are stratified according to patient-specific characteristics such as surgical history and individual risk factors. Suggested imaging modalities and screening intervals vary across each organization’s suggested guidelines.

Discussion

Breast cancer risk in transmasculine and gender-diverse individuals, although lower than that of cisgender women, remains clinically meaningful and warrants appropriate surveillance. In TGD patients who have not undergone chest surgery, lifetime risk appears comparable to cisgender women (~13%) (34,35). Risk decreases following gender-affirming procedures, yet the magnitude of reduction depends on the extent of tissue removal (34,35). Reduction mammoplasty removes only partial tissue, while subcutaneous or contouring mastectomy may leave residual glandular tissue, thereby maintaining a non-zero cancer risk. Bilateral mastectomy reduces risk by approximately 90%, though reported incidence remains higher than in cisgender men, supporting the need for ongoing surveillance (34-36).

The impact of GAHT on breast cancer risk has also been a source of clinical uncertainty regarding the development of breast cancer risk. Although aromatization of testosterone to estrogen could theoretically stimulate residual breast tissue proliferation, multiple studies have demonstrated no clear association between testosterone exposure and increased malignancy risk (35). A Dutch cohort reported four ER+/PR+ ductal cancers after a median of 15 years of testosterone therapy; however, broader analyses suggest that testosterone induces breast atrophy and reduced glandular volume, potentially lowering risk (4,16,36). Overall, current evidence does not support cessation of GAHT based solely on breast cancer risk (22).

In addition to hormonal factors, variability in surgical practice further complicates risk assessment and subsequent screening recommendations. In an American Society of Plastic Surgeons (ASPS) survey, 85.5% of surgeons reported obtaining preoperative imaging for patients over 40 years of age or with a family history of breast cancer, whereas 21% reported performing none. The extent of tissue removal was similarly heterogeneous: only 27.5% of surgeons reported removing all visible breast tissue, while 30% intentionally retained some tissue for contouring purposes. Although 73.9% of surgeons submitted specimens for pathologic evaluation, barriers to routine histopathologic assessment include cost (39%), patient refusal (35%), and perceived low risk (26%) (37). Collectively, these findings demonstrate the absence of standardized protocols for preoperative imaging, tissue excision, and pathologic evaluation in transmasculine chest surgery, and highlight how differences in operative technique may influence residual cancer risk and long-term screening considerations. In light of this heterogeneity in hormonal exposure, surgical technique, and residual risk, it is essential to examine how existing BCS guidelines currently approach screening in TGD populations.

Current guidelines for BCS in transgender patients

Current evidence demonstrates lower cancer screening compliance among transgender individuals compared with cisgender populations (26). In one institutional cohort of 253 transgender and nonbinary (TGNB) patients over age 40, screening rates ranged from 2–50%, markedly below institutional (77%) and national (67–78%) averages, with average mammogram-person years (0.134) also below the recommended 0.5 (38). Similarly, Domínguez-Bali et al. reported pervasive under-screening among trans men, largely driven by negative healthcare experiences including gender dysphoria during physical examinations and fear of discrimination, both of which were associated with appointment avoidance and missed screenings (29).

Even among patients for whom screening was clearly indicated, adherence remains limited. In a retrospective cohort of 29 transgender patients with elevated risk, only 48.3% completed recommended screening, and Medicare enrollment significantly reduced the odds of screening completion (39). These findings suggest that beyond the existence of formal recommendations, structural barriers, socioeconomic factors, and mistrust in the healthcare system substantially limit implementation. Comprehensive education of both patients and healthcare providers remains essential to improving screening uptake.

In parallel with these adherence challenges, several breast cancer risk models have been proposed to guide screening in transgender populations. The Gail Model, traditionally used for cisgender women, estimates risk based on age, reproductive history, prior biopsies, and family history. However, it was developed using data from white cisgender women in the NIH SEER program and does not incorporate BRCA1/2 mutations or extended family history. Although revised for additional racial groups, it continues to underestimate risk in certain populations and has not been validated in transgender individuals (21). Given these limitations, its applicability to transmasculine patients remains uncertain.

The ACR Appropriateness Criteria represent a more tailored effort to incorporate transgender-specific factors, including GAHT exposure, surgical history, and family history. While the ACR recommends against BCS for TGD individuals who have undergone bilateral gender-affirming mastectomy, this description lacks specificity. Given that gender-affirming chest masculinization or “top surgery” can range from an aggressive breast reduction or subtotal mastectomy to a total mastectomy, this recommendation does not adequately differentiate patients by the proportion of residual breast tissue. While the ACR does acknowledge that the health needs of TGD patients may differ from those of cisgender patients and also considers more risk factors than the Gail Model, such as duration of hormone treatment, surgical history, and family history, many authors still find these recommendations insufficient for this patient cohort (21).

To address these limitations, Bacot-Davis et al. developed a novel screening tool that combines the Gail Model with the 2021 ACR Appropriateness Criteria into an accessible online questionnaire for primary care physicians (PCPs). This tool was found to contain both the limitations and strengths of the Gail Model, coupled with the relative strengths of the Appropriateness Criteria (21).

While these tools aim to refine screening in average-risk populations, hereditary cancer syndromes introduce an additional layer of complexity that current guidelines attempt to address separately. TGD patients who have not undergone GAHT or top surgery are generally advised to follow screening guidelines for their sex assigned at birth, regardless of BRCA1/2 status. For BRCA1/2 carriers, post-mastectomy imaging has limited utility, whereas individuals without mastectomy should follow National Comprehensive Cancer Network (NCCN) guidelines for cisgender female carriers (40). In 2024, the NCCN introduced its first section on hereditary cancer risk management in transgender, nonbinary, and gender-diverse individuals, emphasizing organ-based screening by sex assigned at birth and specific pathogenic variants (e.g., BRCA1/2, TP53, PTEN, CDH1) (20). Further refinement and consensus guidelines tailored to patients following GAS remains necessary (41).

Integrating gender-affirming and oncologic care offers an opportunity to enhance BCS but remains nonstandardized. Cortina et al. reported that preoperative breast cancer risk assessment influenced surgical planning for many transgender patients. Gray et al. found that while 23% of respondents would choose total mastectomy over contouring if BRCA-positive, more than half of postoperative patients reported that gender affirmation would have remained their primary goal (23,42). Bedrick et al. suggest that identification of BRCA1/2 carrier status prior to medical or surgical transition can inform discussions regarding GAHT-related risks and surgical planning, and propose that genetic testing in adolescents prior to transition may be medically indicated in select cases. Moreover, because prophylactic cancer surgeries are typically covered by insurance, a known BRCA1/2 mutation could help facilitate coverage for gender-affirming top surgery when oncologic and gender-affirming goals align (40).

Limitations to BCS, diagnosis, and management in TGD individuals

Despite the presence of evolving screening guidance, implementation remains constrained by interrelated patient-, provider-, and system-level barriers, which makes access to high-quality BCS and management in TGD population complex.

At the patient level, knowledge gaps and psychosocial factors significantly limit screening engagement. Lombardo et al. reported that although 92.6% of trans men recognized their breast cancer risk, only 29.8% knew which screenings to pursue and just 22.3% knew when to begin screening, with gaps attributed to limited knowledge, emotional distress, and financial uncertainty (27). Additional studies demonstrate that discrimination, gender dysphoria during clinical encounter, and discomfort discussing breast health further contribute to healthcare avoidance and missed screenings (43,44). These findings highlight the need for improved patient education and preventive care.

Beyond individual-level factors, social, cultural, and policy factors also contribute to disparities in BCS among transgender and gender-diverse patients. TGD individuals experience higher exposure to modifiable cancer risk factors such as smoking, obesity, and inadequate screening (45). Insurance coverage remains inconsistent: Cortina et al. found that only 16.9% of insurance policies used inclusive language, 6.2% explicitly mentioned transgender coverage, and 3.7% required proof of GAHT for transfeminine patients, with no state demonstrating universal inclusivity (46). Although recent regulatory efforts, including Section 1557 of the Affordable Care Act, seek to prohibit discrimination in healthcare delivery and coverage, inconsistent implementation and administrative barriers continue to limit equitable access to BCS for TGD populations (47). Approaches that emphasize inclusive, gender-affirming clinical environments, culturally competent education, and increased transgender representation in healthcare have been associated with improved engagement in preventive care, including consideration of less gendered terminology when discussing breast health (41,47).

The need for robust, universally applicable guidelines is imperative to ensure that the needs of an already marginalized community are promptly addressed. When discriminatory barriers are present, this inevitably leads to health disparities that disadvantage LGBTQ+ patients, specifically transgender patients. As a consequence, they may face cancers with higher stages and higher rates of oncologic mortality when compared to their cisgender counterparts (48).

Physicians and providers

The relationship between providers and their patients is a crucial aspect of providing adequate care and guidance, especially in the realm of BCS. BCS requires proper counseling from PCPs who ideally have regular contact with patients. Breast cancer outcomes are undoubtedly impacted by visits to PCPs who provide referrals for screening (49). However, the overall knowledge base that a given PCP may have regarding proper counseling of transgender patients may be a limiting factor.

Carroll et al. surveyed 95 providers across three academic centers and found that over one-third were unaware of existing BCS guidelines for transgender patients, and only 43% knew where to find them. Greater exposure to transgender health education (≥6 hours) significantly improved awareness (25). Additional survey-based studies, primarily conducted among PCPs, consistently demonstrate limited provider knowledge of BCS guidelines for TGD patients, attributable to limited formal training and clinical exposure, and low confidence in counseling. However, there is strong interest in integrating TGD-specific education into medical school and residency curricula (24,50).

Similar knowledge gaps exist within the radiology community. Huang et al. found that none of the top national or regional breast center websites referenced “transgender,” and over half lacked gender-neutral language or inclusive imagery, with few providing outreach materials addressing transgender screening needs (51). Overall, physician knowledge and comfort with BCS in the TGD populations remain limited, underscoring the need for clearer, standardized guidelines.

Finally, variability in surgical techniques and perioperative counseling further complicates standardized screening recommendations. Differences in the extent of tissue removal, documentation of residual tissue, and postoperative counseling create inconsistency in long-term surveillance recommendations. In one survey, 85.5% of surgeons advised preoperative imaging for patients over 40 or those with a family history of breast cancer, yet postoperative practices varied substantially: 69.6% recommended routine screening and 96% encouraged self-exams (37). Such heterogeneity underscores the absence of standardized guidance and reinforces the difficulty of translating general screening recommendations into individualized follow-up.

Author recommendations and multidisciplinary establishment of proper guidelines

Multidisciplinary approach alongside national consolidation

Given the heterogeneity in surgical practice, hormonal exposure, and genetic risk, comprehensive management of transgender patients requires a multidisciplinary framework centered on patient goals and preferences. Withholding GAHT due to theoretical cancer risk may negatively impact mental health and increase suicide risk, underscoring the importance of balanced, individualized decision-making (10,52). The 2024 NCCN guidelines advocate for integrated care within multidisciplinary gender-affirming centers, involving PCPs, genetic counselors, endocrinologists, mental health professionals, oncologists, and surgeons (20).

For a multidisciplinary model to BCS for TGD to function properly, it must be embedded within the existing healthcare systems rather than exist as an aspirational governance model. Coordination from PCPs, surgical teams, radiologists, and other services often involved in care would be most viable when supported by clear communication during relevant clinical encounters. Screening discussions should begin during initial consultations for GAS and be reinforced during longitudinal follow-up visits. Clear documentation of these conversations can then be provided to PCPs who are best positioned to provide longitudinal preventive care. Encouraging continuity of screening guidance as patients transition between care settings helps bridge knowledge gaps and mitigate discomfort for both patients and providers. In addition, disseminating screening considerations through existing professional societies and educational forums, alongside implementing institution-specific protocols, may further optimize coordination across multidisciplinary teams.

Ensuring equitable and high-quality screening in TGD patients also requires ongoing continuing education for physicians involved in multidisciplinary care. Professional societies, such as the American Society of Breast Surgeons, and equivalent organizations, should dedicate annual meeting sessions to transgender health, reviewing current evidence and screening protocols. Additionally, the development of clear referral pathways and communication templates between PCPs and those involved in focused gender-affirming care is paramount to ensuring adherence to the most up-to-date screening recommendations. This creates accountability for ongoing preventive care beyond the surgical episode.

Improving the language and attitudes of providers

Because patient comfort is a crucial aspect of providing adequate care, the manner in which patients receive information is a powerful tool. Physicians should mirror the language used by their patients to provide culturally sensitive and dignified care. A primary goal that should be adopted is the uncoupling of mammary tissue from associated gender (i.e., being mindful that having breasts does not imply gender of the patient) (41). Enhanced training and awareness among cancer care physicians and providers are necessary to address the issues of alienation and invisibility experienced by transgender patients. This requires improving empathetic communication and having a deeper understanding of transgender patients’ experiences within cancer care (53). Doing so encourages patients to adhere to screening protocols, as they may feel more comfortable in healthcare settings. As an already marginalized community, transgender males experience discrimination through misgendering and distressing interactions with providers (27). Limiting instances of potential alienation by actively using more welcoming language that fosters inclusion and conveying understanding, physicians and providers may be able to encourage stronger adherence to screening protocols.

Institutional BCS

Existing literature emphasizes the role of institutional practices in facilitating equitable access to BCS for TGD individuals, rather than supporting a single prescriptive screening algorithm. While this limits the ability to offer broad, evidence-based screening recommendations, some institutions may have developed structured workflows based on existing guidance. At our institution, this workflow incorporates surgical history, residual breast tissue, age, and genetic risk. Imaging modality selection and screening frequency are based on established society guidelines and shared decision-making. For patients with high genetic risk, a discussion of a total mastectomy is initiated by the breast surgeon involved in the multidisciplinary care model. The total mastectomy options include either immediate reconstruction or delayed reconstruction to achieve similar scar patterns, appropriate nipple construction, and contouring of a gender-affirming mastectomy.

Figure 2 illustrates this institutional workflow, which is intended to reduce ambiguity, support coordination across multidisciplinary teams, and mitigate inappropriate screening or denial of care, rather than to define screening recommendations. The known potential harms of screening, including contrast exposure and cost, must also be considered within institutional multidisciplinary team settings through protocols and open discussion with patients to minimize these risks.

Figure 2 Institutional workflow for operationalizing breast cancer screening in transmasculine and gender-diverse patients. MRI, magnetic resonance imaging; US, ultrasound.

Future perspectives and challenges

The lack of widely adopted, definitive guidelines must be addressed to ensure appropriate care for all. Improving the demographic data collection in large-scale patient registries and databases may better facilitate research with the aim of understanding and mitigating disparities faced by transgender patients regarding breast cancer (48). Additionally, a better assessment of breast cancer risk following top surgery is required, taking into account high-risk individuals who carry BRCA1/2 mutations or have a strong family history, as well as those who have undergone GAHT prior to diagnosis (47). A concerted effort to establish and carry out larger, long-term multi-institutional studies that can assess the impact of screening and downstream outcomes is also required to create guidelines that are generalizable given the overall small size of this population

Further investigation into the disparities that racial and ethnic minorities within the transgender population experience is also warranted, given that there are already existing inequities in breast cancer diagnosis, treatment, and prognosis (21). Collectively, these limitations underscore the need for larger, prospective, population-specific investigations to inform more robust and stratified screening guidance. Ultimately, multidisciplinary consensus across national societies will be needed to effect comprehensive change.

Limitations

Several limitations characterize the current evidence base summarized in this review. The included studies were heterogeneous in design, population, and outcomes measured, with many comprising retrospective analyses, small single-center cohorts, survey-based studies, or narrative reviews rather than prospective comparative research. Sample sizes were frequently limited, and reporting of surgical technique, residual breast tissue, and hormone exposure was inconsistent, restricting generalizability. Additionally, the literature often lacked stratification between transmasculine and transfeminine populations, despite their distinct risk profiles and screening considerations. While a concerted effort was taken to prioritize the inclusion of literature that specifically stratified transmasculine and transfeminine screening guidelines, inclusion of select non-stratified studies allowed for broader assessment of structural and systemic barriers to screening as well as better elucidating the available information.

Conclusions

This scoping review synthesizes current BCS guidance for transmasculine and gender-diverse individuals, demonstrating that existing recommendations remain largely extrapolated from cisgender-based data. While recent efforts by organizations such as the ACR and NCCN have introduced anatomy-, hormone-, and surgery-specific considerations, no universally adopted, population-specific screening framework currently exists. Breast cancer risk in TGD patients remains clinically meaningful, as residual risk persists even after bilateral mastectomy and remains higher than in cisgender men (34). Persistent disparities in screening compliance, driven by socioeconomic barriers and mistrust of healthcare, alongside multiple conflicting recommendations create confusion and further reduce engagement (26). Limited knowledge regarding BCS for the TGD population among both patients and physicians continues to impede optimal care.

Given the complexity of BCS in this population and the heterogeneity of individual risk factors, a national multidisciplinary approach is warranted. Involving PCPs alongside specialists in mental health, endocrinology, and surgery can improve comprehensive, patient-centered management. Additionally, expanded formal education in transgender health is crucial to enhance patient-provider trust and quality of care. Current guidelines remain limited, inconsistent, and variably applied. We have provided our current institutional BCS workflow for AFAB individuals, guided by the amount of residual breast tissue after gender-affirming chest surgery. Future research to identify best practices must be encouraged to ensure equitable care for an already marginalized population.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the PRISMA-ScR reporting checklist. Available at https://abs.amegroups.com/article/view/10.21037/abs-2025-1-61/rc

Peer Review File: Available at https://abs.amegroups.com/article/view/10.21037/abs-2025-1-61/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://abs.amegroups.com/article/view/10.21037/abs-2025-1-61/coif). R.P.C. serves as an unpaid editorial board member of Annals of Breast Surgery from June 2025 to December 2026. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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