October is Breast Cancer Awareness Month, a time when a barrage of pink can be seen on football fields, police badges and ribbons. But one University of Cincinnati expert says there's evidence the feminized and sexualized push for awareness leaves out members of the LGBTQ community, especially transgender people.
"Although I still think it's a great idea to raise awareness in the month of October, it's time to reconsider how it may be uniquely affecting the LGBTQ+ community and maybe rethink about how we're outfitting our centers and websites and what messaging we're sending to be more gender neutral," said Dr. Annie Brown, assistant professor of radiology at University of Cincinnati.
She said data on breast cancer among transgender people is scarce for a lot of reasons. For instance, being transgender was considered a mental illness in the 1980s, and later considered "gender identity disorder" by the American Psychiatric Association. It wasn't until 2013 that being transgender was reclassified as gender dysphoria.
That means data about breast cancer among transgender people doesn't have the same kind of sample size or longevity as data collected about cisgender people.
Limited data limits new recommendations
To combat the data shortage, institutions like the University of California in San Francisco and Fenway Health in Boston have released guidelines about the best transgender health practices. Brown has also been involved in creating summary recommendations regarding trans breast cancer as part of the American College of Radiology and its appropriateness criteria.
She says it gets into the many combinations of factors that should be considered when addressing breast health.
"That's probably one of the most controversial areas," Brown says. "We don't have a lot of data to support our recommendations."
Regardless, she says the breast cancer risks transgender people face are different than for cisgender people.
For instance, limited data shows exposure to estrogen for five or more years could increase a person's risk of developing breast cancer, especially if there are other factors at play, like heredity or lifestyle choices.
Although trans men who've undergone surgery are less at risk of developing breast cancer than cisgender men, they still seem to face higher rates.
"Whereas for trans men, a lot of the conversation is focused on whether or not there's been top surgery," Brown said. "If there has been, it doesn't mean that the risk is zero. There's still some tissue left as part of that surgery that can develop breast or chest cancer, so we focus on patients being aware of the importance of their own self-exam, and clinical exam, just to ensure that they are safe going forward, especially if there are underlying risk factors."
Altering campaigns and public spaces
Transgender people already face an uphill battle when it comes to accessing medical care, historically reporting discrimination and abuse in many social situations.
In a doctor's office, that might include being misgendered, lack of unisex restrooms and dressing areas, and difficulties with insurance.
"Many trans people report that they hide their gender identity or postpone their medical care for fear of discrimination or being denied treatment," Brown said. "And then, to go a step further, about half of medical providers really don't have knowledge about trans people and their specific health care needs. Not to mention structural and legal barriers to access."
Addressing those issues includes going past campaigns like "Save the Ta-tas" and "Save Second Base." Being proactive about inclusivity matters, Brown said, from staff training to altering public spaces.
For instance, a space can be more inclusive by having gender neutral signage, unisex restrooms, imagery that better reflects cultural diversity, and displaying non-discrimination and equal visitation policies.
"It's not detrimental to cisgender people, but again, goes a long way to making transgender people feel more comfortable," Brown said.
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