Background
Breast cancer screening guidelines are often generalized recommendations for women with a paucity of data encompassing transgender and male individuals. The male, transmasculine, and transfeminine breast vary in anatomy and breast cancer risk factors. The most appropriate guidance would be personalized breast cancer screening that considers an individual’s unique risk factors. This exhibit will examine the screening and diagnostic approaches to breast disease in the transgender and male populations to provide more inclusive care.
Educational Goals / Teaching Points
The educational goals of this exhibit are to review the screening and diagnostic approaches to breast disease in the transgender and male populations according to the new American College of Radiology (ACR) and Society of Breast Imaging (SBI) guidelines. We will review normal male breast anatomy and common physiologic changes in the transfeminine breast, as well as breast cancer risk factors with a focus on the role of genetic testing and estrogen use. We will also provide a pictorial review to identify imaging features of benign and malignant breast lesions. Lastly, we will discuss the technical challenges in biopsy of the male and transfeminine breast with ultrasound and stereotactic guidance and provide biopsy tips for challenging cases.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Personalized breast cancer screening is critical to target individuals with unique risk factors, anatomy and pathology. Current screening guidelines for transgender patients give special consideration to genetic predisposition, history of mastectomy in the transmasculine patient, and hormone therapy in the transfeminine patient. Individuals with genetic predispositions such as family history of breast cancer, BRCA mutations and Klinefelter syndrome have higher risk of breast cancer which is incorporated in screening recommendations. Screening of transmasculine patients who undergo mastectomy is not recommended due to low likelihood of malignancy. However, transmasculine patients who do not undergo mastectomy should continue to be screened annually. Transfeminine patients should be screened depending on their utilization of hormone therapy. Male patients undergo diagnostic imaging for symptomatic presentations such as palpable masses or nipple discharge without dedicated screening guidelines. Our exhibit will cover normal male breast anatomy, as well as examples of transfeminine and transmasculine breasts. We will also include multimodality presentations of various pathologies such as gynecomastia, breast cancer and lymphadenopathy. Finally, we will demonstrate biopsy tips for challenging cases.
Conclusion
Personalized breast cancer screening and diagnostic approaches are important to provide effective and inclusive care for transgender and male patients. Therefore, interpreting radiologists must be familiar with current guidelines, various pathologies, and biopsy techniques.
