Table 4

Recommendations for breast and reproductive tract cancer screening

Breast/chestDiscuss mammography in transwomen aged >50 years with additional risk factors for breast cancer (body mass index >35 kg/m2, estrogen and/or progestin use >5 years, family history)
  • Family history of BRCA mutations: prophylactic mastectomy could be recommended, with consecutive primary reconstruction.

Patients who have not undergone bilateral mastectomy should follow cisgender women recommendations for breast cancer screening
Patients who had undergone chest reconstructive surgery should be offered physical examination and/or chest ultrasound
CervixNot recommended (transwomen do not have cervix)
  • Patients should be routinely examined to detect HPV-related lesions.

Patients with intact cervix should follow the recommendations for cisgender woman
  • Consider self-collected vaginal swabs to test for high-risk HPV DNA

  • Pathologists should be aware if patient is taking testosterone

  • Patients who had undergone total hysterectomy and have no history of high-grade cervical pre-cancerous lesion or cervical cancer can discontinue cervical cancer screening

OvarianN/ADo not screen
  • Transmen at increased risk (identified BRCA gene mutation and family history) should be referred for genetic counseling

  • Consider risk-reduction salpingo-oophorectomy

EndometrialN/ADo not screen.
  • Unexplained bleeding (in patients under testosterone who had reached amenorrhea) should be evaluated

ProstateMonitor following framework for cisgender men.
  • PSA cut-offs may be lower in TM receiving anti-androgens.

  • Consider transvaginal digital examination and ultrasound.

  • N/A, not applicable; PSA, prostate-specific antogen.