A study unveiled at the 36th Annual National Society of Genetic Counselors suggests transgender individuals should be aware of their family history of breast cancer and consider getting tested for the BRCA gene mutations before they make decisions about medical interventions.
Having an elevated risk of breast or ovarian cancer could impact when trans men and women choose to start hormone treatments as well as which gender-confirming surgeries to undergo.
The lead author of several case studies, Rosalba Sacca, a genetic counselor from the Dana-Farber Cancer Institute in Boston, argued in a written statement, “Some healthcare providers are afraid to ask relevant medical questions of their transgender patients because they fear it may be offensive. But awareness and testing are important because they may impact their decisions.”
Mutations in the BRCA1 or BRCA2 genes have been shown to increase cisgender women’s risk for breast cancer and ovarian cancer, and so doctors recommend that cis women with a strong family history of breast or ovarian cancer undergo genetic testing to see if they have the mutation. Unfortunately, those providing trans people with health care frequently avoid such conversations.
This is concerning, a press statement by the National Society of Genetic Counselors says, because “although there is limited research, taking female hormones may increase breast cancer risk in transgender women, especially those with a BRCA1 or BRCA2 mutation.” And trans men with the mutations might want to consider a traditional mastectomy versus the usual “top surgery,” which leaves some breast tissue in place (and thereby fails to eliminate breast cancer risks). NSGC’s statement also pointed to the fact that “transgender men do not always have their ovaries removed as part of their transition, but would be encouraged to do so if they were found to carry a BRCA1 or BRCA2 mutation.”
Having one of these mutations isn’t reason for someone not to transition. “Rather than being a barrier to transitioning, genetic counseling can benefit transgender individuals at risk for BRCA1 or BRCA2 mutations by helping them understand their cancer risks and the choices available to them to manage those risks,” says Sacca.