Every October, public service announcements featuring breast cancer survivors and their families flood TV and social media to raise awareness about the illness. Most of the content features cisgender women telling stories about survival and perseverance through the disease’s harrowing effects. But messaging for Breast Cancer Awareness Month typically omits or forgets the transgender community — even though we are actually high-risk.
For many trans people of every gender identity, the chest or breasts are a major part of the transition. So why isn’t the treatment of gender dysphoria paired with outreach and screening for breast cancer? This oversight sends what feels like a hurtful message about the value of our lives.
As insignificant as PSAs seem to some, they’ve proved both influential and helpful in our country’s past. Dating back to the Civil War, government interests have leaned on public outreach. Some of the earliest PSAs aimed to sell war bonds and sway public perceptions about controversial topics. PSAs eventually evolved into ads by nonprofits about various subjects, including fire safety, drug prevention and, more recently, COVID-19 response.
As a transgender journalist who scans the news every day, I’m subjected to hundreds of ads targeting my community. But I’ve never seen a breast cancer PSA that spoke to me. After an extensive search, most information about breast cancer in trans people was produced by vloggers on YouTube and small nonprofits in major cities.
Occasionally, some of the larger nonprofits write blog posts about studies involving trans people or add informational pages to their sites. A video produced by Breastcancer.org was one of the few sources discussing chest cancer for trans men. It’s something, sure. But the amount of prevention outreach is far from enough to match the risk.
Even when breast cancer PSAs target the LGBTQ community, transgender people are rarely mentioned. Transmasculine people and the risk of chest cancer after top surgery are discussed even less. Breast and chest cancers are a threat to the trans community because many trans people will never know they are at risk.
As the battle for gender-inclusive health care rages on, it needs to expand beyond hormones and gender-affirming surgeries. These are crucial and lifesaving treatments, of course, and need to be protected from harmful legislation — but there’s more to our well-being and longevity.
A 2019 study — one of the first of its kind — by the VU University Medical Centre in Amsterdam indicated that transgender women are 47 times more likely to develop breast cancer than cisgender men. Researchers found that feminizing hormones were likely the catalyst, since cisgender women taking similar hormone treatments for menopause experienced comparable levels of risk. Transgender men also showed increased risk compared with cisgender men but less risk than cisgender women.
Although the study only included participants from the Netherlands, it suggested a higher risk of breast cancer among transgender people globally.
Despite new research and advances in medicine, transgender health care greatly depends on the political views of practitioners. Some medical professionals — in defiance of their Hippocratic oath to uphold ethical standards — reserve care for those with the “correct” identity.
In 2016, a transgender man named Jay Kallio died after initially being denied breast cancer treatment at a Manhattan medical facility. A doctor reportedly never told him about his cancer diagnosis because the physician took issue with Kallio’s transgender status. Although the diagnosis may have been unavoidable, his illness could have been treated much sooner if outreach about suitable access to health care had been available to him.
Amy Rachel, a 49-year-old trans woman based in Orlando, Florida, who transitioned in 2016, has never seen a PSA targeting trans people either. She got her first mammogram after her gynecologist suggested it, based on her age.
“The tech who performed the X-ray seemed to know some about trans women and what we experience with our breast tissue. She discussed with me how my breast tissue is dense, which apparently is pretty common for trans women,” said Rachel.
Her experience runs contrary to Florida’s stance on radically limiting health care for the trans community. Recently, the state’s Agency for Health Care Administration published guidance prohibiting transgender people from using Medicaid to cover gender dysphoria treatment. Similar legislation is emerging in several states around the country. Anecdotal evidence, too, suggests that trans people still lack access to quality health care.
Access, for many, can begin with awareness. How can we fight for treatment we’re unaware that we might need?
The Affordable Care Act, former President Barack Obama’s health care law, contains a provision that prohibits federally funded health care providers from discriminating based on race, color, national origin, age, disability or sex. Hopefully, a proposed rule under Section 1557 would add LGBTQI-plus to the provision.
This change would not only improve our care; it would encourage providers to invest in outreach to transgender people about receiving mammograms, and it would create financial and legislative motivation to address breast cancer prevention in the trans community.
Ironically, a good amount of anti-trans messaging currently out there can feel like PSAs about limiting our rights. If conservatives have the energy and resources for that, why can’t we do better? Trans people have a laundry list of challenges that keep us from living our healthiest lives. Outreach needs to happen now, while we still have the opportunity to prevent what early statistics suggest.
Check out more stories from Busted, our series that offers an unfiltered exploration and celebration of our boobs and ourselves during breast cancer awareness month.