Trans and gender diverse people with breast cancer

Trans and gender diverse (trans) people may have questions and concerns about how they will be impacted by breast cancer. These may include:

• Will my treating team respect my affirmed gender?
• How will cancer treatment affect my body image and gender affirmation?
• Will I be able to access trans inclusive peer support?

You have the right to healthcare that is free from discrimination and harassment.

Questions about breast cancer

Will the treating team respect my affirmed gender?

You may have concerns about whether your treating team will acknowledge and respect your affirmed gender. Will they use your correct name and pronouns? Will they understand your needs as a trans person? You may be worried about experiencing discrimination in cancer care.

You have the same rights as all other people to safe, high-quality and respectful health care. See Legal issues for LGBTIQ+ people with breast cancer

Finding a trans friendly treating team can provide reassurance that you will be treated with dignity and respect. See LGBTIQ+ friendly breast cancer services.

If you feel uncomfortable or unhappy with any interactions during your cancer care, ask to speak to someone else in your treating team, get a second opinion, or make a complaint.

How will treatment for breast cancer impact my body image and gender?

Treatment for breast cancer may affect your body image and gender. See LGBTIQ+ body image and gender identity

Some treatments may result in physical changes that you do not like, or that make you feel dysphoric. Other changes may alleviate gender dysphoria.

For some people mastectomy can help to affirm their gender or contribute to gender euphoria if there is a preference for being flat. For others, mastectomy and other breast surgery can be distressing. Ceasing or reducing gender affirming hormone therapy, and breast cancer treatment side effects such as hair loss, scarring and weight changes, may also affect how you feel about yourself and how others see you.

Emotions can be unpredictable. You may have feelings of sadness and loss related to bodily changes, even if you had considered making these changes as part of gender affirmation. Alternatively, you may feel positively towards changes that you thought would be distressing.

Can I still take gender-affirming hormone therapy during breast cancer treatment?

There are very few guidelines to inform clinical decision making about breast cancer treatment and gender affirming hormone therapy. Discussing your gender with your treating team can help them work with you to affirm your gender when making decision about cancer treatment. Your treating team will advise whether or not you can continue taking hormones.

Is a mastectomy the same as having top surgery?

Although a mastectomy can be part of having top surgery, they are not always the same.

A mastectomy for breast cancer involves the removal of one or both breasts. It may also involve the removal of one or more lymph nodes from the armpit. The appearance of your chest following a mastectomy will depend on the amount of tissue removed.

Top surgery usually involves the removal of breast tissue to sculpt the chest into pectoral form. Top surgery is a gender-affirming procedure.

It is important to discuss your expectations and concerns about surgery for breast cancer with your treating team.

Sometimes treating teams do not initiate discussions about the impact of surgery on gender. They may make inaccurate assumptions about your gender or the meaning of mastectomy for you. Talking through your options with your treating team before you have surgery is important.

How can I connect with other trans and gender diverse people with breast cancer?

Finding social connection and support  may be an important part of your breast cancer journey. It can be helpful to speak to other trans and people who have similar experiences to you. You may be able to find connections through official cancer support websites or groups on Facebook, for example. See Social support for LGBTIQ+ people.

BCNA has an online discussion group for people who identify as LGBTIQ+ with breast cancer.

Breast cancer vs chest cancer

We understand that some trans and gender diverse people prefer the term chest to breast.

When it comes to  breast cancer, we use the term breast as the cancer has developed in the breast tissue. Everyone has some breast tissue. Men who develop breast cancer have breast cancer, not chest cancer, and use this term.

Chest cancers are thoracic cancers such as lung, thymic and tracheal (windpipe) cancers.

Acknowledgements

These materials were developed from the Out with Cancer Study, conducted at Western Sydney University, and funded by the Australian Research Council. Thanks are offered to the Out with Cancer study committee members with lived experience of cancer, BCNA LGBTIQ+ consumer representatives, ACON and LGBTIQ+ Health Australia who contributed their time and expertise.

BCNA's LGBTIQ+ project was undertaken with support from Cancer Australia through the Supporting Women in Rural Areas Diagnosed with Breast Cancer program.

Resources

Cancer Council NSW has detailed information including a downloadable book that will help you understand how cancer and its treatment may affect LGBTQI+ people – lesbian, gay, bisexual, transgender, queer, and other diverse sexualities and genders, as well as people with intersex variations.

TransHub is a platform for all trans and gender diverse people in NSW, their loved ones, allies and health providers.

Transgender Victoria is the leading body for trans and gender diverse advocacy, training, and resource development in Victoria. Their website contains information for trans people, friends and family, and clinicians. They also have support a variety of peer-support programs.

TransFolk of WA is a peer support service for transgender people and their loved ones in Western Australia. Services include events, Facebook Groups, and Social & Support Groups.