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A National Survey of Current Practice Trends in Breast Cancer Screening after Gender Affirming Mastectomy: A Call for Inclusive Care
Matthew A. DePamphilis, Sasha Wood, Katya Remy, Ian L. Valerio, William G. Austen, Katherine H. Carruthers
Massachusetts General Hospital
2025-01-16
Presenter: Matthew A. DePamphilis
Affidavit:
NA
Director Name: NA
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Gender-affirming mastectomy (GAM) may leave behind varying amounts of breast tissue conferring an unknown, nonzero risk of developing breast cancer. Current breast cancer screening guidelines provide minimal evidence-based direction tailored to this patient population. This study aimed to assess the current practices by plastic surgeons when recommending breast cancer screening following GAM.
Methods
A 12-item electronic survey was distributed to 5802 members of the American Society of Plastic Surgeons (ASPS) in 2024. Survey items focused on familiarity with current screening guidelines, individual practices, and confidence in recommendations. Descriptive analyses were performed.
Results
A total of 582 responses were received and among respondents, 25.4% perform GAM. Of the currently available breast screening recommendations, 31.1% of respondents follow the WPATH Standards of Care, 20.9% guidelines for cisgender women, 12.8% ACR Appropriateness Criteria, 9.5% Fenway Health guidelines, 5.4% UCSF guidelines, and 20.3% none. Only 1 in 4 plastic surgeons express confidence in providing the appropriate recommendations. The overwhelming majority (93.9%) of plastic surgeons support the development of more specific, evidence-based, and transgender-inclusive screening guidelines.
Conclusion
This is the first study to provide insight on plastic surgeons perspectives on the current breast cancer screening guidelines for transgender individuals. Our findings reveal significant variability in practice among ASPS members regarding breast cancer screening after GAM. There is a critical need to develop improved guidelines in order to provide equitable cancer screening surveillance. Longitudinal research aimed at understanding breast cancer risk following GAM is needed to aid in the development of evidence-based screening protocols.
