MRI Breast Without and With IV Contrast There is insufficient evidence to support the use of MRI breast without and with intravenous (IV) contrast to screen for breast cancer in this clinical setting. However, MRI screening may have limited use in patients who have undergone direct injection of particles such as silicone, mineral oil, liquid paraffin, or petroleum jelly to augment the breasts because fibrosis and injection granulomas can obscure the breast tissue on mammography and ultrasound (US). Hence, contrast-enhanced breast MRI is the preferred modality for breast cancer detection in patients who have undergone breast augmentation with free-particle injections [4,10]. US Breast There is insufficient evidence to support screening with US breast in this clinical setting. A small study of screening whole-breast US in 50 transgender women found no cancers [11]. The majority of patients were on estrogen therapy (94%) and had no family history of breast cancer (88%). However, the lack of incremental cancer detection may be secondary to the small sample size. Transgender Breast Cancer Screening to hormones as well as small sample size and relatively short duration of follow-up. Large prospective cisgender studies have shown that exogenous hormones, in particular estrogen and progestin, increase breast cancer risk in cisgender postmenopausal females [18-20], which could support a role for screening in this clinical setting. In the absence of definitive data, some transgender health experts and professional societies recommend digital mammography or DBT to screen for breast cancer in transgender women with higher-than-average risk of breast cancer (https://transcare. ucsf.edu/guidelines/breast-cancer-women). There is no consensus on the age at which to initiate screening in this clinical setting. The Endocrine Society recommends screening transgender women with the same frequency as cisgender women [10].
Transgender Breast Cancer Screening. MRI Breast Without and With IV Contrast There is insufficient evidence to support the use of MRI breast without and with intravenous (IV) contrast to screen for breast cancer in this clinical setting. However, MRI screening may have limited use in patients who have undergone direct injection of particles such as silicone, mineral oil, liquid paraffin, or petroleum jelly to augment the breasts because fibrosis and injection granulomas can obscure the breast tissue on mammography and ultrasound (US). Hence, contrast-enhanced breast MRI is the preferred modality for breast cancer detection in patients who have undergone breast augmentation with free-particle injections [4,10]. US Breast There is insufficient evidence to support screening with US breast in this clinical setting. A small study of screening whole-breast US in 50 transgender women found no cancers [11]. The majority of patients were on estrogen therapy (94%) and had no family history of breast cancer (88%). However, the lack of incremental cancer detection may be secondary to the small sample size. Transgender Breast Cancer Screening to hormones as well as small sample size and relatively short duration of follow-up. Large prospective cisgender studies have shown that exogenous hormones, in particular estrogen and progestin, increase breast cancer risk in cisgender postmenopausal females [18-20], which could support a role for screening in this clinical setting. In the absence of definitive data, some transgender health experts and professional societies recommend digital mammography or DBT to screen for breast cancer in transgender women with higher-than-average risk of breast cancer (https://transcare. ucsf.edu/guidelines/breast-cancer-women). There is no consensus on the age at which to initiate screening in this clinical setting. The Endocrine Society recommends screening transgender women with the same frequency as cisgender women [10].