A National Multidisciplinary Survey of Current Practice Trends in Breast Cancer Screening After Gender Affirming Mastectomy: A Call for Inclusive Care.

BACKGROUND

Gender-affirming mastectomy (GAM) often preserves residual breast tissue, conferring an unknown but nonzero risk of breast cancer. However, current breast screening guidelines are inconsistent and lack evidence-based specificity for this population. To date, no study has evaluated how plastic and breast surgeons approach post-GAM cancer surveillance or their confidence in doing so. Therefore, this study aimed to evaluate the practices and perspectives of plastic and breast surgeons regarding breast cancer screening following GAM.

METHODS

A 12-item electronic survey was distributed to 5802 ASPS and 707 ASBrS members (2024-2025), assessing practice profiles, guideline familiarity, screening practices, and provider confidence.

RESULTS

The survey was completed by 586 ASPS (25.8% perform GAM) and 101 ASBrS members. In total, 34.1% of respondents were unaware of existing breast cancer screening recommendations for transgender patients while 40.5% reported not adhering to them. In comparing guideline utilization between ASPS and ASBrS members, ASPS members favored WPATH guidelines (ASPS: 31.8%; ASBrS: 11.9%, P < 0.001), whereas ASBrS members favored ACR criteria (ASBrS: 32.7%; ASPS: 12.6%, P < 0.001). For an average risk patient following GAM, ASPS members provided 25 distinct screening recommendations while ASBrS provided 16 distinct screening recommendations. Only 23.8% of providers felt confident in their recommendations. Nearly all respondents (ASPS: 94%, ASBrS: 93.1%) supported development of transgender-specific, evidence-based guidelines.

CONCLUSION

This national, multidisciplinary cross-sectional study reveals substantial variability in screening practices and low provider confidence. Evidence-based, transgender-inclusive guidelines are urgently needed. Advancing inclusive cancer prevention will require data-driven guidelines, provider education, and system-level reforms to ensure equitable care for transgender and gender-diverse individuals.