Beyond the Binary: Advancing Inclusive Breast Cancer Care for Transgender and Gender-Diverse Patients

Abstract

Background: Person-centered, gender-inclusive breast cancer care is essential for improving outcomes in transgender and gender-diverse (TGD) individuals. Given the complexity of breast cancer management, shared decision-making and personalized treatment plans are key to delivering the best care to all patients, regardless of gender identity. Common issues, like misgendering individuals and low screening rates among TGD individuals, reflect inadequate recommendations and clinical training. System-wide improvements are needed to address these inequities. Case Description: A 67-year-old transgender man was diagnosed with stage II triple-negative breast cancer. The initial treatment plan included a bilateral mastectomy for both cancer removal and gender affirmation. However, severe chemotherapy-related complications, patient’s mobility limitations, and anticoagulation therapy rendered this option unfeasible, and the patient received a partial mastectomy instead. Following radiation, the patient was hospitalized for heart failure and placed on capecitabine to prevent recurrence. Clearer screening guidelines for transgender care may have allowed earlier cancer detection, potentially enabling more surgical options and better outcomes. Clinical Significance: This case highlights the need for inclusive, personalized cancer care for TGD individuals. Traditional oncology practices often rely on binary sex markers, overlooking anatomical variations and risking gaps in screening. Implementing organ surveys, where patients report their anatomy, enables more accurate screening. Additionally, gender-inclusive language in clinical settings is crucial, as binary checkboxes and non-affirming language can deter TGD patients from seeking care. Misgendering and lack of TGD-focused training further impact follow-up and screening reluctance. Conclusion: Implementing gender-affirming language, personalized screening protocols, and gender diversity education system-wide is essential to address health inequities and enhance cancer care for TGD patients.