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

Abstract

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. 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. 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. 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.