Nationwide Mammographic Screening Among Transgender and Gender Diverse Individuals

You probably walked past a mammography clinic today, or at least an ad for one - those pastel-pink reminders plastered on bus stops and pharmacy bags telling you to "schedule your screening." But here's a question almost nobody thinks to ask: who are those reminders actually reaching, and who's getting quietly left out of the conversation?

A massive new study in the Journal of Clinical Oncology just dropped some numbers that paint a surprisingly nuanced picture - and for once, the healthcare system might actually be doing something... right? I know, I know. Hold your applause.

The Biggest Study of Its Kind (And That's Not Hype for Once)

Researchers led by Elizabeth Cathcart-Rake at Mayo Clinic dug into the OptumLabs Data Warehouse - a sprawling national dataset - and pulled records on over 10,000 transgender and gender diverse (TGD) individuals alongside 6.2 million cisgender women. They wanted to know a deceptively simple thing: who's actually showing up for mammograms?

The team sorted people into groups - transgender men, transgender women, individuals with gender dysphoria not meeting other TGD criteria (NMOT), and cisgender women - then measured who had "high" screening rates, meaning they completed more than 75% of their recommended mammograms (Cathcart-Rake et al., 2025).

The Numbers Are Actually... Encouraging?

Here's where my built-in skepticism took a hit. The high-adherence rates broke down like this:

• Transgender men: 41.1%
• Cisgender women: 38.3%
• Gender dysphoria NMOT: 11.9%
• Transgender women: 7.4%

Wait. Transgender men are screening at slightly higher rates than cisgender women? Before you start writing headlines about healthcare miracles, let's unpack why this actually makes sense rather than being weird.

Why This Isn't as Backwards as It Sounds

Transgender men - people assigned female at birth who identify as male - generally still have breast tissue unless they've had top surgery. That means they carry breast cancer risk comparable to cisgender women. The fact that they're screening at roughly the same rate as cisgender women suggests clinicians are correctly identifying who needs mammograms based on actual anatomy and risk, not just checking a gender box in the electronic health record.

Meanwhile, transgender women - people assigned male at birth who identify as female - have a much lower breast cancer risk, even with feminizing hormone therapy. Studies suggest their risk is about 46-fold higher than cisgender men but still substantially lower than cisgender women (de Blok et al., 2019). The American College of Radiology recommends screening for transgender women only after age 50 and at least five years of feminizing hormone use (Monticciolo et al., 2025). So that low 7.4% rate? It might actually reflect appropriate, guideline-concordant care rather than neglect.

I'll admit, that's not the narrative I expected. Healthcare systems getting screening right for a marginalized population? Color me cautiously optimistic.

Before We Throw a Parade

Let's pump the brakes, though. A few things keep me from doing a victory lap on behalf of the medical establishment.

First, this study measured who got mammograms, not who should have. The NMOT group's 11.9% rate raises questions - are they being appropriately screened, or are they falling through the cracks because their clinical situations are more ambiguous? Second, previous research has found that only about 1.7% of transmasculine individuals had a mammogram within two years of turning 40, and trans people broadly face disproportionate barriers to healthcare including provider discomfort and dysphoria triggered by screening itself (Bustamante et al., 2023).

Third - and this is the big one - a matched analysis of transgender men versus cisgender women found that even after adjusting for age, race, and insurance factors, differences in screening adherence persisted. So the system is doing better than feared, but "better than feared" is a low bar we've practically tripped over.

Why This Matters Beyond the Data

Breast cancer screening guidelines for transgender individuals have only recently been formalized, and many primary care providers still aren't familiar with them. A 2023 survey found that fewer than one-third of practitioners could correctly identify screening recommendations for transgender women on hormone therapy (Farsi et al., 2023). This study gives us a national baseline - finally, actual data instead of assumptions. It tells us where the gaps are and, surprisingly, where the gaps aren't.

The real takeaway isn't "everything is fine." It's that evidence-based screening appears to be happening for some TGD subgroups, which means the infrastructure exists to make it work for all of them. The question is whether we'll actually close the remaining gaps or just congratulate ourselves and move on. Given healthcare's track record with underserved populations, I'm keeping my skepticism warmed up.

References:

1. Cathcart-Rake EJ, Thao V, Le-Rademacher J, et al. Nationwide Mammographic Screening Among a Large Population of Underserved Subgroups. J Clin Oncol. 2025. DOI: 10.1200/JCO-25-01659. PMID: 41774876.

2. de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652. DOI: 10.1136/bmj.l1652.

3. Monticciolo DL, Newell MS, Moy L, et al. ACR Appropriateness Criteria Female Breast Cancer Screening: 2025 Update. J Am Coll Radiol. 2025. DOI: 10.1016/j.jacr.2025.04.014.

4. Bustamante G, Reiter PL, McRee AL. Mammography screening among transgender and gender diverse adults in the United States. J Gen Intern Med. 2023. DOI: 10.1007/s11606-023-08441-0.

5. Farsi D, Engel K, Engel H, et al. Breast Cancer Screening Recommendations for Transgender and Gender Diverse Patients: A Knowledge and Familiarity Assessment of Primary Care Practitioners. J Gen Intern Med. 2023. DOI: 10.1007/s11606-023-08226-5.

Disclaimer: The image accompanying this article is for illustrative purposes only and does not depict actual experimental results, data, or biological mechanisms.