Transgender patients face multiple barriers
Mammography in cranio-caudal (A) and medio-lateral oblique (B) views in a 52-year-old transgender woman after 5 years of hormone therapy.
Anna D’Angelo from the Catholic University of the Sacred Heart in Rome addressed transgender breast imaging, emphasising the importance of correct terminology. Transgender, she clarified, is an umbrella term for people whose gender identity does not align with the sex assigned to them at birth, while cisgender describes people whose gender identity aligns with their birth-assigned sex.
D’Angelo focused on patients undergoing feminising and masculinising gender-affirming surgery and gender-affirming hormone therapy (GAHT). However, evidence of breast cancer risk in this population remains limited due to a lack of long-term follow-up, inadequate documentation of hormone exposure, and an absence of prospective studies.
Screening challenges and healthcare inequities
Breast cancer screening for transgender individuals faces multiple challenges, D’Angelo noted. These include low participation in or awareness of screening programmes, lack of trust in healthcare professionals, and poor knowledge of screening guidelines among both the transgender population and healthcare providers. A lack of training and education among clinicians compounds the problem.
‘Radiologists must be familiar with the correct terminology and the types of gender-affirming processes; healthcare providers – both GPs and specialists – must be aware of the most current guidelines for the TGD population; the scientific societies and individual research groups must collaborate to close gaps in research and education, reducing healthcare inequities; and LGBTQIA+ advocacy groups should be involved in research and educational activities,’ D’Angelo concluded. She confirmed that EUSOBI is launching a survey on radiologists’ knowledge of transgender populations in breast imaging.
Dr Machteld Keupers from the University Hospital Leuven in Belgium discussed paediatric breast imaging, covering how to perform imaging in this age group, the most common benign and malignant breast lesions in children, and clinical management of paediatric breast masses.
Profiles:
Professor Nuala Healy is Chair of Radiology at RCSI University of Medicine and Health Sciences in Dublin, Ireland, where she leads the academic Department of Radiology while providing patient care as a consultant radiologist at Beaumont Hospital. She is the research lead for the British Society of Breast Radiology.
Anna D’Angelo is a radiologist at the Department of Radiology, Catholic University of the Sacred Heart and Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy. Her research focuses on breast imaging, including neoadjuvant chemotherapy response assessment, automated breast ultrasound, MRI in breast cancer staging, and imaging in transgender populations. She has published extensively on ultrasound-guided biopsy techniques and radiomic applications in breast imaging.
Dr Machteld Keupers is a radiologist at the Department of Radiology, University Hospitals Leuven (UZ Leuven), Belgium, and is affiliated with the Department of Imaging and Pathology at KU Leuven. Her expertise includes breast imaging, mammography, digital breast tomosynthesis, and paediatric breast imaging. She has published research on breast imaging surveillance after curative treatment and is a regular faculty member at the Update in Breast Imaging conference.