• Posted August 3, 2026

Transgender 'Top Surgery' Patients Aren't Receiving Adequate Breast Cancer Advice, Researchers Say

Transgender individuals undergoing “top surgery” aren’t being provided adequate counseling about their future risk of breast cancer, a new study says.

Top surgery — gender-affirming mastectomy — might appear to reduce or eliminate breast cancer risk by removing most or all breast tissue, researchers said.

But 10% to 20% of breast cancers are caused by genetic or hereditary risk factors, and these risks will remain even after top surgery, researchers said.

Interviews with healthcare professionals indicate that patients aren’t always informed of this fact, and therefore, of the continued need to receive breast cancer screening, researchers reported July 29 in the journal Breast Cancer Research and Treatment.

Many patients also aren’t receiving testing for the presence of breast cancer-linked genes like BRCA mutations, which might guide their future screening decisions, researchers said.

“Every person — transgender or cisgender — deserves clear information about their cancer risk and access to prevention. As it stands, trans people are diagnosed with cancer at later, more dangerous, stages than cisgender people,” lead researcher Kim Zayhowski said in a news release. She’s an assistant professor of medical sciences and education at Boston University Chobanian & Avedisian School of Medicine.

For the study, researchers interviewed 20 healthcare professionals — primary care physicians, genetic counselors, oncologists and plastic surgeons — about current practices related to breast cancer risk assessments for transgender patients.

Results showed that members of a person’s care team always tend to figure someone else will handle such a risk assessment.

Conflicting guidelines also force doctors to rely on their own judgment, resulting in inconsistent practice, researchers found.

“Many healthcare professionals caring for transgender patients want to help, but there is currently no standardized conversation about breast/chest cancer risk (e.g. what screening looks like after surgery or whether they should consider having more tissue removed based on a genetic or familial risk for cancer),” Zayhowski said.

Another problem is that gender-affirming mastectomies tend to occur at younger ages, before a person is eligible for regular breast cancer screening, researchers said.

“We’re talking about top surgery in the twenties. When should we get them tested for the BRCA? What is the plan there?” one genetic counselor said in an interview.

These structural inadequacies are compromising patient safety, researchers concluded.

“[I had] a patient who had had top surgery elsewhere in a different state several years ago, but then came in with a palpable mass in the chest wall, which ended up being breast cancer,” one cancer surgeon told the researchers. 

“And then I have had one or two who’ve had incidental cancers, which were really only found incidentally in the specimens having had top surgery,” they added.

To improve care, the research team is developing CHESTcare — Cancer & Hereditary Risk Education & Support for Transgender and nonbinary individuals.

This online toolkit will integrate cancer and hereditary risk education with support for informed decision-making about breast/chest cancer screening in the context of gender-affirming care, researchers said.

More information

Johns Hopkins Medicine has more about top surgery.

SOURCES: Boston University School of Medicine, news release, July 30, 2026; Breast Cancer Research and Treatment, July 29, 2026