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Transgender Breast Cancer Screening

Variant: 1   Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
Procedure Appropriateness Category Relative Radiation Level
Digital breast tomosynthesis screening May Be Appropriate ☢☢
Mammography screening May Be Appropriate ☢☢
US breast Usually Not Appropriate O
MRI breast without and with IV contrast Usually Not Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 2   Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
Procedure Appropriateness Category Relative Radiation Level
Digital breast tomosynthesis screening Usually Appropriate ☢☢
Mammography screening Usually Appropriate ☢☢
US breast Usually Not Appropriate O
MRI breast without and with IV contrast Usually Not Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 3   Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
Procedure Appropriateness Category Relative Radiation Level
US breast Usually Not Appropriate O
Digital breast tomosynthesis screening Usually Not Appropriate ☢☢
Mammography screening Usually Not Appropriate ☢☢
MRI breast without and with IV contrast Usually Not Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 4   Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
Procedure Appropriateness Category Relative Radiation Level
Digital breast tomosynthesis screening May Be Appropriate ☢☢
Mammography screening May Be Appropriate ☢☢
US breast Usually Not Appropriate O
MRI breast without and with IV contrast Usually Not Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 5   Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies (“top surgery”) at any age and any risk.
Procedure Appropriateness Category Relative Radiation Level
US breast Usually Not Appropriate O
Digital breast tomosynthesis screening Usually Not Appropriate ☢☢
Mammography screening Usually Not Appropriate ☢☢
MRI breast without and with IV contrast Usually Not Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 6   Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
Procedure Appropriateness Category Relative Radiation Level
Digital breast tomosynthesis screening Usually Appropriate ☢☢
Mammography screening Usually Appropriate ☢☢
US breast Usually Not Appropriate O
MRI breast without and with IV contrast Usually Not Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 7   Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
Procedure Appropriateness Category Relative Radiation Level
Digital breast tomosynthesis screening Usually Appropriate ☢☢
Mammography screening Usually Appropriate ☢☢
US breast May Be Appropriate O
MRI breast without and with IV contrast May Be Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Variant: 8   Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
Procedure Appropriateness Category Relative Radiation Level
Digital breast tomosynthesis screening Usually Appropriate ☢☢
Mammography screening Usually Appropriate ☢☢
MRI breast without and with IV contrast Usually Appropriate O
US breast May Be Appropriate O
MRI breast without IV contrast Usually Not Appropriate O

Panel Members
Summary of Literature Review
Introduction/Background
Discussion of Procedures by Variant
Variant 1: Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
Variant 1: Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
A. Digital Breast Tomosynthesis Screening
Variant 1: Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
B. Mammography Screening
Variant 1: Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
C. MRI Breast Without and With IV Contrast
Variant 1: Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
D. MRI Breast Without IV Contrast
Variant 1: Breast cancer screening. Transfeminine (male-to-female) patient, 40 years of age or older with past or current hormone use equal to or greater than 5 years. Average-risk patient.
E. US Breast
Variant 2: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
Variant 2: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
A. Digital Breast Tomosynthesis Screening
Variant 2: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
B. Mammography Screening
Variant 2: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
C. MRI Breast Without and With IV Contrast
Variant 2: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
D. MRI Breast Without IV Contrast
Variant 2: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with past or current hormone use equal to or greater than 5 years. Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
E. US Breast
Variant 3: Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
Variant 3: Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
A. Digital Breast Tomosynthesis Screening
Variant 3: Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
B. Mammography Screening
Variant 3: Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
C. MRI Breast Without and With IV Contrast
Variant 3: Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
D. MRI Breast Without IV Contrast
Variant 3: Breast cancer screening. Transfeminine (male-to-female) patient with no hormone use (or hormone use less than 5 years) at any age. Average-risk patient.
E. US Breast
Variant 4: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
Variant 4: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
A. Digital Breast Tomosynthesis Screening
Variant 4: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
B. Mammography Screening
Variant 4: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
C. MRI Breast Without and With IV Contrast
Variant 4: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
D. MRI Breast Without IV Contrast
Variant 4: Breast cancer screening. Transfeminine (male-to-female) patient, 25 to 30 years of age or older with no hormone use (or hormone use less than 5 years). Higher-than-average risk (patient with personal history of breast cancer or chest irradiation at 10 to 30 years of age, patient with genetic predisposition to breast cancer, patient with family history of breast or ovarian cancer, and untested patient with first-degree relative with genetic predisposition to breast cancer).
E. US Breast
Variant 5: Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies ("top surgery”) at any age and any risk.
Variant 5: Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies ("top surgery”) at any age and any risk.
A. Digital Breast Tomosynthesis Screening
Variant 5: Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies ("top surgery”) at any age and any risk.
B. Mammography Screening
Variant 5: Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies ("top surgery”) at any age and any risk.
C. MRI Breast Without and With IV Contrast
Variant 5: Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies ("top surgery”) at any age and any risk.
D. MRI Breast Without IV Contrast
Variant 5: Breast cancer screening. Transmasculine (female-to-male) patient with bilateral mastectomies ("top surgery”) at any age and any risk.
E. US Breast
Variant 6: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
Variant 6: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
A. Digital Breast Tomosynthesis Screening
Variant 6: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
B. Mammography Screening
Variant 6: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
C. MRI Breast Without and With IV Contrast
Variant 6: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
D. MRI Breast Without IV Contrast
Variant 6: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 40 years of age or older. Average-risk patient (less than 15% lifetime risk of breast cancer).
E. US Breast
Variant 7: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
Variant 7: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
A. Digital Breast Tomosynthesis Screening
Variant 7: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
B. Mammography Screening
Variant 7: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
C. MRI Breast Without and With IV Contrast
Variant 7: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
D. MRI Breast Without IV Contrast
Variant 7: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 30 years of age or older. Intermediate risk (patient with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer).
E. US Breast
Variant 8: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
Variant 8: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
A. Digital Breast Tomosynthesis Screening
Variant 8: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
B. Mammography Screening
Variant 8: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
C. MRI Breast Without and With IV Contrast
Variant 8: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
D. MRI Breast Without IV Contrast
Variant 8: Breast cancer screening. Transmasculine (female-to-male) patient with reduction mammoplasty or no chest surgery, 25 to 30 years of age or older. High risk (patient with genetic predisposition to breast cancer or untested patient with a first-degree relative with genetic predisposition to breast cancer, patient with a history of chest irradiation between 10 to 30 years of age, patient with 20% or greater lifetime risk of breast cancer).
E. US Breast
Summary of Recommendations
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information
References
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Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked.  Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document.  The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged.  The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination