Breast Cancer in LGBTQ+ People

Why this guide matters

Breast cancer can affect anyone who has breast tissue. That includes lesbian, gay, bisexual, trans, non-binary and queer (LGBTQ+) people, whatever their gender. The basic facts about breast cancer are the same for everyone, but LGBTQ+ people can face extra hurdles, such as confusion about who is invited for screening, worry about how they will be treated, and a shortage of information written with them in mind.

The reassuring message is that the NHS is for everyone, and you have the same right to good care as anyone else. This page brings the key information together in one place: what affects your risk, how breast screening works depending on how you are registered with your GP, things that are worth knowing if you are trans or non-binary, and where to find support that understands you.

This is general, educational information, not personal medical advice. If you notice a breast or chest change, or you have questions about your own screening or treatment, please speak to your GP or breast care team. They can give advice based on your own body, your medical history and any hormones or surgery you have had.

Understanding your risk

Being LGBTQ+ does not, on its own, cause breast cancer. There is no gene or sexual orientation that gives someone the disease. What research suggests is that some risk factors for breast cancer are more common in parts of the LGBTQ+ community, and being aware of them can help you look after your health. According to Cancer Research UK, the main things that raise the risk of breast cancer for everyone include getting older, drinking alcohol, being overweight, and family history.

Studies highlighted by Cancer Research UK and others have found that, on average, some groups of lesbian and bisexual women are more likely to drink alcohol at higher levels and are more likely to be overweight than heterosexual women. Drinking less alcohol and keeping to a healthy weight are two of the clearest ways anyone can lower their breast cancer risk, according to the NHS and Cancer Research UK. Not having had children, or having them later in life, can also slightly raise breast cancer risk, and this is more common in some LGBTQ+ groups.

Some general points about risk that apply to everyone:

• Cutting down on alcohol lowers your risk. The less you drink, the lower the risk, according to Cancer Research UK.
• Keeping to a healthy weight, especially after the menopause, helps lower risk.
• Being physically active is linked with a lower risk of breast cancer.
• A strong family history of breast or ovarian cancer can raise risk; your GP can advise if this applies to you.
• Getting older is the biggest single risk factor, which is why screening is offered from age 50.

Worrying about your time being wasted, or about how you will be treated, should never stop you getting a change checked. A breast or chest change is exactly what your GP wants to see, and most changes turn out not to be cancer.

How NHS breast screening works for you

The NHS Breast Screening Programme offers a mammogram (an X-ray of the breast) every 3 years to women aged 50 up to their 71st birthday. The aim is to find cancers early, before they cause symptoms. How you are invited depends largely on how you are registered with your GP, rather than on your gender identity itself. This is the part that causes the most confusion for LGBTQ+ people, so it is worth understanding clearly.

According to the NHS and Cancer Research UK:

• If you are registered with your GP as female, you will be invited automatically for screening every 3 years between 50 and 71, whatever your gender identity.
• If you are registered with your GP as male, you will not be invited automatically, even if you have breast tissue. You can ask your GP or local breast screening service for an appointment.
• If your sex is recorded as 'not specified', or you are not sure how you are registered, it is worth checking with your GP so you are not missed, and you can ask your local breast screening service for an appointment if needed.
• Whatever your registration, if you have a new lump or other change, contact your GP straight away rather than waiting for screening.

Screening is for people without symptoms. It is not a test for a lump you have already found. If you notice a change, that needs a separate, prompt appointment with your GP. It is also your choice whether to take part in screening at all; the NHS provides information to help you decide what is right for you.

Information for trans men and non-binary people assigned female at birth

If you were assigned female at birth and have not had chest (top) surgery, you still have breast tissue and the usual screening advice applies. According to Cancer Research UK, if you are registered with your GP as female you will be invited automatically; if you are registered as male, you can request screening through your GP or local breast screening service.

If you have had chest reconstruction or top surgery, some breast tissue usually remains, but a standard mammogram may not be possible or useful, according to Cancer Research UK. In this situation it is especially important to be aware of your chest and to report any new changes, such as a lump, skin change, or any change around the nipple, to your doctor without waiting for a screening invitation. Taking testosterone does not remove the need to stay chest aware.

Mammograms can feel uncomfortable or distressing for some trans and non-binary people, both physically and emotionally. You are allowed to explain your needs in advance. You can ask the screening service about what the appointment involves, request a longer or quieter appointment, and bring someone with you for support. It also helps to let the team know if you are taking testosterone.

Information for trans women and non-binary people assigned male at birth

Taking feminising hormones (oestrogen) leads to the growth of breast tissue, and this raises breast cancer risk compared with people who do not take them. According to the NHS, if you have been taking feminising hormones for longer than 2 years you can have breast screening, because these hormones increase risk. Even so, research summarised by Cancer Research UK suggests the overall risk for trans women remains lower than for cisgender women (women assigned female at birth), although the numbers studied so far are small and more research is needed.

What this means in practice, according to the NHS and Cancer Research UK:

• If you are registered with your GP as female, you will be invited for screening automatically from age 50.
• If you are registered as male and have taken feminising hormones for longer than 2 years, you can ask your GP or breast screening service about arranging screening.
• If you have breast implants, let the radiographer know, as implants can make mammograms harder to read. You do not have to disclose that you are trans if you would rather not.
• Whatever your situation, report any new lump or change in your chest to your doctor promptly.

If you are unsure whether screening is right for you, your GP, gender service or local breast screening service can talk it through with you and weigh up the benefits and limitations for your own situation. You should never stop or change gender-affirming hormones because of a worry about cancer without first discussing it with the team who prescribes them.

Barriers to care and how to get past them

Many LGBTQ+ people have had experiences in healthcare that left them feeling judged, misunderstood or invisible. This can make people put off appointments, avoid screening, or hold back information that a clinician needs. Research highlighted by Cancer Research UK and others has found that lesbian, bisexual and trans people can have lower uptake of some cancer screening. None of this is the fault of the individual; it reflects services that have not always been welcoming. The good news is that things are improving, and there is plenty you can do to get the care you deserve.

Practical steps that can help:

• Find a GP practice where you feel comfortable. Many practices now display that they are LGBTQ+ friendly, and you can ask to see a particular GP or nurse.
• Be as open as you feel able about your body, hormones and any surgery, as this helps your clinician give you the right care. What you say is confidential.
• Take someone with you to appointments if it helps, and write down your questions beforehand.
• Ask for a chaperone, a longer appointment, or a quiet space if examinations or mammograms feel difficult.
• If you feel you have been treated unfairly, you can give feedback through the practice or hospital, or ask the Patient Advice and Liaison Service (PALS) for support.

Knowing your own body matters whatever your gender. Cancer Research UK encourages everyone to be breast or chest aware, which simply means knowing what is normal for you so you notice if something changes. See your GP if you notice a new lump or thickening, a change in size, shape or feel, skin changes such as dimpling or redness, nipple changes or discharge, or pain that does not go away.

Finding inclusive support

Going through breast cancer worries, or a diagnosis, can feel isolating, and it can feel doubly so if you are not sure a service will understand you. You do not have to face it alone, and inclusive support does exist. Your breast care nurse is there for you whatever your gender or sexuality, and is a good first point of contact for questions about your treatment.

Trusted UK organisations that offer free, reliable information and support include:

• Cancer Research UK, for clear information about cancer, screening and risk, including pages written for trans and non-binary people.
• Macmillan Cancer Support, which has information and support for people affected by cancer, including trans and non-binary people, alongside wider emotional and practical help.
• Breast Cancer Now, for information, support and ways to connect with others affected by breast cancer.
• LGBT Foundation and other community organisations, which can offer support and signposting for LGBTQ+ people navigating health services.

At breastcancer-charity.org our mission is to improve early detection and access to care in underserved communities, where clear, welcoming information can be harder to reach. LGBTQ+ people are sometimes overlooked by mainstream health messages, and no one should miss out on early detection because they were not sure the service was for them. It is. If anything here raises a question about your own health, please speak to your GP or breast care team, who can give advice tailored to you.