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Transgender patients comprise a sensitive population of medically underserved individuals who are less likely than their cisgender counterparts to undergo traditional medical management and cancer screening. Breast cancer risk and incidence in transgender patients remains effectively unknown and likely underreported, and we propose an algorithm for screening and risk assessment of breast cancer in male and female transgender individuals in the context of hormone-replacement therapy, type of chest reconstruction, and risk factor profiles. Through a literature review of current guidelines, recommendations and position statements for breast cancer screening in transgender and cisgender women, we found that transgender women with a positive family history and/or genetic risk of breast cancer require specialized screening after an extent of hormone therapy, and that no surveillance guidelines currently exist for cisgender women after chest reconstruction, but that transgender men with a positive family history and/or genetic risk of breast cancer also require specialized screening based on the presence and type of chest reconstruction.

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