HYDERABAD: In the hullabaloo of various news items and concerns, there is less focus on transgender communities when it comes to their health especially breast cancer given there’s not much awareness about it. Dr Ridhima Bindlish, Consultant Breast Oncoplastic Surgeon, who works at Basavatarakam Indo-American Cancer Hospital and Research Hospital, Banjara Hills, spoke about breast cancer risks among the transgender at Shilparamam where Indian Council for Cultural Relations had organised a cultural programme this weekend. She spoke to us more about the issue in an exclusive interview:
Why is breast cancer among the transgender population is not much talked about?
There are many stigmas that transgender people face which hinders them from getting proper health care. The primary barrier is the social stigma leading them to hide their identity to avoid discrimination. Secondly, there is still a lack of knowledge and training amongst care providers. Thirdly, there are still legal and monetary complications faced by them. But with changing legal and social scenarios, we can hope for the situation to get more and more friendly for our transgender population where they can exercise their right to proper health care in future.
Is there an increased risk of breast cancer among the transgender population?
At present, the risk of breast cancer in the transgender population is lacking due to heterogeneity in the population. A study conducted and published in the Netherlands in 2019 reported an increased risk of breast cancer in transgender women (male gender assigned at birth, female gender identity) as compared to cisgender men. The main reason was an alteration in their bodies with hormones, silicone injections, surgery, or a combination thereof. Feminising hormonal therapy primarily includes estrogen and androgen-reducing medication such as spironolactone. But a similar risk was reported in transgender men (female gender assigned at birth, male gender identity) as natal women who did not undergo sex reassignment surgery, regardless of whether they took hormonal supplements. But future studies are required to investigate in more detail the cause of breast cancer in transgender people receiving hormone treatment.
How can others be more inclusive in terms of providing support?
The key to providing better care is to accept that people are free to express their identities differently from the norms set by society and that basic health care is the right of all despite their gender preference. The importance of this issue has been having recognized and most hospitals and clinicians are working their best to make the health care system more friendly for the LGBTQIA+ population where they can feel comfortable to express their concerns and not feel discriminated against. Clinicians treating them should be aware of strictly maintaining patient-doctor confidentiality so that people can openly discuss their concerns and get correct guidance and treatment.
Does a transgender person affected feel different as compared to when a cisgender person is affected?
Most of the time, since many hide the relevant medical information, it becomes difficult for clinicians to diagnose it correctly. A transgender person might not correctly inform
the clinician regarding hormonal supplements they are taking or the surgical procedure done for body imaging. This can cause difficulty in advising correct imaging and treatment modality. There should be complete transparency between
the treating clinician and the transgender person so that the best treatment can be provided.
What are the treatments available?
Treatment modalities include clinical examination, appropriate imaging and tissue biopsies to confirm the diagnosis. Surgery, Chemotherapy, Radiotherapy and Hormonal therapy are the four main treatment modalities. But of course, it is tailored for each patient specifically according to their diagnosis and stage of the disease.