Gender-affirming mastectomy is one of the most common procedures within gender-affirming surgery: breast tissue is removed so that the chest matches the person’s felt identity. Before entering the operating room, one question should have an answer: does this person carry a hereditary breast cancer risk? A qualitative study published in Breast Cancer Research and Treatment interviewed twenty US health professionals caring for transgender and gender diverse people in this setting and found an uncomfortable pattern: nobody feels that assessing that risk is their job.
A common operation that comes before screening programmes start
The paper starts from a clinical reality: gender-affirming mastectomy is usually performed at young ages, often before the age at which population breast cancer screening begins. That makes the pre-surgical consultation the only natural moment to talk about family history, hereditary variants and what to do later with residual tissue and follow-up.
To document it, the authors conducted in-depth interviews with twenty professionals experienced in caring for transgender people considering or undergoing this surgery: six primary care providers, five cancer genetic counsellors, six oncologists and three plastic surgeons. The interviews were analysed within a social constructivist framework using reflexive thematic analysis.
Five cracks in the same chain of care
Five recurring themes emerged. The first is the absence of a clear owner: no professional group perceives the integration of breast cancer risk assessment as its task. The second is conflicting clinical guidelines, which push each clinician to rely on personal judgement and produce inconsistent practice from one service to another.
The third is that care pathways depend on particular individuals — the authors call them individual champions — rather than on standardised protocols. The fourth is age: operating before screening begins complicates the conversation about risk and about what a genetic test result means for someone in their twenties. The fifth points to structural failures in care delivery that compromise patient safety.
What they propose to close the gap
The authors do not ask for indiscriminate testing; they ask for an explicit division of responsibility. Their proposal is to assign clear institutional accountability, harmonise guidelines with the available evidence, standardise referral pathways and, above all, embed genetic counselling inside multidisciplinary gender-affirming care teams. In other words, hereditary risk assessment should stop being a step that happens — or does not — depending on who sees the patient, and become a predictable part of the surgical pathway, like informed consent or post-operative follow-up.
The limits: twenty voices, not a full picture
This is a qualitative study, which narrows its conclusions. Twenty interviews describe how the problem is perceived in one health system, the US one; they cannot quantify how often risk assessment fails, nor allow cross-country comparison. They do not measure clinical outcomes either: there are no data on later diagnoses or mortality. What the study does document clearly is a care gap acknowledged by the very professionals who deliver that care, and a concrete route to close it.
Source: Healthcare professional perspectives on hereditary breast cancer risk assessment prior to gender-affirming mastectomy. Zayhowski K, Blumen K, Mittendorf KF, Pratt R, Berro T, Streed CG Jr, MacFarlane IM. Breast Cancer Research and Treatment 2026;218(2):22. DOI: 10.1007/s10549-026-08038-9.
Article published on dosier.es. Image generated with artificial intelligence (marta ai → marta.syf.es).
