Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The adult transgender population in the US:
    • Is estimated to be 0.6% of the population:
      • At least 1.4 million people
  • Cross sex hormonal therapy:
    • Is estrogen based for people transitioning male to female:
      • This results in stimulation of breast glandular tissue:
        • The breast tissue will develop with muted Tanner stage development:
          • Subareolar breast buds typically develop at 3 to 6 months of treatment and maximum development is achieved after 2 to 3 years of treatment
    • The addition of progesterone:
      • Has not been shown to increase breast size or add to feminization:
        • Thus, the risk of adding progesterone appears to outweigh the benefits
  • Breast enhancement / augmentation is a safe procedure:
    • Providers should educate their patients about the associated risk of various implant illnesses, including large cell lymphoma
  • Guidelines regarding imaging for transgender women:
    • May follow established guidelines for cis gendered males, the number of years of estrogen therapy, breast development, and known risk factors
  • The American College of Radiology guidelines:
    • Support digital breast  tomosynthesis or routine mammography for:
      • Transgender women 40 years old or more with more than 5 years of hormone use
    • For transgender women older than 25 to 30 years of age with more than 5 years of current or prior hormone therapy use or for individuals with genetic predisposition to breast cancer:
      • ACR also supports digital breast tomosynthesis or routine mammography as appropriate
    • In transgender women deemed at average risk with no hormone use or less than 5 years of use:
      • Routine breast screening imaging is not appropriate or necessary:
        • There is no longitudinal data, however
  • The risk of breast cancer for transgender women:
    • Does not appear to be significantly greater than that of natal males
  • Cross sex hormone therapy:
    • Does not appear to alter breast cancer risk
  • References:
    • Hayward J. Updates in Transgender Breast Imaging. Seminars in Ultrasound CT and MRI. Published online November 2022. doi:https://doi.org/10.1053/j.sult.2022.10.002
    • Guerrero DL, Sowinski J, Patel KM. (Apr 26, 2022). Effects of Gender-affirming Medical and Surgical Therapy on Breast Imaging Findings and Breast Cancer Risk. Appl Radiol. 2022; 51(3):24-32.
    • Legato MJ. PLASTICITY of SEX : The Molecular Biology and Clinical Features of Genomic Sex, Gender … Identity and Sexual Behavior.;  pages 187-205; 2020.
    • Lockhart, Ryan, and Aya Kamaya. “Patient-Friendly Summary of the ACR Appropriateness Criteria: Transgender Breast Cancer Screening.” Journal of the American College of Radiology , Jan. 2022, doi:https://doi.org/10.1016/j.jacr.2021.10.015.
    • Pivo S, Montes J, Schwartz S, et al. Breast Cancer Risk Assessment and Screening in Transgender Patients. Clinical Breast Cancer. 2017;17(5):e225-e227. doi:https://doi.org/10.1016/j.clbc.2016.08.003
    • Brown A, Lourenco AP, Niell BL, et al. ACR Appropriateness Criteria® Transgender Breast Cancer Screening. Journal of the American College of Radiology. 2021;18(11):S502-S515. doi:https://doi.org/10.1016/j.jacr.2021.09.005
    • Meggetto O, Peirson L, Yakubu M, et al. Breast cancer risk and breast screening for trans people: an integration of 3 systematic reviews. CMAJ Open. 2019;7(3):E598-E609. doi:https://doi.org/10.9778/cmajo.20180028
    • Hartley RL, Stone JP, Temple-Oberle C. Breast cancer in transgender patients: A systematic review. Part 1: Male to female. European Journal of Surgical Oncology: The Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2018;44(10):1455-1462. doi:https://doi.org/10.1016/j.ejso.2018.06.035
Rodrigo Arrangoiz, MD (Oncology Surgeon)
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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