On the Joy of Cancer Screening
After a lifetime of watching my partner dread her regular screenings for breast and cervical cancer, I found myself doing the same. Experience taught me that when I brought BC Cancer’s brown envelope in from the mailbox and set it on the counter, it would sit there unopened for months. It would eventually end up on her desk, where it might sit for a year before she called to make an appointment.
The first brown envelope to arrive for me was for the new cervical cancer self-screening kit. I was overjoyed to be nominated, like an Academy Award, despite not having a cervix. I read and reread the letter, searching for a loophole that would let me order the kit and take the test. Over 80% of sexually active people are exposed to at least one type of HPV in their lifetime, and they collectively cause not just cervical cancer, but also anal, oropharyngeal, penile, vaginal, and vulvar cancers. I’d like to know if I was at risk, but it would come with an awkward conversation with my doctor when she saw the results and an avoidable sense of guilt for wasting tax dollars.
I wondered whether the same system that flagged me for cervical screening would automatically add me to the roster of mammogram-eligible patients. Year after year, I was relieved that the BC Cancer envelopes weren’t mine. Unlike thyroid and lung cancer, for which I was already on an annual screening protocol, I didn’t worry about breast cancer because my breasts were less than ten years old. Ten-year-olds don’t get mammograms, I reasoned.
Then came the surprise. While renewing my prescription, my doctor said, “It looks like you haven’t had a mammogram yet. We recommend one after you’ve been on hormones for five years. You should be able to visit the BC Cancer website and book one.” I put it off for a week, then searched for evidence that it was a waste of time and resources, only to find that trans women are diagnosed with late-stage breast cancer more often than cisgender women.[i]
With faint hope that I wasn’t eligible, I read the short eligibility list for Two-Spirit, transgender, and non-binary people. As my doctor said, I met the third condition: “Has breast (chest) tissue after taking hormones (estrogen) for 5+ years.”
Then I saw below, “You are not eligible for a screening mammogram if you:” and felt a new sense of hope. It asked whether I had breast implants (no), was pregnant or breastfeeding (no), had a history of breast cancer (no), had new breast complaints (no), or had a mammogram in the past twelve months (no again). Dejected, I called the phone number listed for my area and booked the first available appointment.
What happened next was pure gender euphoria. The technologist led me to a changing booth, where I stripped to the waist and put on a gown. When I asked, “Which way should I put it on?” she replied, “It doesn’t matter.” I wore the gown for the three steps it took to cross the hallway into the X-ray room, then she had me set it on a chair with my purse. She placed my breasts gently in the scanner four times (two positions for each) and let me see the X-rays when we finished.[ii]
I left feeling elated. It wasn’t painful, drudgery, embarrassing, or anything I’d imagined it would be. I was treated like every other woman who walked into the clinic, because I am. As I walked back to the mall to meet Sarah, I don’t think my feet touched the ground.
My next mammogram in 2028 can’t come soon enough.
What did you think? How are you doing? I’d love to chat…
[i] A large study from the Netherlands concluded that current screening guidelines for breast cancer are appropriate for trans women because the risk of breast cancer in trans women was less than that in cisgender women but 47-fold higher than in cisgender men.
[ii] When I returned home, I looked up images of the different breast densities and discovered that mine are BI-RADS Density Category C, like 40% of other women.