Two advocacy groups are demanding that transgender women be given free mammograms under President Obama's new health care law, following reports that a transgender woman was denied a government-financed mammogram at a clinic in Colorado.
"That is irrational discrimination, plain and simple," said Harper Jean Tobin, director of policy for the National Center for Transgender Equality.
"Breast-cancer screenings save lives and should be available to all women, period," added Shane Snowdon, director of the Human Rights Campaign's health and aging program.
Mr. Obama's 2010 Affordable Care Act prohibits discrimination "on the basis of sex, including on the basis of gender identity or sex stereotyping," they wrote Friday in a letter to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC).
Current federal guidance says that only women who are "genetically female" are eligible for subsidized mammograms.
The complaint was sparked by Jennifer Blair, a 62-year-old transwoman who was born a man and sought a free mammogram at a Denver Planned Parenthood clinic after she found a strange growth in her breast, KUSA-TV said.
The Women's Wellness Connection, which conducts the mammograms and pays for them under a federal grant, declined to give her a screening because CDC guidelines do not recognize patients who undergo gender-reassignment surgery as having changed sexes, the report said.
Ms. Blair has now sued Planned Parenthood and Women's Wellness Connection for discriminating against her in violation of state law.
Separately, a New Jersey transgender woman, aged 44, also had to fight for a mammogram for breasts that developed from hormone therapy, the New York Daily News reported.
In that case, the Transgender Legal Defense and Education Fund helped the transwoman get the screening — and an apology from Aetna, the paper said. Previously, Aetna denied the mammogram because it fell under policy exclusions for treatments related to "changing sex."
In their letter last week to Dr. Frieden, Ms. Tobin and Ms. Snowdon demanded the CDC promptly change its policy.
Denying preventive care to an at-risk population — including cancer screenings for transgender women — "puts individuals at risk and generally exacerbates the health disparities and poor health outcomes experienced by the transgender community," they said.
Dr. Madeline Deutsch of the Center of Excellence for Transgender Health in San Francisco said Friday that evidence is scant about breast cancer in transwomen, but the issue "is on my radar."
The transgender-health center recommends mammograms for male-to-female transgender patients who are on feminizing hormone therapy if they have been using estrogen for at least 30 years and are at least 50 years old.
Younger transwomen with a family history of early breast or ovarian cancer should consider getting mammograms at an earlier age, noted the center, which is located at University of California-San Francisco.
Male-to-female transgender people typically use hormone therapy to grow breasts. It is not uncommon to also have implants or surgery to enhance the breasts.
According to the American Cancer Society, women who have had breast-conserving treatment, such as a lumpectomy, continue to need regular mammograms of both breasts.
However, women who have had a total mastectomy and reconstruction with silicone gel or saline implants do not need routine mammograms of the affected side. Women who have a reconstructed breast using their own tissue also do not need a mammogram of that breast, unless indicated in a physical exam.
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