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People of all genders can get breast cancer, so it’s important for trans men and trans women to consider that as part of their health care.

“Anyone who has breast tissue could potentially or theoretically develop breast cancer,” says Fan Liang, MD, medical director of the Center for Transgender Health at Johns Hopkins Medicine in Baltimore.

Many things influence your breast cancer risk, including your own medical history, any family history of breast cancer, whether you have certain genes that make breast cancer more likely, and whether you get gender-affirming treatment.

There aren’t yet official breast cancer screening guidelines that are specific to trans people. But experts do have general recommendations, detailed below.

You should talk with your doctor about what screening you need, when to start, and how often. Of course, if you notice a lump or other unusual breast change, see your doctor to get it checked out. (“Screening” refers to routine checking for possible signs of breast cancer, not diagnosing what a lump or other change may be.)

Breast Cancer Screening Recommendations for Trans Women

Each person is unique. In gauging trans women’s breast cancer risk, one of the factors that doctors consider include whether they are taking hormone therapy, their age, and for how long. That’s on top of all the other breast cancer risk factors a person might have.

Trans women who take estrogen as part of hormone therapy: If you’re older than 50, get a mammogram every 2 years after you’ve been taking hormones for at least 5 to 10 years.

Not all trans women take gender-affirming hormone therapy. Those who do will develop breast tissue. Any breast tissue can develop breast cancer. And estrogen, which is part of this therapy, does raise the risk for breast cancer.

If you start taking estrogen as an adult, it may not raise your risk as much as if you start taking it as a teen because over your lifetime, you’d have less exposure to estrogen. There hasn’t been a lot of research in this area yet, so it’s not clear how much taking estrogen raises risk for people of various ages.

Trans women with the BRCA1 or BRCA2 genes and/or a strong family history of breast cancer: These genes raise your risk of breast cancer. So it’s very important that you discuss with your doctor how to manage this risk, such as with screenings or other preventive care. You may need to start getting mammograms earlier – and get them more often.

“There are other health conditions, not just cancer, that might not make you a good candidate for estrogen,” says Gwendolyn Quinn, PhD, professor of obstetrics and gynecology at NYU Grossman School of Medicine in New York. “That’s why the decision to use hormones should be overseen by a health care provider, but many trans people don’t have access to a clinician and buy their hormones on the internet.”

If you aren’t taking gender-affirming therapy but are considering it, make sure your doctor knows that you are BRCA-positive.

“It’s not a formal recommendation, but there has been talk about testing trans women for BRCA before starting gender-affirming hormones,” Quinn says. “But a lot of people feel that gender-affirming hormones are lifesaving and that it’s unreasonable to ask that trans women get tested first.”

If you do have a doctor and want to get tested for the BRCA genes – and other genes linked to breast cancer – your doctor can help you find out about what’s involved.

Trans women who don’t take hormones: Although there’s no recommended screening timing, be sure to see your doctor if you notice any breast lumps or changes – and tell them about anyone in your family who’s had breast cancer.

Trans women who got breast augmentation: Some trans women choose to get breast augmentation surgery to create the look of breasts. This is done with implants, fat transferred from another place on the body, or a combination of those methods.

Fat transfer uses your own body fat from somewhere else on your body to create breasts, and studies don’t show that this raises breast cancer risk. Today’s breast implants don’t cause breast cancer, either. They have been linked to a low risk of a rare form of cancer called anaplastic large-cell lymphoma (ALCL). There hasn’t been a lot of research on implant-related ALCL specifically in trans women. But in one review, researchers called it a “rare but serious” complication and recommended being aware of the risk and keeping up with any follow-up care after getting the implants.

Breast Cancer Screening Recommendations for Trans Men

Among the many factors that can affect your risk are whether you’ve had “top surgery” to change the appearance of your chest, whether you take testosterone, and whether you have certain genes that make breast cancer more likely.

Trans men who have not had top surgery or who have only had breast reduction: Get a mammogram every year or two starting at age 40.

If you haven’t had top surgery, your breast cancer risk is the same as it was before you transitioned. That’s true whether or not you’ve had a hysterectomy (surgery to remove your uterus). Removal of the ovaries and uterus only somewhat lowers breast cancer risk. Removing the breasts makes the biggest impact on breast cancer risk.

Trans men who have had top surgery: You may not have enough breast tissue to put in a mammogram machine, so your doctor may recommend that you do self-exams and also get breast exams done by a doctor.

Not every trans man gets top surgery. But some do. Top surgery lowers breast cancer risk, but not as much as a mastectomy you’d get to prevent or treat breast cancer.

With a breast cancer mastectomy, the goal is to remove as much breast tissue as possible, including tissue under the arms and on the ribcage. With top surgery, the aim is different: to change the chest’s appearance to be flatter. “The breast mass is removed, but we don’t go after every single cell because it’s not necessary to do that in order to get the overall result that we want,” Liang says.

“How much surgery lowers [breast cancer] risk depends on how much tissue is left behind, including the nipple, where there’s also potential for cancer cells to develop,” Quinn says.

Trans men who have the BRCA1 or BRCA2 gene mutations and have had standard top surgery (but not a complete preventive mastectomy): You may need annual breast cancer screenings. Since you likely won’t have enough breast tissue to put into a mammogram machine, a breast cancer specialist may need to give you a chest exam. It’s important that your doctors know that you are BRCA+ so they can make a preventive screening plan for you based on how much breast tissue you have.

Trans men who take hormone therapy with testosterone: Testosterone suppresses estrogen. So if you take hormone therapy with testosterone consistently over time, your breast cancer risk is likely to be somewhat lower. But if you don’t take testosterone – or if you only take a low dose or take it intermittently – you won’t have that protective benefit.

Regardless of whether or not you take testosterone therapy, there is still at least some risk for breast cancer. Your doctor can advise you about what screening you need.

Finding Gender-Affirming Care

While experts can make recommendations about cancer screenings for trans people, finding a gender-affirming health care provider is easier said than done in some places.

The World Professional Association for Transgender Health has an online directory of providers of gender-affirming care. You may also simply call doctors in your area and ask about their experience with providing care to trans patients.

“If you can’t find a transgender health clinic near where you live, call the doctor beforehand,” Liang says. “Ask about the provider’s experience with transgender preventive care. See how they respond to the question – whether they have an understanding of what you need or whether the question seems to them to come out of left field.” Your health concerns – about breast cancer or anything else – should be taken seriously and treated with respect by your health care team.

Editor’s note: Find more information about long COVID in Medscape’s Long COVID Resource Center.

Sept. 22, 2022 – Entrepreneur Maya McNulty, 49, was one of the first victims of the COVID-19 pandemic. The Schenectady, NY, businesswoman spent 2 months in the hospital after catching the disease in March 2020. That September, she was diagnosed with long COVID.

“Even a simple task such as unloading the dishwasher became a major challenge,” she says.

Over the next several months, McNulty saw a range of specialists, including neurologists, pulmonologists, and cardiologists. She had months of physical therapy and respiratory therapy to help regain strength and lung function. While many of the doctors she saw were sympathetic to what she was going through, not all were.

“I saw one neurologist who told me to my face that she didn’t believe in long COVID,” she recalls. “It was particularly astonishing since the hospital they were affiliated with had a long COVID clinic.”

McNulty began to connect with other patients with long COVID through a support group she created at the end of 2020 on the social media app Clubhouse. They exchanged ideas and stories about what had helped one another, which led her to try, over the next year, a plant-based diet, Chinese medicine, and vitamin C supplements, among other treatments.

She also acted on unscientific reports she found online and did her own research, which led her to discover claims that some asthma patients with chronic coughing responded well to halotherapy, or dry salt therapy, during which patients inhale micro-particles of salt into their lungs to reduce inflammation, widen airways, and thin mucus. She’s been doing this procedure at a clinic near her home for over a year and credits it with helping with her chronic cough, especially as she recovers from her second bout of COVID-19.

It’s not cheap – a single half-hour session can cost up to $50 and isn’t covered by insurance. There’s also no good research to suggest that it can help with long COVID, according to the Cleveland Clinic.

McNulty understands that but says many people who live with long COVID turn to these treatments out of a sense of desperation.

“When it comes to this condition, we kind of have to be our own advocates. People are so desperate and feel so gaslit by doctors who don’t believe in their symptoms that they play Russian roulette with their body,” she says. “Most just want some hope and a way to relieve pain.”

Across the country, 16 million Americans have long COVID, according to the Brookings Institution’s analysis of a 2022 Census Bureau report. The report also estimated that up to a quarter of them have such debilitating symptoms that they are no longer able to work. While long COVID centers may offer therapies to help relieve symptoms, “there are no evidence-based established treatments for long COVID at this point,” says Andrew Schamess, MD, a professor of internal medicine at Ohio State Wexner Medical Center, who runs its Post-COVID Recovery Program. “You can’t blame patients for looking for alternative remedies to help them. Unfortunately, there are also a lot of people out to make a buck who are selling unproven and disproven therapies.”

Sniffing Out the Snake Oil

With few evidence-based treatments for long COVID, patients with debilitating symptoms can be tempted by unproven options. One that has gotten a lot of attention is hyperbaric oxygen. This therapy has traditionally been used to treat divers who have decompression sickness, or the bends. It’s also being touted by some clinics as an effective treatment for long COVID.

A very small trial of 73 patients with long COVID, published this July in the journal Scientific Reports, found that those treated in a high-pressure oxygen system 5 days a week for 2 months showed improvements in brain fog, pain, energy, sleep, anxiety, and depression, compared with similar patients who got sham treatments. But larger studies are needed to show how well it works, notes Schamess.

“It’s very expensive – roughly $120 per session – and there just isn’t the evidence there to support its use,” he says.

In addition, the therapy itself carries risks, such as ear and sinus pain, middle ear injury, temporary vision changes, and, very rarely, lung collapse, according to the FDA.

One “particularly troubling” treatment being offered, says Kathleen Bell, MD, chair of the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center, is stem cell therapy. This therapy is still in its infancy, but it’s being marketed by some clinics as a way to prevent COVID-19 and also treat long-haul symptoms.

The FDA has issued advisories that there are no products approved to treat long COVID and recommends against their use, except in a clinical trial.

“There’s absolutely no regulation – you don’t know what you’re getting, and there’s no research to suggest this therapy even works,” says Bell. It’s also prohibitively expensive – one Cayman Islands-based company advertises its treatment for as much as $25,000.

Patients with long COVID are even traveling as far as Cyprus, Germany, and Switzerland for a procedure known as blood washing, in which large needles are inserted into veins to filter blood and remove lipids and inflammatory proteins, the British Medical Journal reported in July. Some patients are also prescribed blood thinners to remove microscopic blood clots that may contribute to long COVID. But this treatment is also expensive, with many people paying $10,000-$15,000 out of pocket, and there’s no published evidence to suggest it works, according to theBMJ.

It can be particularly hard to discern what may work and what’s unproven, since many primary care providers are themselves unfamiliar with even traditional long COVID treatments, Bell says. She recommends that patients ask the following questions:

• What published research is there to support these claims?
• How long should I expect to do this treatment before I see an improvement?
• What are the potential side effects?
• Will the medical provider recommending the treatment work with your current medical team to monitor progress?

“If you can’t get answers to these questions, take a step back,” says Bell.

Sorting Through Supplements

Yufang Lin, MD, an integrative specialist at the Cleveland Clinic, says many patients with long COVID enter her office with bags of supplements.

“There’s no data on them, and in large quantities, they may even be harmful,” she says.

Instead, she works closely with the Cleveland Clinic’s long COVID center to do a thorough workup of each patient, which often includes screening for certain nutritional deficiencies.

“Anecdotally, we do see many patients with long COVID who are deficient in these vitamins and minerals,” says Lin. “If someone is low, we will suggest the appropriate supplement. Otherwise, we work with them to institute some dietary changes.”

­This usually involves a plant-based, anti-inflammatory eating pattern such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains, nuts, fatty fish, and healthy fats such as olive oil and avocados.

Other supplements some doctors recommend for patients with long COVID are meant to treat inflammation, Bell says, although there’s not good evidence they work. One is the antioxidant coenzyme Q10.

But a small preprint study published in The Lancet this past August of 121 patients with long COVID who took 500 milligrams a day of coenzyme Q10 for 6 weeks saw no differences in recovery than those who took a placebo. Because the study is still a preprint, it has not been peer-reviewed.

Another is probiotics. A small 2021 study published in the journal Infectious Diseases Diagnosis & Treatment found that a blend of five lactobacillus probiotics, along with a prebiotic called inulin, taken for 30 days, helped with long-term COVID symptoms such as coughing and fatigue. But larger studies need to be done to support their use.

One that may have more promise is omega-3 fatty acids. Like many other supplements, these may help with long COVID by easing inflammation, says Steven Flanagan, MD, a rehabilitation medicine specialist at NYU Langone in New York who works with long COVID patients. Researchers at the Mount Sinai School of Medicine in New York are studying whether a supplement can help patients who have lost their sense of taste or smell after an infection, but results aren’t yet available.

Among the few alternatives that have been shown to help patients are mindfulness-based therapies – in particular, mindfulness-based forms of exercise such as tai chi and qi gong may be helpful, as they combine a gentle workout with stress reduction.

“Both incorporate meditation, which helps not only to relieve some of the anxiety associated with long COVID but allows patients to redirect their thought process so that they can cope with symptoms better,” says Flanagan.

A 2022 study published in BMJ Open found that these two activities reduced inflammatory markers and improved respiratory muscle strength and function in patients recovering from COVID-19.

“I recommend these activities to all my long COVID patients, as it’s inexpensive and easy to find classes to do either at home or in their community,” he says. “Even if it doesn’t improve their long COVID symptoms, it has other benefits such as increased strength and flexibility that can boost their overall health.”

Sept. 22, 2022 — Sonia Chavez was on the balcony of her midrise Dallas apartment when the unthinkable happened: As she was filming a thunderstorm with her cellphone, lightning struck her in a flash of blinding light and searing heat that knocked her off her feet.

The thunderbolt, which Chavez captured on film, damaged her eyes and left her with some cognitive, speech, and mobility issues.

But somehow, she survived.

“When it hit, it sounded like a bomb going off,” says Chavez, 38. “I felt this intense electric force that hit me hard, like a gut punch or whiplash. It was the biggest pain you could imagine. I remember seeing the electricity coming off my hands and seeing different colors — blue, then red, and then white — and there was ringing in my ears.

“I don’t remember much after that, but the next thing I knew I was in the closet of my apartment, pinching and scratching myself to see if I was dead or alive.”

As traumatic as the experience was, Chavez is one of the lucky ones. While she is still recovering from injuries caused by the strike 18 months ago, she lived to tell her story.

Many others struck by lightning don’t. And lightning fatalities are on the rise in the U.S., possibly due to an increase in severe storms tied to global climate change.

So far, the U.S. has recorded 17 lightning fatalities this year, according to the National Weather Service (NWS). That’s more than the 11 that occurred by this time last year and as many as were seen in all of 2020.

“I do feel like I’ve been lucky,” says Chavez, who is receiving physical and speech therapy, as well as ongoing treatments to address her vision loss from the strike. “I’ve had teams of people helping me, including my husband, who found me in the closet a half-hour after it happened [and] got me to the hospital.”

Aaron Treadway, a lightning specialist with the National Weather Service, explains that lightning-strike survivors like Chavez are not as rare as you might think. Indeed: Nine in 10 people struck by lightning survive the incident.

“On average around 300 people are struck by lightning each year, with roughly 10 percent of those being fatal injuries,” says Treadway. “For those who are struck and do not die, many have serious injuries.”

While lightning fatalities have been rising in recent years, they are still well below what they were 20 years ago, he says. Between 1970 and 2000, the average annual lightning death tally was over 70, National Weather Service figures show.

“The reduction in fatalities [since 2000] is due to the success of the lightning safety campaign that many people and organizations have contributed to,” Treadway says. “These include NWS offices across the country and our many partners in the broadcast and print media, outdoor and sports organizations, emergency management officials, and other safety organizations.

“Sayings like ‘When Thunder Roars, Go Indoors’ or ‘See a Flash, Dash Inside’ for our deaf and hard-of-hearing community are easy to remember and apply, keeping people safe.”

Lightning Strikes: By the Numbers

The National Weather Service maintains a detailed website of facts on lightning strikes that provides a compelling overview of how, when, and where people die during thunderstorms.

It offers a glimpse into the kinds of activities individuals were engaged in at the time of fatal strikes, providing key clues to how best to avoid risky behaviors during a storm.

For instance, of the 17 lightning deaths so far this year:

• Five people were struck during camping trips or visits to public parks.
• Four were killed while engaging in water sports: boating, jet skiing, or swimming.
• Four were hit as they were working around the house: doing yard work, loading tools into a van, standing on a roof, and replacing a window.
• Four died while walking a dog, flying a remote-control plane in a field, fixing a truck on a highway, and during Army training exercises.

The National Weather Service has also compiled an extraordinary online database of lightning survivors, including detailed interviews, their stories, and the health impacts they suffered.

Beyond these personal stories, the National Weather Service has publicized a wealth of information on these giant sparks of electricity in the atmosphere that often strike the ground.

According to the National Weather Service and other federal agencies:

• A typical lightning flash carries about 300 million volts. By comparison, a household current is 120 volts.
• Lightning can heat the air it passes through to 50,000 degrees Fahrenheit. That’s five times hotter than the surface of the sun.
• Lightning strikes somewhere in the U.S. 25 million times each year on average.
• Florida is the nation’s lightning capital, with the highest average number of cloud-to-ground strikes, ranked by flashes per square mile. The Sunshine State also has the most fatalities of any state due to the frequency of lightning and because most people are outdoors during the peak lightning season (June to August).
• Florida sees 1.2 million strikes in a typical year, covering 20 square miles. Next in line: Louisiana (875,136, 18.9 miles); Mississippi (768,126, 16.1 miles); Oklahoma (1.1 million-plus, 15.8 miles); and Arkansas (837,978, 15.7 miles).
• Worldwide, the U.S. had the second most lightning strikes in 2021. Brazil was first.
• Certain occupations carry a higher risk for lightning strikes, including those in the logging, construction, utility, lawn services, and recreational industries, according to the U.S. Occupational Safety and Health Administration.

National Weather Service officials have also collected a surprising list of lightning myths and facts. They are:

• Crouching down or lying flat on the ground in a thunderstorm won’t reduce your risk of being struck. You can still be vulnerable to ground current from bolts that strike the earth nearby. It’s better to run to a building or vehicle for shelter.
• Lightning can strike twice in the same place and often does. The Empire State Building is hit 23 times every year, on average.
• Even if it’s not raining outside you can still be struck by a “bolt from the blue” — literally — because lightning can strike 10 to 15 miles from the center of a storm.
• Metal watches, jewelry, and personal electronic devices such as cellphones and portable music players do NOT attract lightning.
• Your mother was right: Don’t stand under a tree during a storm. Being beneath a tree during a storm is the second-leading cause of lightning fatalities.

Why Are Fatalities Up and What Can You Do?

What’s behind the recent increase in fatal lightning strikes? Treadway says global climate change might be a factor. But he notes scientists aren’t entirely certain, in part because they have not been tracking the weather phenomenon for very long.

“While a warming climate will produce more ingredients that are conducive to the development of thunderstorms, quantitatively, the period of record of ground-based lightning detection is fairly short,” he explains. “In order to say that there is a substantial increase in lightning coverage, scientists need to have a longer period of data to make those types of conclusions.”

But that research has shown that education and awareness or risks can help reduce lightning fatalities overall.

“Lightning doesn’t follow rules; it strikes where it wants to,” he says. “It is up to the public to take those safety precautions and reduce their risk of getting struck overall.”

With that in mind, National Weather Service officials recommend keeping the following safety tips and information in mind to reduce your risk during an electrical storm:

• If you can hear thunder, lightning is close enough to strike you, so you should seek shelter in a building or hard-topped vehicle with the windows rolled up.
• Wait 30 minutes after you hear the last crack of thunder before going outside.
• Stay off landline phones, computers, and other electrical equipment that put you in direct contact with electricity during a storm.
• Avoid plumbing, including sinks, baths, and faucets.
• Stay away from windows and doors, and don’t venture onto porches or balconies.
• Don’t lie on or lean against concrete walls.
• Avoid elevated areas such as hills, mountain ridges, and peaks if you’re caught outdoors and can’t seek shelter.
• Don’t lie flat on the ground, and keep away from trees or objects that can conduct electricity (like metal or wire fences, power lines, and windmills).
• Don’t swim or go near ponds, lakes, or other bodies of water.

Treadway also recommends checking weather forecasts before engaging in outdoor summer activities and adjusting your plans accordingly.

“About two thirds of the victims were enjoying outdoor leisure activities before being struck, with water-related activities topping the list,” he notes. “Of the water-related activities, fishing ranked highest, with boating and beach activities also contributing significantly to the water-related deaths.

“Camping, ranching/farming, and riding an exposed vehicle (bike/motorcycle) also ranked highly in activities people were doing when fatally struck. Among the sports activities, soccer ranked highest, followed by golf and running. … Interestingly, about 80% of lightning fatalities are men.”

Looking back on her experiences, Chavez says she knew she was taking a risk standing on her balcony, filming the electrical storm on the day she was struck by lightning. She acknowledges that she didn’t believe she was at risk because it was not raining outside, which she now knows is a dangerous falsehood.

She is still in recovery.

“I’m a work in progress,” she says, noting that she struggles with vision problems and mobility. She speaks slowly and deliberately, but articulately, about her experiences.

But Chavez says she is regaining her abilities little by little every day. She recently returned to work as a project manager and even started jogging again — something she had to give up after the strike.

There is one surprising development she attributes to the lightning strike, she says: The experience gave her a new outlook on life and that her mind is calmer, with less “brain chatter” than before.

“Through this journey, I actually feel very blessed,” she says. “Having had a near-death experience completely changes your outlook on life. And even though this created such havoc on my mind and body, it actually helped my soul.

“The brain chatter I used to experience is gone because I can only concentrate on the current moment. And to me that is just so peaceful. You just hit this different space, and a few other survivors will tell you that they have felt similar things.”

Chavez also says she feels compelled to share her story, believing it may help others avoid what happened to her as well as those who’ve survived lightning strikes.

“There needs to definitely be more education around what happens to people who have been impacted by a lightning incident [and] who have experienced electrical shock in general,” she says. “A lot of us experience the same things, they do rattle our brains and nervous systems, and it’s not as rare as you think.

“I want to help as much as possible to spread awareness in hopes that it helps someone else.”