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McCaffrey RL, James AJ, Torres-Guzman RA, Addae JK, Sullivan LE, Dash E, Slutsky H, Finer ZR, Assi PE, Al-Kassis S. Incidence of High Risk and Malignant Pathological Findings in Transgender and Gender Diverse Individuals Undergoing Gender-Affirming Mastectomy. Ann Surg Oncol 2024; 31:8086-8092. [PMID: 39110348 PMCID: PMC11469726 DOI: 10.1245/s10434-024-16005-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/23/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Concrete, data-driven guidelines for breast cancer screening among the transgender and gender diverse (TGD) population is lacking. The present study evaluates possible associations of gender-affirming hormone therapy (GAHT) on incidental breast pathology findings in trans-masculine patients to inform decision making about breast cancer screening. PATIENTS AND METHODS This was a retrospective cohort study of patients who had gender-affirming mastectomy or breast reduction at a single center from July 2019 to February 2024. A total of 865 patients met the inclusion criteria. Gender-affirming testosterone therapy and length of exposure were evaluated to seek differences in post-operative pathology findings. RESULTS The median age at the time of surgery was 27 years [interquartile range (IQR) 21-30]. Most participants identified as female to male (658, 75.6%). A significant portion of the participants (688, 79.2%) were undergoing testosterone therapy at the time of surgery, with the median duration of testosterone use prior to surgery being 14 months (IQR 4-29). High risk or malignant findings were noted in pathology results for 12 of 1730 breasts (0.7%). Ordered logistic regression found that duration of testosterone therapy was not associated with increasing severity of incidental breast pathology. Additionally, patients under 25 years of age were 70% less likely to have any incidental finding on pathological evaluation than older patients [odds ratio (OR) 0.3, p < 0.01, confidence interval (CI) 0.18-0.50]. CONCLUSIONS The present study found that patients undergoing GAHT should not be screened for breast cancer with increased frequency compared with cis-gender women. Additionally, it may be appropriate for trans women under the age of 25 with normal breast cancer risk to forego pathological breast tissue examination.
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Affiliation(s)
- Rachel L McCaffrey
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Andrew J James
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Lauren E Sullivan
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elianna Dash
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hanna Slutsky
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zoe R Finer
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Patrick E Assi
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Salam Al-Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Cathcart-Rake EJ, Tevaarwerk A, Jatoi A, Carroll EF, Scout N, Chedid VG, Gonzalez CA, Fee-Schroeder K, Kling JM, Shufelt CL, Ridgeway JL, Davidge-Pitts C. Building a Cancer Care Clinic for Transgender and Gender Diverse Individuals. Mayo Clin Proc Innov Qual Outcomes 2024; 8:443-450. [PMID: 39263427 PMCID: PMC11387547 DOI: 10.1016/j.mayocpiqo.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Transgender and gender diverse (TGD) people experience disparities in cancer care, including more late-stage diagnoses, worse cancer-related outcomes, and an increased number of unaddressed and more severe symptoms related to cancer and cancer-directed therapy. This article outlines plans to address the unique needs of TGD people through a TGD-focused oncology clinic. Such a clinic could be structured by upholding the following tenets: (1) champion a supportive, gender-affirming environment that seeks to continuously improve, (2) include a transdisciplinary team of specialists who are dedicated to TGD cancer care, and (3) initiate and embrace TGD-patient-centric research on health outcomes and health care delivery.
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Affiliation(s)
| | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Nfn Scout
- National LGBT Cancer Network, Providence, Rhode Island
| | - Victor G Chedid
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Cesar A Gonzalez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kelli Fee-Schroeder
- Mayo Clinic College of Medicine and Science, Medical Oncology Research, Rochester, Minnesota
| | - Jewel M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | | | - Jennifer L Ridgeway
- Department of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota
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3
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Cathcart-Rake EJ, Jatoi A, Dressler EV, Kittel C, Weaver KE, Nightingale C, Neuman H, Loh KP, Kamen C. Sexual Orientation and Gender Identity Data Collection in Cancer Care: A Nationwide Landscape Assessment Update. JCO Oncol Pract 2024; 20:1272-1279. [PMID: 38768413 DOI: 10.1200/op.23.00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Routine collection of sexual orientation (SO) and gender identity (GI; collectively SOGI) in cancer clinics advances cancer care equity. METHODS In 2022, NCI Community Oncology Research Program (NCORP) practice groups were asked about routine collection of SOGI data in the electronic health record. The proportions of practice groups reporting collection of SO and/or GI data were calculated, and practice group characteristics were assessed for associations. RESULTS Of 271 practice groups nationwide, 42% (n = 112) collect SO data, 58% (n = 157) collect GI data, and 35% (n = 96) collect both. In multivariate analyses, SO data collection was associated with practice groups having minority outreach staff (odds ratio [OR], 2.07 [95% CI, 1.12 to 3.81]; P = .02); GI data collection was associated with practice groups located in the Northeastern United States (OR, 2.08 [95% CI, 0.73 to 5.91]; P = .045), and those with a higher proportion of new patients who were White (OR, 1.02 [95% CI, 1.01 to 1.04]; P < .001). Practice groups in the South were least likely to collect SOGI data (OR, 0.49 [95% CI, 0.26 to 0.94]; P = .004). There were no statistically significant differences in SO and/or GI collection on the basis of the practice group's proportion of Medicaid/Medicare patients, number of new patients with cancer per year, or practice ownership. CONCLUSION Slightly over one third of NCORP practice groups report routinely collecting SOGI data. There are regional differences in data collection, underscoring the need to craft targeted, region-specific interventions focused on boosting the capture and recording of SOGI data in an affirming manner.
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Affiliation(s)
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Carol Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Chandylen Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Heather Neuman
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Kah Poh Loh
- Department of Surgery, University of Rochester, Rochester, NY
| | - Charles Kamen
- Department of Surgery, University of Rochester, Rochester, NY
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4
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Pace R, Goldstein KM, Williams AR, Clayton-Stiglbauer K, Meernik C, Shepherd-Banigan M, Chawla N, Moss H, Skalla LA, Colonna S, Kelley MJ, Zullig LL. The Landscape of Care for Women Veterans with Cancer: An Evidence Map. J Gen Intern Med 2024; 39:2300-2316. [PMID: 38965201 PMCID: PMC11347519 DOI: 10.1007/s11606-024-08903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Women are the fastest growing veteran group in the US and the number of women veterans (WVs) with cancer is rising; however, little is known about this population. Cancer care for WVs is complex and it is essential to understand their unique needs and care coordination challenges to provide evidence-based care. The purpose of this review is to map the quantity, distribution, and characteristics of literature describing cancer and its treatment among WVs. METHODS We searched MEDLINE (via PubMed), Embase (Elsevier), and Web of Science Core Collection (Clarivate) from inception through January, 2024. Publications were eligible that reported gender-specific data on any aspect of cancer care among WVs. Data was abstracted by a single investigator with over-reading. RESULTS Forty-six reports were included; 44 were observational and 19 had a women-only sample. There were no interventional reports and no qualitative reports had a patient sample. Breast cancer was the most commonly addressed (n = 19). There were six additional reports on sex-specific cancers. Many reports used large VA databases or previous trial data, creating the potential for patient overlap between reports. Among VA-specific areas of interest, only three reports evaluated the potential implications of racial differences and only two included a transgender population. No reports examined the effects of toxic exposures on cancer. Within the NCI Cancer Control Continuum, crosscutting areas were more commonly represented; over half (25) of the reports addressed epidemiology. There were few reports on focus areas and little overlap between focus and crosscutting areas. DISCUSSION Existing literature provides an inadequate understanding of the population of WVs with cancer. There is scant information regarding the population of WVs with cancer, their care preferences or experiences, or how to best identify and address unmet healthcare needs. It is imperative to expand research to provide evidence-based care for this population.
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Affiliation(s)
- Rachel Pace
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA.
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - April R Williams
- Division of Hematology and Oncology, Durham VA Healthcare System, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Healthcare System, Durham, NC, USA
- Million Veteran Program, Boston Coordinating Center, Boston, MA, USA
| | | | | | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Institute for Health Policy, Duke University, Durham, NC, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham VA Healthcare System, Durham, NC, USA
| | - Neetu Chawla
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Haley Moss
- Division of Hematology and Oncology, Durham VA Healthcare System, Durham, NC, USA
- Department of Obstetrics and Gynecology, Duke University Healthcare System, Durham, NC, USA
| | - Lesley A Skalla
- Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, NC, USA
| | | | - Michael J Kelley
- Division of Hematology and Oncology, Durham VA Healthcare System, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- National Oncology Program, Department of Veterans Affairs, Washington, DC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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5
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Berner AM, Atkinson SE. The implications of hormone treatment for cancer risk, screening and treatment in transgender individuals. Best Pract Res Clin Endocrinol Metab 2024; 38:101909. [PMID: 38964988 DOI: 10.1016/j.beem.2024.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
There is evidence that gender-affirming hormone treatment (GAHT) for transgender individuals modulates their risk for specific malignancies including breast and prostate cancer, and meningiomas. However, there is insufficient data to make precise risk estimates accounting for age and inherited cancer risk. As such, screening recommendations remain broad. Even less evidence exists for best practice in the management of active or historical cancers in the transgender population. Guidance is therefore mainly extrapolated from cisgender populations but with considerations of the significant benefits of GAHT in the face of any hormonal risk. Clinical experience, the multidisciplinary team and shared decision making with the patient are vital in providing person-centred care, while further research is acquired.
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Affiliation(s)
- Alison May Berner
- Barts Cancer Institute, Queen Mary University of London, United Kingdom; Gender Identity Clinic London, Tavistock and Portman NHS Trust, United Kingdom.
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6
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Heng YJ, Baker GM, Fein-Zachary VJ, Guzman-Arocho YD, Bret-Mounet VC, Massicott ES, Torous VF, Schnitt SJ, Gitin S, Russo P, Tobias AM, Bartlett RA, Varma G, Kontos D, Yaghjyan L, Irwig MS, Potter JE, Wulf GM. Effect of testosterone therapy on breast tissue composition and mammographic breast density in trans masculine individuals. Breast Cancer Res 2024; 26:109. [PMID: 38956693 PMCID: PMC11221014 DOI: 10.1186/s13058-024-01867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The effect of gender-affirming testosterone therapy (TT) on breast cancer risk is unclear. This study investigated the association between TT and breast tissue composition and breast tissue density in trans masculine individuals (TMIs). METHODS Of the 444 TMIs who underwent chest-contouring surgeries between 2013 and 2019, breast tissue composition was assessed in 425 TMIs by the pathologists (categories of lobular atrophy and stromal composition) and using our automated deep-learning algorithm (% epithelium, % fibrous stroma, and % fat). Forty-two out of 444 TMIs had mammography prior to surgery and their breast tissue density was read by a radiologist. Mammography digital files, available for 25/42 TMIs, were analyzed using the LIBRA software to obtain percent density, absolute dense area, and absolute non-dense area. Linear regression was used to describe the associations between duration of TT use and breast tissue composition or breast tissue density measures, while adjusting for potential confounders. Analyses stratified by body mass index were also conducted. RESULTS Longer duration of TT use was associated with increasing degrees of lobular atrophy (p < 0.001) but not fibrous content (p = 0.82). Every 6 months of TT was associated with decreasing amounts of epithelium (exp(β) = 0.97, 95% CI 0.95,0.98, adj p = 0.005) and fibrous stroma (exp(β) = 0.99, 95% CI 0.98,1.00, adj p = 0.05), but not fat (exp(β) = 1.01, 95%CI 0.98,1.05, adj p = 0.39). The effect of TT on breast epithelium was attenuated in overweight/obese TMIs (exp(β) = 0.98, 95% CI 0.95,1.01, adj p = 0.14). When comparing TT users versus non-users, TT users had 28% less epithelium (exp(β) = 0.72, 95% CI 0.58,0.90, adj p = 0.003). There was no association between TT and radiologist's breast density assessment (p = 0.58) or LIBRA measurements (p > 0.05). CONCLUSIONS TT decreases breast epithelium, but this effect is attenuated in overweight/obese TMIs. TT has the potential to affect the breast cancer risk of TMIs. Further studies are warranted to elucidate the effect of TT on breast density and breast cancer risk.
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Affiliation(s)
- Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Dana 517B, Boston, MA, 02115, USA.
| | - Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Dana 517B, Boston, MA, 02115, USA
| | - Valerie J Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yaileen D Guzman-Arocho
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Dana 517B, Boston, MA, 02115, USA
| | - Vanessa C Bret-Mounet
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Dana 517B, Boston, MA, 02115, USA
| | - Erica S Massicott
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Dana 517B, Boston, MA, 02115, USA
| | - Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart J Schnitt
- Dana-Farber/Brigham and Women's Cancer Center, Dana-Farber Cancer Institute-Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sy Gitin
- The Fenway Institute, Boston, MA, USA
| | | | - Adam M Tobias
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard A Bartlett
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gopal Varma
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Despina Kontos
- Departments of Radiology, Biomedical Informatics, and Biomedical Engineering, Columbia University Irving Medical Center, New York, NY, USA
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael S Irwig
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer E Potter
- The Fenway Institute, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerburg M Wulf
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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7
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Nakao S, Tanaka S, Abe K, Komiyama T, Sugiura Y, Nakaseko C, Shimizu N. Successful Treatment of Primary Mediastinal Large B-cell Lymphoma with DA-EPOCH-Rituximab Therapy in a Transgender Woman. Intern Med 2024; 63:1923-1927. [PMID: 37981304 PMCID: PMC11272505 DOI: 10.2169/internalmedicine.2701-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/01/2023] [Indexed: 11/21/2023] Open
Abstract
In recent years, lesbian, gay, bisexual, and transgender (LGBT) populations have been gaining acceptance in society. However, very few cases of malignancy in the LGBT population have been reported thus far. We herein report a transgender woman receiving estrogen supplementation who developed primary mediastinal large B-cell lymphoma (PMBCL) and was treated with dose-adjusted EPOCH-rituximab (DA-EPOCH-R) therapy. The patient achieved complete remission after the sixth course of DA-EPOCH-R therapy. To help this LGBT patient continue receiving chemotherapy smoothly on admission, adjusting the hospital environment, such as the allocation of rooms, was essential.
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Affiliation(s)
- Sanshiro Nakao
- Department of Hematology, Toho University Sakura Medical Center, Japan
| | - Sho Tanaka
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Sakura Medical Center, Japan
| | - Kazuki Abe
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Sakura Medical Center, Japan
| | - Tomomi Komiyama
- Center for Diabetes, Metabolism, and Endocrinology, Toho University Sakura Medical Center, Japan
| | - Yoshiya Sugiura
- Department of Surgical Pathology, Toho University Sakura Medical Center, Japan
| | - Chiaki Nakaseko
- Department of Hematology, International University of Health and Welfare School of Medicine, Japan
| | - Naomi Shimizu
- Department of Hematology, Toho University Sakura Medical Center, Japan
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Miglietta F, Pontolillo L, De Angelis C, Caputo R, Marino M, Bria E, Di Rienzo R, Verrazzo A, Buonerba C, Tortora G, Di Lorenzo G, Del Mastro L, Giuliano M, Montemurro F, Puglisi F, Guarneri V, De Laurentiis M, Scafuri L, Arpino G. Gender minorities in breast cancer - Clinical trials enrollment disparities: Focus on male, transgender and gender diverse patients. Breast 2024; 75:103713. [PMID: 38493590 PMCID: PMC10959718 DOI: 10.1016/j.breast.2024.103713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The last years have seen unprecedented improvement in breast cancer (BC) survival rates. However, this entirely apply to female BC patients, since gender minorities (male, transgender/gender-diverse) are neglected in BC phase III registration clinical trials. METHODS We conducted a scoping review of phase III clinical trials of agents with a current positioning within the therapeutic algorithms of BC. RESULTS We selected 51 phase III trials. Men enrollment was allowed in 35.3% of trials. In none of the trial inclusion/exclusion criteria referred to transgender/gender-diverse people. A numerical higher rate of enrolled men was observed in the contemporary as compared to historical group. We found a statistically significant association between the drug class and the possibility of including men: 100%, 80%, 50%, 33.3%, 25%, 10% and 9.1% of trials testing ICI/PARP-i, ADCs, PI3K/AKT/mTOR-i, anti-HER2 therapy, CDK4/6-i, ET alone, and CT alone. Overall, 77409 patients were enrolled, including 112 men (0.2%). None of the trial reported transgender/gender-diverse people proportion. Studies investigating PARP-i were significantly associated with the highest rate of enrolled men (1.42%), while the lowest rates were observed for trials of CT (0.13%), ET alone (0.10%), and CDK 4/6-I (0.08%), p < 0.001. CONCLUSIONS We confirmed that gender minorities are severely underrepresented among BC registration trials. We observed a lower rate of men in trials envisaging endocrine manipulation or in less contemporary trials. This work sought to urge the scientific community to increase the awareness level towards the issue of gender minorities and to endorse more inclusive criteria in clinical trials.
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Affiliation(s)
- Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto - IOV IRCCS, Padova, Italy
| | - Letizia Pontolillo
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberta Caputo
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Pascale, Naples, Italy
| | - Monica Marino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto - IOV IRCCS, Padova, Italy
| | - Emilio Bria
- Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy; UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rossana Di Rienzo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Annarita Verrazzo
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Pascale, Naples, Italy
| | - Carlo Buonerba
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy; Associazione O.R.A. ETS - Oncology Research Assistance, Salerno, Italy
| | - Giampaolo Tortora
- UOC Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Di Lorenzo
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy; Associazione O.R.A. ETS - Oncology Research Assistance, Salerno, Italy
| | - Lucia Del Mastro
- UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | | | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto - IOV IRCCS, Padova, Italy
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Pascale, Naples, Italy
| | - Luca Scafuri
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy; Associazione O.R.A. ETS - Oncology Research Assistance, Salerno, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
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Chowdhury A, Saad Eddin A, Kim Hsieh S, Policeni FC. Review of Breast Imaging in Transgender and Gender-Diverse Patients: Gender-Affirming Care, Histopathologic Findings, Breast Cancer Risk, and Screening Recommendations. JOURNAL OF BREAST IMAGING 2024; 6:238-245. [PMID: 38613363 DOI: 10.1093/jbi/wbae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 04/14/2024]
Abstract
Gender diversity, especially pertaining to transgender and gender-diverse (TGD) populations, is often stigmatized. A small but not insignificant number of adults in the United States identify as TGD, including transgender, nonbinary, and other gender identities than cisgender. Accessing health care remains a significant challenge for TGD individuals because many health care systems adhere to a gender binary model and many TGD individuals experience negative interactions when interfacing with health care. There is also a scarcity of literature addressing their unique health care needs, limiting our current understanding of breast cancer risks and screening recommendations for TGD patients. This article reviews important considerations when providing care to TGD patients. It covers background information on gender identity and sexuality, explores gender-affirming care, discusses histopathologic findings of breast biopsy specimens, examines breast cancer risks, and presents current breast cancer screening recommendations for TGD patients. Education on TGD breast cancer risks and screening and creating a standardized screening protocol for TGD patients who may receive gender-affirming care through hormonal and surgical therapies could help improve their health care equity and access.
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Affiliation(s)
- Ajmain Chowdhury
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Su Kim Hsieh
- Department of Radiology, University of Iowa, Iowa City, IA, USA
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10
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Pamulapati S, Conroy M, Cortina C, Harding E, Kamaraju S. Systematic Review on Gender-Affirming Testosterone Therapy and the Risk of Breast Cancer: A Challenge for Physicians Treating Patients from Transgender and Gender-Diverse Populations. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1969-1980. [PMID: 38148450 DOI: 10.1007/s10508-023-02773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
Conflicting evidence exists about the risk of breast cancer in transgender and gender-diverse (TGD) patients treated with testosterone. This review aimed to summarize current knowledge regarding the risk of breast cancer associated with gender-affirming testosterone treatment (GATT). A systematic literature search using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was conducted in January 2023 through Ovid, Scopus, and Web of Science databases. English-language, peer-reviewed articles evaluating breast cancer in TGD patients after GATT that met the inclusion criteria were included. This review included 22 articles, with 14 case reports, 4 case series, and 4 retrospective cohort studies. The review identified 26 TGD patients who developed breast cancer post-GATT therapy, with inconclusive evidence on the relationship between testosterone and the risk of breast cancer in TGD patients. This uncertainty in part arises from the mechanisms governing testosterone's effects within breast tissue, with contrasting theories proposing both proliferative and antiproliferative impacts. Considering this ambiguity, it is imperative for healthcare providers to engage in informed discussions with patients prior to initiating hormone therapy to discuss potential adverse effects, including the possibility of breast cancer development in TGD individuals. Patient education and shared decision-making are essential components of responsible care in this context.
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Affiliation(s)
- Saagar Pamulapati
- Mercyhealth Javon Bea Hospital, 2400 N Rockton Ave., Rockford, IL, 61103, USA.
| | - Meghan Conroy
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chandler Cortina
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Harding
- Clinical Services Librarian, Froedtert Hospital, Milwaukee, WI, USA
| | - Sailaja Kamaraju
- Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
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11
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Yang S, Li Y, Wheldon CW, Prosperi M, George TJ, Shenkman EA, Wang F, Bian J, Guo Y. The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.24.24304777. [PMID: 38585849 PMCID: PMC10996763 DOI: 10.1101/2024.03.24.24304777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV), tobacco, alcohol, lung, breast, colorectum, and built multivariable logistic models to examine the association between gender identity and the presence of cancer or pre-cancer. Results indicated similar odds of developing cancer across gender identities, but transgender individuals exhibited significantly higher risks for pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-related, tobacco-related, alcohol-related, and colorectal pre-cancers compared to cisgender men. These findings underscore the need for tailored interventions and policies addressing cancer health disparities affecting the transgender population.
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Affiliation(s)
- Shuang Yang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Yongqiu Li
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Christopher W. Wheldon
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Thomas J. George
- Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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12
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Wahlström E, Audisio RA, Selvaggi G. Aspects to consider regarding breast cancer risk in trans men: A systematic review and risk management approach. PLoS One 2024; 19:e0299333. [PMID: 38451995 PMCID: PMC10919728 DOI: 10.1371/journal.pone.0299333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The risk of breast cancer in trans men is currently a poorly understood subject and trans men likely carries a different level of risk from that of cis women. AIM This review aims to review several aspects that affects breast cancer risk in trans men and to apply the Swiss cheese model to highlight these risks. The study takes its cue from a systematic review of all described breast cancer cases in trans men following medical or surgical intervention because of gender dysphoria. METHODS PubMed was systematically searched on the 14th of March 2023 to find all published cases of breast cancer following chest contouring surgery in trans men. Included articles had to involve trans men, the diagnosis of breast cancer had to be preceded by either a medical or surgical intervention related to gender dysphoria, and cases needed to involve invasive breast cancer or ductal carcinoma in situ. Articles were excluded if gender identity in the case subject was unclear and/or a full English version of the report was unavailable. Quality and risk of bias was evaluated using the GRADE protocol. A literature review of specific risk altering aspects in this population followed. The Swiss cheese model was employed to present a risk analysis and to propose ways of managing this risk. RESULTS 28 cases of breast cancer in trans men have been published. The Swiss cheese model identified several weaknesses associated with methods of preventing breast cancer in trans men. CLINICAL IMPLICATIONS This study may highlight the difficulties with managing risk factors concerning breast cancer in trans men to clinicians not encountering this patient group frequently. CONCLUSION This review finds that evidence for most aspects concerning breast cancer in trans men are inadequate, which supports the establishment of a risk-management approach to breast cancer in trans men.
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Affiliation(s)
- Edvin Wahlström
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Riccardo A. Audisio
- Department of General Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gennaro Selvaggi
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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13
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Pleasant V. Gynecologic Care of Black Breast Cancer Survivors. CURRENT BREAST CANCER REPORTS 2024; 16:84-97. [PMID: 38725438 PMCID: PMC11081127 DOI: 10.1007/s12609-024-00527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 05/12/2024]
Abstract
Purpose of Review Black patients suffer from breast cancer-related racial health disparities, which could have implications on their gynecologic care. This review explores considerations in the gynecologic care of Black breast cancer survivors. Recent Findings Black people have a higher risk of leiomyoma and endometrial cancer, which could confound bleeding patterns such as in the setting of tamoxifen use. As Black people are more likely to have early-onset breast cancer, this may have implications on long-term bone and heart health. Black patients may be more likely to have menopausal symptoms at baseline and as a result of breast cancer treatment. Furthermore, Black patients are less likely to utilize assisted reproductive technology and genetic testing services. Summary It is important for healthcare providers to be well-versed in the intersections of breast cancer and gynecologic care. Black breast cancer survivors may have unique considerations for which practitioners should be knowledgeable.
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Affiliation(s)
- Versha Pleasant
- University of Michigan Hospital, Mott Children & Women’s Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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14
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Cathcart-Rake EJ, Ruddy KJ, Tevaarwerk AJ, Jatoi A. Breast cancer and gender-affirming hormone therapy for transgender and gender-diverse (TGD) individuals. Maturitas 2024; 181:107913. [PMID: 38262089 PMCID: PMC10872221 DOI: 10.1016/j.maturitas.2024.107913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/01/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024]
Abstract
Transgender and gender-diverse (TGD) individuals are at risk for breast cancer, but are less likely to undergo screening mammograms and appear to suffer poorer cancer-related outcomes than cisgender women. Gender-affirming hormone therapy (GAHT) may be lifesaving for TGD individuals from the perspective of affirming their core identities; however, the effects of GAHT on cancer development, progression, and outcomes are poorly understood.
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Affiliation(s)
| | - Kathryn J Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Amye J Tevaarwerk
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
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15
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Seiger KW, McNamara B, Berrahou IK. Gynecologic Care for Sexual and Gender Minority Patients. Obstet Gynecol Clin North Am 2024; 51:17-41. [PMID: 38267126 DOI: 10.1016/j.ogc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.
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Affiliation(s)
- Kyra W Seiger
- Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Blair McNamara
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Iman K Berrahou
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, Suite 302 FMB, New Haven, CT 06520-806, USA.
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16
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Pleasant V. A Public Health Emergency: Breast Cancer Among Black Communities in the United States. Obstet Gynecol Clin North Am 2024; 51:69-103. [PMID: 38267132 DOI: 10.1016/j.ogc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Piñar-Gutiérrez A, Dueñas Disotuar S, de Lara-Rodríguez I, Amuedo-Domínguez S, González-Cejudo C, Tejero-Delgado J, Mangas-Cruz MÁ. Difficulties of gender affirming treatment in trans women with BRCA1+ mutation: A case report. ENDOCRINOL DIAB NUTR 2024; 71:144-148. [PMID: 38555112 DOI: 10.1016/j.endien.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 04/02/2024]
Abstract
Gender affirming treatment in transgender women is based on a combination of antiandrogens and estrogens, with the latter maintained over the long term. When prescribing these treatments, we must consider the possibility of developing estrogen-dependent breast cancer. In transgender women, a breast cancer incidence of 4.1 per 100,000 has been estimated, which would increase the risk by 46% in relation to cisgender men but decrease it by 70% in relation to cisgender women. It is known that certain gene mutations such as BRCA1 imply an increased risk of breast cancer, but at present the risk in transgender women with BRCA1 treated with estrogens is not well established. We present the case of a transgender woman with a family history of breast cancer and BRCA1 mutation and the therapeutic decisions made in a multidisciplinary team. Following this case, we review and discuss the published literature.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Suset Dueñas Disotuar
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Irene de Lara-Rodríguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; UGC de Ginecología, Oncología Ginecológica y Patología mamaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Carmen González-Cejudo
- UGC de Ginecología, Oncología Ginecológica y Patología mamaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Tejero-Delgado
- UGC de Ginecología, Oncología Ginecológica y Patología mamaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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18
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Heng YJ, Baker GM, Fein-Zachary VJ, Guzman-Arocho YD, Bret-Mounet VC, Massicott ES, Gitin S, Russo P, Tobias AM, Bartlett RA, Varma G, Kontos D, Yaghjyan L, Irwig MS, Potter JE, Wulf GM. Effect of testosterone therapy on breast tissue composition and mammographic breast density in trans masculine individuals. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.09.24300987. [PMID: 38260574 PMCID: PMC10802634 DOI: 10.1101/2024.01.09.24300987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Objective Determine the association between TT and breast tissue composition and breast tissue density in trans masculine individuals (TMIs). Design This is a cross-sectional study. Setting TMIs (n=444) underwent chest-contouring surgeries to treat their gender dysphoria between 2013 and 2019 at an urban medical center. Participants Of the 444 TMIs, 425 had pathology images analyzed by our deep-learning algorithm to extract breast tissue composition. A subset of 42/444 TMIs had mammography prior to surgery; mammography files were available for 25/42 TMIs and analyzed using a breast density software, LIBRA. Main Outcomes and Measures The first outcome was the association of duration of TT and breast tissue composition assessed by pathologists (categories of lobular atrophy and stromal composition) or by our algorithm (% epithelium, % fibrous stroma, and % fat). The second outcome is the association of TT and breast density as assessed by a radiologist (categorical variable) or by LIBRA (percent density, absolute dense area, and absolute non-dense area). Results Length of TT was associated with increasing degrees of lobular atrophy ( p <0.001) but not fibrous content ( p =0.821) when assessed by the pathologists. Every six months of TT was associated with decreased amounts of both epithelium (exp(β)=0.97, 95% CI 0.95-0.98, adj p =0.005) and stroma (exp(β)=0.99, 95% CI 0.98-1.00, adj p =0.051), but not fat (exp(β)=1.01, 95%CI 0.98-1.05, p =0.394) in fully adjusted models. There was no association between TT and radiologist's breast density assessment ( p =0.575) or LIBRA measurements ( p >0.05). Conclusions TT decreases breast epithelium and fibrous stroma, thus potentially reducing the breast cancer risk of TMIs. Further studies are warranted to elucidate the effect of TT on breast density and breast cancer risk. Summary Box Very little is known about the effect of gender-affirming testosterone therapy on cancer risks, such as breast cancer.Epidemiological studies had different conclusions about the association between testosterone and breast cancer in cisgender women (positive association) and trans masculine individuals (inverse association).More laboratory-based research are needed to understand the effect of testosterone on breast cancer risk in the understudied trans masculine population.Our study provides quantitative histological evidence to support prior epidemiological reports that testosterone may reduce breast cancer risk in trans masculine individuals.
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19
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Carroll EF, Rogers C, Summerside M, Cortina CS. Breast care considerations for transgender and gender-diverse patients. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241289706. [PMID: 39382481 PMCID: PMC11465296 DOI: 10.1177/17455057241289706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/16/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024]
Abstract
Transgender and gender-diverse (TGD) persons represent a small but growing population in the United States. Accessing inclusive, equitable, and evidence-based healthcare remains a challenge for this patient population. Many TGD persons seek gender-affirming care, including gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS), to help ameliorate the physical and mental aspects of their gender incongruence. Both GAHT and GAS induce clinically important histopathologic and anatomic changes in breast tissue. Consequently, breast care in TGD persons has become an increasingly recognized topic of importance in gender-affirming care. However, there remains a scarce but growing base of literature specifically addressing the unique healthcare needs of breast care in TGD patients. This article will review how to establish trusting patient-provider relationships for TGD patients, gender inclusivity in breast clinics and imaging centers, the influence of GAHT and GAS on breast tissue, breast cancer screening recommendations and barriers, and breast cancer risk and treatment considerations in TGD persons.
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Affiliation(s)
- Evelyn F Carroll
- Division of Breast Imaging and Intervention, Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Division of Emergency and Hospital Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
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20
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Sato S, Imada S, Hayami R, Arai K, Kosugi R, Tsuneizumi M, Matsunuma R. Complexities in Adjuvant Endocrine Therapy for Breast Cancer in Female-to-Male Transgender Patients. Case Rep Oncol 2024; 17:208-216. [PMID: 38327829 PMCID: PMC10849748 DOI: 10.1159/000536212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Managing breast cancer in female-to-male (FtM) transgender patients is complicated and challenging. Androgens play a crucial role in the development of secondary sexual identity in FtM transgender patients, but their effectiveness in breast cancer remains unclear. Furthermore, the considerations for adjuvant endocrine therapy in this population are highly intricate and warrant thorough discussion. Case Presentation We describe the case of a 44-year-old FtM transgender diagnosed with breast cancer 3 years after initiating androgen receptor agonist therapy as part of his gender identity transition. After mastectomy, adjuvant endocrine therapy was initiated, consisting of a combination of an aromatase inhibitor and a gonadotropin-releasing hormone agonist, along with a cross-sex hormone. Conclusion Estradiol levels were significantly reduced, and male-typical levels of sex hormones were attained.
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Affiliation(s)
- Shoko Sato
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Sae Imada
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryosuke Hayami
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazumori Arai
- Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan
| | - Rieko Kosugi
- Center for Diabetes, Endocrinology and Metabolism, Shizuoka General Hospital, Shizuoka, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryoichi Matsunuma
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
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21
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Jackson SS, Hammer A. Cancer risk among transgender adults: A growing population with unmet needs. Acta Obstet Gynecol Scand 2023; 102:1428-1430. [PMID: 37842752 PMCID: PMC10577612 DOI: 10.1111/aogs.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Sarah S. Jackson
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMarylandUSA
| | - Anne Hammer
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Obstetrics and GynecologyGødstrup HospitalHerningDenmark
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22
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Mercer J, Bandy S, Tang H, Wenger B, Ryan L, Lee G, Lipscomb J. Gender-affirming pharmacotherapy and additional health considerations: A contemporary review. J Am Pharm Assoc (2003) 2023; 63:1669-1676.e1. [PMID: 37619851 DOI: 10.1016/j.japh.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Transgender and gender-diverse (TGD) individuals in the United States face health care disparities compounded with discrimination and limited access to necessary medical services. Gender-affirming interventions have been shown to mitigate gender dysphoria and psychiatric comorbidities, yet United States legislation limiting such interventions has increased. As medication experts, pharmacists can facilitate access to care and appropriate use of gender-affirming hormone therapy (GAHT) and educate other health care providers on best practices for caring for TGD individuals in a variety of settings. OBJECTIVES To provide pharmacists with a contemporary review of GAHT and associated medication-related concerns. METHODS We searched PubMed for articles published until December 2022. MeSH terms such as transgender, transsexual, gender diverse, gender variant, or gender nonconforming in combination with phrases like gender-affirming care, treatment, pharmacotherapy, or hormone therapy were used to capture desired articles. RESULTS Feminizing hormone therapy (FHT), such as estrogen and antiandrogen agents, increases female secondary sex characteristics while suppressing male secondary sex characteristics. Masculinizing hormone therapy (MHT) achieves male secondary sex characteristics and minimizes female secondary sex characteristics using testosterone. For both FHT and MHT, the choice of therapy and formulation ultimately involves the patient's treatment goals, preferences, and tolerability. GAHT has additional health considerations pertaining to renal drug dosing, fertility, cardiovascular, and cancer risks. Pharmacists may provide crucial guidance and education to both patients and health care providers regarding risks associated with GAHT. CONCLUSION Many pharmacists feel unprepared to help provide, manage, and optimize GAHT. For many TGD individuals, GAHT is medically necessary and a life-saving treatment. Therefore, pharmacists should be provided tools to close knowledge gaps and improve their ability to care for these patients. By offering a thorough updated overview of GAHT, pharmacists can gain confidence to provide appropriate care for this increasingly visible population.
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Hodan R, Rodgers-Fouche L, Chittenden A, Dominguez-Valentin M, Ferriss J, Gima L, Hamnvik OPR, Idos GE, Kline K, Koeller DR, Long JM, McKenna D, Muller C, Thoman M, Wintner A, Bedrick BS. Cancer surveillance for transgender and gender diverse patients with Lynch syndrome: a practice resource of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer. Fam Cancer 2023; 22:437-448. [PMID: 37341816 DOI: 10.1007/s10689-023-00341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
Transgender and gender diverse (TGD) populations with hereditary cancer syndromes face unique obstacles to identifying and obtaining appropriate cancer surveillance and risk-reducing procedures. There is a lack of care provider knowledge about TGD health management. Lynch syndrome (LS) is one of the most common hereditary cancer syndromes, affecting an estimated 1 in 279 individuals. There are no clinical guidelines specific for TGD individuals with LS, highlighting a need to improve the quality of care for this population. There is an urgent need for cancer surveillance recommendations for TGD patients. This commentary provides recommendations for cancer surveillance, risk-reducing strategies, and genetic counseling considerations for TGD patients with LS.
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Affiliation(s)
- Rachel Hodan
- Cancer Genetics, Stanford Health Care and Department of Pediatrics (Genetics), Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Linda Rodgers-Fouche
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Anu Chittenden
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mev Dominguez-Valentin
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
| | - James Ferriss
- Department of Gynecology and Obstetrics, Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lauren Gima
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, CA, USA
| | - Ole-Petter R Hamnvik
- Center for Transgender Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Gregory E Idos
- Division of Gastroenterology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin Kline
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Diane R Koeller
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jessica M Long
- Division of Hematology and Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Danielle McKenna
- Division of Hematology and Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Charles Muller
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA
| | - Maxton Thoman
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Coelingh Bennink HJT, Schultz IJ, Schmidt M, Jordan VC, Briggs P, Egberts JFM, Gemzell-Danielsson K, Kiesel L, Kluivers K, Krijgh J, Simoncini T, Stanczyk FZ, Langer RD. Progesterone from ovulatory menstrual cycles is an important cause of breast cancer. Breast Cancer Res 2023; 25:60. [PMID: 37254150 DOI: 10.1186/s13058-023-01661-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
Many factors, including reproductive hormones, have been linked to a woman's risk of developing breast cancer (BC). We reviewed the literature regarding the relationship between ovulatory menstrual cycles (MCs) and BC risk. Physiological variations in the frequency of MCs and interference with MCs through genetic variations, pathological conditions and or pharmaceutical interventions revealed a strong link between BC risk and the lifetime number of MCs. A substantial reduction in BC risk is observed in situations without MCs. In genetic or transgender situations with normal female breasts and estrogens, but no progesterone (P4), the incidence of BC is very low, suggesting an essential role of P4. During the MC, P4 has a strong proliferative effect on normal breast epithelium, whereas estradiol (E2) has only a minimal effect. The origin of BC has been strongly linked to proliferation associated DNA replication errors, and the repeated stimulation of the breast epithelium by P4 with each MC is likely to impact the epithelial mutational burden. Long-lived cells, such as stem cells, present in the breast epithelium, can carry mutations forward for an extended period of time, and studies show that breast tumors tend to take decades to develop before detection. We therefore postulate that P4 is an important factor in a woman's lifetime risk of developing BC, and that breast tumors arising during hormonal contraception or after menopause, with or without menopausal hormone therapy, are the consequence of the outgrowth of pre-existing neoplastic lesions, eventually stimulated by estrogens and some progestins.
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Affiliation(s)
| | - Iman J Schultz
- Pantarhei Bioscience BV, P.O. Box 464, 3700 AL, Zeist, The Netherlands
| | - Marcus Schmidt
- Department of Obstetrics and Gynaecology, University Medical Center Mainz, Mainz, Germany
| | - V Craig Jordan
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paula Briggs
- Sexual and Reproductive Health, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | | | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Münster, Münster, Germany
| | - Kirsten Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan Krijgh
- Pantarhei Bioscience BV, P.O. Box 464, 3700 AL, Zeist, The Netherlands
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynaecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Robert D Langer
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA, USA
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25
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Jackson SS, Patel S, Parker K. Cancer disparities among sexual and gender minority populations. J Natl Med Assoc 2023; 115:S32-S37. [PMID: 37202001 PMCID: PMC10204147 DOI: 10.1016/j.jnma.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/01/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Sarah S Jackson
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shyam Patel
- Sexual & Gender Minority Research Office, National Institutes of Health, Bethesda, MD, USA
| | - Karen Parker
- Sexual & Gender Minority Research Office, National Institutes of Health, Bethesda, MD, USA.
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26
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Ussher JM, Power R, Allison K, Sperring S, Parton C, Perz J, Davies C, Cook T, Hawkey AJ, Robinson KH, Hickey M, Anazodo A, Ellis C. Reinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:901-920. [PMID: 36689129 PMCID: PMC10101894 DOI: 10.1007/s10508-023-02530-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/14/2022] [Accepted: 01/02/2023] [Indexed: 05/11/2023]
Abstract
There is a pressing need for greater understanding and focus on cancer survivorship and informal cancer caring of trans people (binary and non-binary), across tumor types, to inform culturally safe trans inclusive cancer information and care. This qualitative study, part of the mixed methods Out with Cancer project, examined experiences of trans embodiment and identity after cancer diagnosis and treatment. We drew on open-ended survey responses from 63 trans cancer survivors and 23 trans cancer carers, as well as interviews and a photo-elicitation activity with a subset of 22 participants (15 cancer survivors, 7 cancer carers). Reflexive thematic analysis identified three themes: Cancer enhances trans embodiment, through experiences of gender euphoria following cancer treatment, and acceleration of decisions about gender affirmation; cancer erases or inhibits gender affirmation; trans embodiment is invisible or pathologized in cancer care. These findings demonstrate that trans embodiment and identity, as well as the process of gender affirmation, may be disrupted by cancer or informal cancer caring. Conversely, cancer and cancer treatment can positively impact the embodied identity and lives of trans people, despite the anxiety and strain of negotiating medical procedures. However, if healthcare professionals operate within a cis-heteronormative framework and do not understand the meaning of embodied change following cancer treatment for trans individuals, these positive benefits may not be realized.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia.
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Samantha Sperring
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Chloe Parton
- School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
- School of Social Sciences, Western Sydney University, Penrith, Sydney, Australia
| | - Teddy Cook
- TransHub, ACON, Surry Hills, Sydney, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Kerry H Robinson
- School of Social Sciences and Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's, University of New South Wales, Sydney, Australia
| | - Colin Ellis
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
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27
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Green R, Eckstrand KL, Faeder M, Tilstra S, Ufomata E. Affirming Care for Transgender Patients. Med Clin North Am 2023; 107:371-384. [PMID: 36759103 DOI: 10.1016/j.mcna.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Gender identity is a deeply felt internal sense of self, which may correspond (cisgender) or not correspond (transgender) with the person's assigned sex at birth. Transgender, nonbinary, and gender diverse people may choose to affirm their gender in any number of ways including medical gender affirmation. This is a primer on the medical care of transgender individuals which covers an introduction to understanding a common language, history of transgender medical care, creating a welcoming environment, hormone therapy, surgical therapies, fertility considerations, and cancer screening in transgender people.
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Affiliation(s)
- Rebecca Green
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Kristen L Eckstrand
- Department of Psychiatry, University of Pittsburgh School of Medicine, Loeffler Building #301, 121 Meyran Avenue, Pittsburgh, PA 15213, USA
| | - Morgan Faeder
- University of Pittsburgh School of Medicine, UPMC Psychiatry CL, 3600 Forbes Avenue, Suite 306, Pittsburgh, PA 15213, USA
| | - Sarah Tilstra
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Eloho Ufomata
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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28
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Roznovjak D, Petroll AE, Lakatos AEB, Narayan R, Cortina CS. Perceptions of Transgender and Nonbinary Persons Toward Breast and Cervical Cancer Development, Screening, and Potential Impact on Gender-Affirming Hormone Therapy. JCO Oncol Pract 2023; 19:e794-e800. [PMID: 36800556 DOI: 10.1200/op.22.00681] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE Approximately 1.6% of adult Americans identify as transgender (TG) or nonbinary (NB) and many take gender-affirming hormone therapy (GAHT). Little data exist to inform breast and cervical cancer risks, gender-specific screening guidelines, and inclusive cancer treatment algorithms that consider GAHT. We aimed to assess TGNB persons' perceptions on breast and cervical cancer development, screening knowledge and practices, and attitude toward GAHT in the setting of a hormone receptor-positive breast cancer diagnosis. METHODS This single-institution survey study was conducted through an LGBTQ+ focused clinic from 2021 to 2022. Noncisgender patients age ≥ 18 years who were English speaking were eligible to participate. A 5-point Likert scale was used to assess concern of developing breast (all participants) and cervical cancer (those assigned female sex at birth). Demographic and quantitative variables were examined in comparison with responses via chi-squared tests. RESULTS Eighty-six participants completed the survey: 43% TG men, 24% TG women, and 20% NB persons. Most (84.9%) were age < 40 years, and 86% were non-Hispanic White. The majority were unaware of breast (77%) or cervical (60%) cancer screening recommendations for their sex assigned at birth or their gender. Approximately 35% reported concern regarding breast cancer development and of those age > 40 years; only 50% had undergone screening mammography. Of those assigned female sex at birth with an intact cervix, 47% were concerned about cervical cancer development and 46.6% had a Papanicolaou smear within the past 5 years. Nearly all (87.2%) were on GAHT, and 35.1% reported they would not consider stopping GAHT if diagnosed with a hormone receptor-positive breast cancer. CONCLUSION The findings support the need for patient and provider education on screening options and large prospective cohort data to elucidate optimal gender-specific screening guidelines and treatment algorithms.
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Affiliation(s)
- David Roznovjak
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew E Petroll
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Froedtert & the Medical College of Wisconsin's Inclusion Health Clinic, Milwaukee, WI
| | - Annie E B Lakatos
- Froedtert & the Medical College of Wisconsin's Inclusion Health Clinic, Milwaukee, WI
| | - Raj Narayan
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.,Medical College of Wisconsin Cancer Center, Milwaukee, WI
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29
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Risk and incidence of breast cancer in transgender individuals: a systematic review and meta-analysis. Eur J Cancer Prev 2023; 32:207-214. [PMID: 36789830 DOI: 10.1097/cej.0000000000000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND AIMS The risk of developing breast cancer in transgender individuals [male-to-female (MtF) or female-to-male (FtM)] is still inadequately quantified. We aimed to evaluate the impact of breast cancer in this population. METHODS We conducted a systematic literature search and review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines through the PUBMED and SCOPUS databases. We identified six cohort studies (for both populations) plus 35 case reports. Incidence and breast cancer risk quantification were the main outcomes considered. RESULTS FtM individuals had a higher risk of developing breast cancer in comparison to cisgender men [standardized incidence ratio (SIR) = 63.4; 95% confidence interval (CI), 32.2-124.9] but a lower risk than cisgender women (SIR = 0.42; 95% CI, 0.07-2.41). Similarly, MtF individuals were at higher risk of developing breast cancer in comparison to cisgender men (SIR = 22.5; 95% CI, 5.54-91.8) and at lower risk than cisgender women (SIR = 0.30; 95% CI, 0.22-0.42). CONCLUSION In this systematic study and meta-analysis, we identified that FtM and MtF individuals are at substantially higher risk of developing breast cancer in comparison to cisgender men, though at lower risk than cisgender women. These individuals, in the absence of defined guidelines for breast cancer prevention, should periodically undergo breast or chest examinations.
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30
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Leone AG, Trapani D, Schabath MB, Safer JD, Scout NFN, Lambertini M, Berardi R, Marsoni S, Perrone F, Cinieri S, Miceli R, Morano F, Pietrantonio F. Cancer in Transgender and Gender-Diverse Persons: A Review. JAMA Oncol 2023; 9:556-563. [PMID: 36757703 DOI: 10.1001/jamaoncol.2022.7173] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Importance Transgender and gender-diverse individuals face unique challenges, including barriers to health care access and inequities in treatment, that may influence cancer risk and outcomes. Observations In this narrative review, a scoping review was conducted focusing on primary and secondary prevention and epidemiology of cancer, barriers to health care services, and health care practitioners' knowledge about specific issues pertaining to transgender and gender-diverse individuals. PubMed, the Cochrane Library, and Embase, were reviewed for citations from their inception to December 31, 2021. This review revealed that transgender and gender-diverse people had a high prevalence of tobacco consumption and alcohol use and high rates of infection with human papillomavirus (HPV) and HIV. Transgender and gender-diverse individuals were less likely to adhere to cancer screening programs and had a higher incidence of HIV- and HPV-associated cancers. Social and economic determinants seemed to drive these disparities in risk factors and outcomes. A lack of knowledge about gender minorities' health needs among health care practitioners was evidenced, and it represented a major hurdle to cancer prevention, care, and survivorship for transgender and gender-diverse individuals. Discrimination, discomfort caused by gender-labeled oncological services, stigma, and lack of cultural sensitivity of health care practitioners were other barriers met by transgender and gender-diverse persons in the oncology setting. Conclusions and Relevance The findings suggest that transgender and gender-diverse peoples' needs in the cancer care continuum are not optimally addressed. Effective solutions are needed to offer the best care to every patient in a person-centric and gender diversity-sensitive environment.
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Affiliation(s)
| | - Dario Trapani
- European Institute of Oncology, IRCCS, Milan, Italy.,Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York.,Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
| | - N F N Scout
- National LGBT Cancer Network, Providence, Rhode Island
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, Unità Operativa Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Marsoni
- IFOM, FIRC Institute of Molecular Oncology, Milan, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - Rosalba Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Defreyne J, Vander Stichele C, Iwamoto SJ, T'Sjoen G. Gender-affirming hormonal therapy for transgender and gender-diverse people-A narrative review. Best Pract Res Clin Obstet Gynaecol 2023; 86:102296. [PMID: 36596713 PMCID: PMC11197232 DOI: 10.1016/j.bpobgyn.2022.102296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
As the number of transgender and gender-diverse (TGD) people accessing gender-affirming care increases, the need for healthcare professionals (HCPs) providing gender-affirming hormonal therapy (GAHT) also increases. This chapter provides an overview of the HCPs interested in getting involved in providing GAHT.
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Affiliation(s)
- J Defreyne
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
| | - Clara Vander Stichele
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, and Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
| | - G T'Sjoen
- Department of Endocrinology and Center for Sexology, Ghent University Hospital, Ghent, Belgium.
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32
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Hayward JH. Updates in Transgender Breast Imaging. Semin Ultrasound CT MR 2023; 44:23-34. [PMID: 36792271 DOI: 10.1053/j.sult.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender patients are seen in breast imaging centers for routine screening mammography and diagnostic imaging of the symptomatic breast. This comprehensive review of transgender breast imaging aims to update the radiologist on appropriate terminology, breast cancer risk in different patient populations, screening guidelines, and diagnostic scenarios. The chapter concludes with practical tips on how to optimize the patient experience.
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Affiliation(s)
- Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco.
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33
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Fatima A, Jami H, Irwin JA. Barriers faced by trans men (female to male transgender persons) in gender transitioning in Pakistan. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2023. [DOI: 10.1080/19359705.2022.2156648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Arooj Fatima
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Humaira Jami
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jay A. Irwin
- Department of Sociology and Anthropology, University of Nebraska at Omaha, Omaha, Nebraska, USA
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34
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Ramsey I, Kennedy K, Sharplin G, Eckert M, Peters MDJ. Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:174-194. [PMID: 37114110 PMCID: PMC10128429 DOI: 10.1080/26895269.2022.2155289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.
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Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Micah D. J. Peters
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
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Hughto JMW, Varma H, Babbs G, Yee K, Alpert A, Hughes L, Ellison J, Downing J, Shireman TI. Disparities in health condition diagnoses among aging transgender and cisgender medicare beneficiaries, 2008-2017. Front Endocrinol (Lausanne) 2023; 14:1102348. [PMID: 36992801 PMCID: PMC10040837 DOI: 10.3389/fendo.2023.1102348] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The objective of this research is to provide national estimates of the prevalence of health condition diagnoses among age-entitled transgender and cisgender Medicare beneficiaries. Quantification of the health burden across sex assigned at birth and gender can inform prevention, research, and allocation of funding for modifiable risk factors. METHODS Using 2009-2017 Medicare fee-for-service data, we implemented an algorithm that leverages diagnosis, procedure, and pharmacy claims to identify age-entitled transgender Medicare beneficiaries and stratify the sample by inferred gender: trans feminine and nonbinary (TFN), trans masculine and nonbinary (TMN), and unclassified. We selected a 5% random sample of cisgender individuals for comparison. We descriptively analyzed (means and frequencies) demographic characteristics (age, race/ethnicity, US census region, months of enrollment) and used chi-square and t-tests to determine between- (transgender vs. cisgender) and within-group gender differences (e.g., TMN, TFN, unclassified) difference in demographics (p<0.05). We then used logistic regression to estimate and examine within- and between-group gender differences in the predicted probability of 25 health conditions, controlling for age, race/ethnicity, enrollment length, and census region. RESULTS The analytic sample included 9,975 transgender (TFN n=4,198; TMN n=2,762; unclassified n=3,015) and 2,961,636 cisgender (male n=1,294,690, female n=1,666,946) beneficiaries. The majority of the transgender and cisgender samples were between the ages of 65 and 69 and White, non-Hispanic. The largest proportion of transgender and cisgender beneficiaries were from the South. On average, transgender individuals had more months of enrollment than cisgender individuals. In adjusted models, aging TFN or TMN Medicare beneficiaries had the highest probability of each of the 25 health diagnoses studied relative to cisgender males or females. TFN beneficiaries had the highest burden of health diagnoses relative to all other groups. DISCUSSION These findings document disparities in key health condition diagnoses among transgender Medicare beneficiaries relative to cisgender individuals. Future application of these methods will enable the study of rare and anatomy-specific conditions among hard-to-reach aging transgender populations and inform interventions and policies to address documented disparities.
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Affiliation(s)
- Jaclyn M. W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
- *Correspondence: Jaclyn M. W. Hughto,
| | - Hiren Varma
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Gray Babbs
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Kim Yee
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, United States
| | - Ash Alpert
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Landon Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Jacqueline Ellison
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh Department of Medicine, Pittsburgh, PA, United States
| | - Jae Downing
- Oregon Health & Science University - Portland State University School of Public Health, Portland, OR, United States
| | - Theresa I. Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
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36
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Gurrala RR, Kumar T, Yoo A, Mundinger GS, Womac DJ, Lau FH. The Impact of Exogenous Testosterone on Breast Cancer Risk in Transmasculine Individuals. Ann Plast Surg 2023; 90:96-105. [PMID: 36534108 DOI: 10.1097/sap.0000000000003321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exogenous testosterone is vital to gender-affirming therapy for transmasculine individuals. Testosterone may be implicated in breast cancer (BCa) because it can activate androgen and estrogen receptors. To further explore this risk, we performed a systematic review to investigate the impact of exogenous testosterone on BCa risk in transmasculine individuals. METHODS We searched PubMed/MEDLINE and Ovid/Embase for clinical and preclinical studies assessing BCa and testosterone therapy and screened 6125 articles independently. We ascertained level of evidence using a modified tool from Cook et al (Chest. 1992;102:305S-311S) and risk of bias using a modified Joanna Briggs Institute's Critical Appraisal Tool. RESULTS Seventy-six studies were included. Epidemiological data suggested that BCa incidence was higher in transmasculine individuals compared with cisgender men but lower compared with cisgender women. Histological studies of transmasculine breast tissue samples also demonstrated a low incidence of precancerous lesions. Interestingly, cases demonstrated that BCa occurred at a younger average age in transmasculine individuals and was predominantly hormone receptor positive. The mechanism for BCa in transmasculine individuals may be related to androgen receptor stimulation or conversion to estradiol. Serum studies reported varied estradiol levels associated with exogenous testosterone. Animal and in vitro studies demonstrated that testosterone was growth inhibitory but may induce proliferation at higher doses or with low estradiol levels. CONCLUSIONS Plastic surgeons play a critical role in providing gender-affirming care for transmasculine patients. The limited studies available suggest that this patient population has decreased risk for BCa when compared with cisgender women; however, any BCa that does occur may have different clinical presentations and underlying mechanisms compared with cisgender women and men. Overall, the limitations for clinical studies and discrepancies among preclinical studies warrant further investigation.
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Affiliation(s)
| | | | - Aran Yoo
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA
| | | | - Daniel J Womac
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA
| | - Frank H Lau
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA
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Heng YJ, Zhang KJ, Valero MG, Baker GM, Fein-Zachary VJ, Irwig MS, Wulf GM. Invasive Ductal Carcinoma of the Breast in a Transgender Man: A Case Report. Case Rep Oncol 2023; 16:811-817. [PMID: 37900827 PMCID: PMC10601725 DOI: 10.1159/000529859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 10/31/2023] Open
Abstract
There is limited literature about breast cancer in the transgender population. Very little is known about how gender-affirming hormone therapy affects their breast cancer risk. On the other end, for those diagnosed with breast cancer, there are no clinical guidelines to manage their breast cancer, specifically, how to manage their gender-affirming hormone therapy during breast cancer treatment. Here, we report a 52-year-old transman diagnosed with a grade 2 invasive ductal carcinoma (ER+/PR+/HER2-), and ductal carcinoma in situ (DCIS) of intermediate grade. We discussed his risk factors as well as treatment options.
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Affiliation(s)
- Yujing J. Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kevin J. Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Monica G. Valero
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gabrielle M. Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valerie J. Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael S. Irwig
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerburg M. Wulf
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Berliere M, Coche M, Lacroix C, Riggi J, Coyette M, Coulie J, Galant C, Fellah L, Leconte I, Maiter D, Duhoux FP, François A. Effects of Hormones on Breast Development and Breast Cancer Risk in Transgender Women. Cancers (Basel) 2022; 15:cancers15010245. [PMID: 36612241 PMCID: PMC9818520 DOI: 10.3390/cancers15010245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Transgender women experience gender dysphoria due to a gender assignment at birth that is incongruent with their gender identity. Transgender people undergo different surgical procedures and receive sex steroids hormones to reduce psychological distress and to induce and maintain desired physical changes. These persons on feminizing hormones represent a unique population to study the hormonal effects on breast development, to evaluate the risk of breast cancer and perhaps to better understand the precise role played by different hormonal components. In MTF (male to female) patients, hormonal treatment usually consists of antiandrogens and estrogens. Exogenous hormones induce breast development with the formation of ducts and lobules and an increase in the deposition of fat. A search of the existing literature dedicated to hormone regimens for MTF patients, their impact on breast tissue (incidence and type of breast lesions) and breast cancer risk provided the available information for this review. The evaluation of breast cancer risk is currently complicated by the heterogeneity of administered treatments and a lack of long-term follow-up in the great majority of studies. Large studies with longer follow-up are required to better evaluate the breast cancer risk and to understand the precise mechanisms on breast development of each exogenous hormone.
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Affiliation(s)
- Martine Berliere
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Gynecology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Correspondence: (M.B.); (M.C.)
| | - Maximilienne Coche
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Gynecology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Correspondence: (M.B.); (M.C.)
| | - Camille Lacroix
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Gynecology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Julia Riggi
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Gynecology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Maude Coyette
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Plastic Surgery, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Julien Coulie
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Plastic Surgery, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Christine Galant
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Pathology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Latifa Fellah
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Radiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Isabelle Leconte
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Radiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Dominique Maiter
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Francois P. Duhoux
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Medical Oncology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
| | - Aline François
- Breast Clinic, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
- Department of Pathology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium
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Wolters EA, Rabe KE, Siegel L, Butts J, Klein ME. Histopathologic Features of Breast Tissue From Transgender Men and Their Associations With Androgen Therapy. Am J Clin Pathol 2022; 159:43-52. [PMID: 36469057 PMCID: PMC9825198 DOI: 10.1093/ajcp/aqac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/20/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVES To assess the histopathologic features of breast tissue of transgender men (TM) undergoing gender-affirming bilateral mastectomies in relation to androgen therapy (AT). METHODS We reviewed 374 transgender bilateral mastectomy cases from 2017 to 2020. Of these, 314 (84.4%) patients received preoperative AT. We compared these with 127 cases of cisgender females undergoing elective breast reduction. RESULTS Breast specimens from TM on AT, compared with cisgender women, showed a median higher gross percentage of fibrous tissue (P < .001), reduced lobular density (P = .004), higher amount of lobular atrophy (P < .001), and lower incidence of cysts (P < .001), apocrine metaplasia (P < .001), calcifications (P < .001), columnar cell change (P = .002), and atypia (P = .003). Each additional month of AT was associated with a 2% decrease in the odds of having nonapocrine cysts (P = .02), a 5% decrease in the odds of having usual ductal hyperplasia (P = .007), and a 0.14% decrease in median lobular density (95% confidence interval, -0.18 to -0.05). CONCLUSIONS In this study, breast specimens from TM, particularly with a history of AT, had a higher proportion of fibrous tissue, fewer lobules, and a higher degree of lobular atrophy than cisgender females. Rare cases of atypia were not predicted by preoperative imaging or gross findings, supporting routine microscopic evaluation of these specimens.
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Affiliation(s)
- Emily A Wolters
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimmie E Rabe
- Pathology Department, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Lianne Siegel
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Jessica Butts
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
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OH JW, Yun Y, Lee ES. A Review of Gender-Affirming Hormone Therapy for Transgender and Gender Diverse Adults in South Korea. J Menopausal Med 2022; 28:92-102. [PMID: 36647272 PMCID: PMC9843037 DOI: 10.6118/jmm.22039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023] Open
Abstract
Recently, gender-affirming hormone therapy for gender incongruence has become an issue in various countries and organizations with various guidelines. In South Korea, several clinical treatments are also used with many possible options. These treatments include masculinizing (female-to-male [FTM]) or feminizing (male-to-female [MTF]) hormone therapies, with regimens usually driven by standards of hormonal replacement therapy for hypogonadism (i.e., hypogonadal natal men and postmenopausal women). This cross-sex hormone therapy can change patients' physical appearance to better match their gender identity and expression. Regarding masculinizing therapy, injection and transdermal gel types of testosterone are used according to international guidelines. Progesterone is utilized in the form of oral pills, injections, or intrauterine devices to suppress menstruation and avoid pregnancy. Essentially, feminizing therapy uses androgen blockers along with estrogen. This is because estrogen alone cannot exert sufficient androgen-suppressing effects. In South Korea, the most commonly used androgen blockers are spironolactone and cyproterone acetate. Gonadotropin-releasing hormone (GnRH) agonist is also available. Regarding estrogen, oral pills, injections, and transdermal gels are utilized. This review introduces these gender-affirming hormone therapies in South Korea and discusses the side effects of each regimen.
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Affiliation(s)
- Jeong-Won OH
- Department of Obstetrics and Gynecology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Yeoul Yun
- Department of Obstetrics and Gynecology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soon Chun Hyang University Seoul Hospital, Soon Chun Hyang University College of Medicine, Seoul, Korea
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Sudhakar D, Huang Z, Zietkowski M, Powell N, Fisher AR. Feminizing gender‐affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks. Neurourol Urodyn 2022. [DOI: 10.1002/nau.25097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022]
Affiliation(s)
| | - Zhong Huang
- Pritzker School of Medicine University of Chicago Chicago Illinois USA
| | - Maeson Zietkowski
- Pritzker School of Medicine University of Chicago Chicago Illinois USA
| | - Natasha Powell
- Pritzker School of Medicine University of Chicago Chicago Illinois USA
| | - Andrew R. Fisher
- Department of Obstetrics and Gynecology University of Chicago Chicago Illinois USA
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Abstract
Transgender and gender diverse (TGD) individuals may undergo a wide range of care during gender transition including mental health counseling, gender-affirming hormonal therapy, and various surgeries. Hormone therapy effectively converts the hormonal milieu into that of the affirmed gender and produces measurable alterations in serum markers for coronary artery disease and other hematologic conditions (eg, erythrocytosis, venous thrombosis). Although illegal in the United States, some transgender women may receive silicone injections for breast and soft tissue augmentation, which can lead to devastating local complications, as well as silicone migration, pulmonary embolism, systemic reactions, and death. Smoking rates are higher among transgender and sexual minority populations, placing them at elevated risk of smoking-related diseases, including lung cancer. Some opportunistic infections may be more common in the TGD populations, attributable to higher rates of coexisting infection with human immunodeficiency virus. Radiologists should be aware that these patients may develop cancer of their natal organs (eg, breast, prostate), especially as some of these tissues are not completely removed during gender-affirming surgery, which may manifest with thoracic involvement by secondary neoplasia. As more TGD patients seek medical care, thoracic radiologists can reasonably expect to interpret imaging performed in this population and should be aware of possible disease processes and potential complications of hormonal and surgical therapies.
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Cole NA, Copeland-Halperin LR, Shank N, Shankaran V. BRCA2-associated Breast Cancer in Transgender Women: Reconstructive Challenges and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4059. [PMID: 35475284 PMCID: PMC9029988 DOI: 10.1097/gox.0000000000004059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Breast cancer in trans women is rare. Only 21 cases have been reported worldwide. Multidisciplinary teams must balance oncologic treatment with patient goals. Here we describe a case of invasive ductal carcinoma in a transgender woman who was found to have a BRCA2 gene mutation. A shared decision-making process led to the patient undergoing bilateral nipple-sparing mastectomy with immediate tissue expander placement. Later findings prompted discussions about adjuvant chemotherapy and radiation. Additionally, we discuss the complexities associated with reconstructing a transfeminine chest.
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Affiliation(s)
- Naomi A. Cole
- From the Dartmouth Geisel School of Medicine, Lebanon, NH
| | | | - Nina Shank
- Dartmouth-Hitchcock Medical Center, Division of Plastic Surgery, Lebanon, NH
| | - Vidya Shankaran
- From the Dartmouth Geisel School of Medicine, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Division of Plastic Surgery, Lebanon, NH
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Lombardo J, Ko K, Shimada A, Nelson N, Wright C, Chen J, Maity A, Ruggiero ML, Richard S, Papanagnou D, Mitchell E, Leader A, Simone NL. Perceptions of and barriers to cancer screening by the sexual and gender minority community: a glimpse into the health care disparity. Cancer Causes Control 2022; 33:559-582. [PMID: 34984592 PMCID: PMC9076188 DOI: 10.1007/s10552-021-01549-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE A disparity exists in cancer screening rates for the Sexual and Gender Minority (SGM) community. We sought to understand the perceptions and baseline knowledge of cancer screening among SGM community members. METHODS Survey administered via social media from June 2018 to October 2018. We asked 31 questions focused on cancer screening, human papillomavirus, emotional distress, and experience with the health care system. Those included were 18 years or older. Cancer screening attitudes and knowledge, as well as perceptions of the health care system were investigated. RESULTS There were 422 respondents analyzed: 24.6% identified as female, 25.5% as male, 40.1% transgender, and 9.6% as other. 65.4% of the SGM community is not certain what cancer screening to do for themselves. Only 27.3% and 55.7% knew that HPV was a risk factor associated with head and neck cancer and anal cancer, respectively. Half stated their emotional distress prevents them from getting cancer screening. It was identified that process changes in making appointments, comforts during the visit, and formal training for physicians and nurses could increase cancer screening compliance for this community. The transgender population had a trend in more gaps in knowledge of appropriate cancer screening and significant excess emotional distress. CONCLUSION Gaps in cancer screening knowledge and emotional and financial distress may be responsible for the disparity of lower cancer screening rates for the SGM population and the transgender population may be most at risk. Appreciating the cancer screening concerns of the SGM population can help shape future clinical and institutional approaches to improve health care delivery.
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Affiliation(s)
- Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicolas Nelson
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerry Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alisha Maity
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marissa L Ruggiero
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott Richard
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Edith Mitchell
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Leader
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Department of Radiation Oncology, Bodine Center for Cancer Treatment, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA, 19107, USA.
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Gender-affirming Mastectomy with Concurrent Oncologic Mastectomy. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4092. [PMID: 35169524 PMCID: PMC8830861 DOI: 10.1097/gox.0000000000004092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Transmasculine individuals may not have undergone gender-affirming mastectomy and retain natal breast tissue. Our center offers simultaneous oncologic mastectomy with gender-affirming reconstruction to patients who are diagnosed with breast cancer. This study is the first reported series of concurrent gender-affirming and oncologic mastectomies.
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BRCA Mutations and the Implications in Transgender Individuals Undergoing Top Surgery: An Operative Dilemma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4012. [PMID: 35028250 PMCID: PMC8747588 DOI: 10.1097/gox.0000000000004012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
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Brown A, Lourenco AP, Niell BL, Cronin B, Dibble EH, DiNome ML, Goel MS, Hansen J, Heller SL, Jochelson MS, Karrington B, Klein KA, Mehta TS, Newell MS, Schechter L, Stuckey AR, Swain ME, Tseng J, Tuscano DS, Moy L. ACR Appropriateness Criteria® Transgender Breast Cancer Screening. J Am Coll Radiol 2021; 18:S502-S515. [PMID: 34794604 DOI: 10.1016/j.jacr.2021.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022]
Abstract
Breast cancer screening recommendations for transgender and gender nonconforming individuals are based on the sex assigned at birth, risk factors, and use of exogenous hormones. Insufficient evidence exists to determine whether transgender people undergoing hormone therapy have an overall lower, average, or higher risk of developing breast cancer compared to birth-sex controls. Furthermore, there are no longitudinal studies evaluating the efficacy of breast cancer screening in the transgender population. In the absence of definitive data, current evidence is based on data extrapolated from cisgender studies and a limited number of cohort studies and case reports published on the transgender community. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Ann Brown
- University of Cincinnati, Cincinnati, Ohio.
| | - Ana P Lourenco
- Panel Chair, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany L Niell
- Panel Vice-Chair; and Section Chief, Breast Imaging and Lead Interpreting Physician, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Chair, ACR Commission on Breast Imaging Government Relations Committee; Panel Member, NCCN Breast Cancer Screening and Diagnosis Panel; Radiomics Chair, ECOG-ACRIN EA1202 DCIS DUET TRIAL; and Member, ACR and SBI Screening Leadership Group
| | - Beth Cronin
- Women and Infants Hospital, Providence, Rhode Island; RI Section Chair, for American College of Obstetrics and Gynecology; and Primary care physician-obstetrician/gynecologist
| | | | - Maggie L DiNome
- Chief, Breast Surgey and Director, Breast Health UCLA Medical Center, Los Angeles, California; and Society of Surgical Oncology
| | - Mita Sanghavi Goel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; American College of Physicians
| | - Juliana Hansen
- Oregon Health and Science University, Portland, Oregon; and Board Member, American Society of Plastic Surgeons
| | | | - Maxine S Jochelson
- Director, Imaging, Evelyn Lauder Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Tejas S Mehta
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; BIDMC Trustee Advisory Board; Tufts University School of Medicine Board of Advisors; and Mass Radiology Society - Breast Imaging Committee
| | - Mary S Newell
- Interim Division Director, Breast Imaging, Emory University Hospital, Atlanta, Georgia; Governor, ABR; Board Member and SBI Chair, ACR BI-RADS; and Chair, ACR PP/TS
| | - Loren Schechter
- Weiss Memorial Hospital, Chicago, Illinois; and Treasurer and Member of the Executive Committee, World Professional Association for Transgender Health
| | - Ashley R Stuckey
- Women and Infants Hospital, Providence, Rhode Island; American College of Obstetricians and Gynecologists
| | - Mary E Swain
- Radiology Associates of Tallahassee, Tallahassee, Florida
| | - Jennifer Tseng
- The University of Chicago Medicine, Chicago, Illinois; and Editorial Board, American Board of Surgery SCORE; Editor, Journal of Surgical Education; Training Committee, Society of Surgical Oncology; American College of Surgeons
| | | | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York; Chair, ACR PP/TS; Chair, ACR NMD Registry; Senior Deputy Editor, Radiology; and Advisory Board, iCAD and Lunit
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Sieberg R, Soriano K, Zuurbier R. A rare case of breast cancer in a transgender woman. Radiol Case Rep 2021; 16:3285-3288. [PMID: 34484532 PMCID: PMC8403717 DOI: 10.1016/j.radcr.2021.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/17/2021] [Accepted: 07/18/2021] [Indexed: 12/03/2022] Open
Abstract
We report a case of breast cancer in a transgender woman (assigned male sex at birth, gender identity female) of Ashkenazi Jewish descent with BRCA2 mutation who had been taking cross-sex hormone therapy for 2 years. In addition to demonstrating breast cancer imaging findings and risk factors, this case draws attention to the paucity of research and data regarding breast cancer in transgender women and exemplifies the need for evidence-based consensus breast cancer screening recommendations for transgender women.
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Affiliation(s)
- Ryan Sieberg
- Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Katrina Soriano
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA
| | - Rebecca Zuurbier
- Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
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de Blok CJ, Wiepjes CM, van Velzen DM, Staphorsius AS, Nota NM, Gooren LJ, Kreukels BP, den Heijer M. Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria. Lancet Diabetes Endocrinol 2021; 9:663-670. [PMID: 34481559 DOI: 10.1016/s2213-8587(21)00185-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased mortality in transgender people has been described in earlier studies. Whether this increased mortality is still present over the past decades is unknown. Therefore, we aimed to investigate trends in mortality over five decades in a large cohort of adult transgender people in addition to cause-specific mortality. METHODS We did a retrospective cohort study of adult transgender people who visited the gender identity clinic of Amsterdam University Medical Centre in the Netherlands. Data of transgender people who received hormone treatment between 1972 and 2018 were linked to Statistics Netherlands. People were excluded if they used alternating testosterone and oestradiol treatment, if they started treatment younger than age 17 years, or if they had ever used puberty-blockers before gender-affirming hormone treatment. Standardised mortality ratios (SMRs) were calculated using general population mortality rates stratified by age, calendar period, and sex. Cause-specific mortality was also calculated. FINDINGS Between 1972 and 2018, 8831 people visited the gender identity clinic. 4263 were excluded from the study for a variety of reasons, and 2927 transgender women and 1641 transgender men were included in the study, with a total follow-up time of 40 232 person-years for transgender women and 17 285 person-years for transgender men. During follow-up, 317 (10·8%) transgender women died, which was higher than expected compared with general population men (SMR 1·8, 95% CI 1·6-2·0) and general population women (SMR 2·8, 2·5-3·1). Cause-specific mortality in transgender women was high for cardiovascular disease, lung cancer, HIV-related disease, and suicide. In transgender men, 44 people (2·7%) died, which was higher than expected compared with general population women (SMR 1·8, 95% CI 1·3-2·4) but not general population men (SMR 1·2, 95% CI 0·9-1·6). Cause-specific death in transgender men was high for non-natural causes of death. No decreasing trend in mortality risk was observed over the five decades studied. INTERPRETATION This observational study showed an increased mortality risk in transgender people using hormone treatment, regardless of treatment type. This increased mortality risk did not decrease over time. The cause-specific mortality risk because of lung cancer, cardiovascular disease, HIV-related disease, and suicide gives no indication to a specific effect of hormone treatment, but indicates that monitoring, optimising, and, if necessary, treating medical morbidities and lifestyle factors remain important in transgender health care. FUNDING None.
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Affiliation(s)
- Christel Jm de Blok
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Chantal M Wiepjes
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Daan M van Velzen
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annemieke S Staphorsius
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Nienke M Nota
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Louis Jg Gooren
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Baudewijntje Pc Kreukels
- Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Division of Endocrinology, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam University Medical Centres, VU University Medical Centre, Amsterdam, The Netherlands.
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Lienhoop T, Green L. Breast imaging in transgender women: a review. Clin Imaging 2021; 80:283-289. [PMID: 34455238 DOI: 10.1016/j.clinimag.2021.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022]
Abstract
Transgender women are increasingly evaluated in breast imaging centers. Radiologists should be familiar with a range of imaging findings related to feminizing hormone therapy and breast augmentations as well as benign and malignant lesions seen in this population. A growing body of literature has suggested that feminizing hormone therapy may increase the risk of breast cancer, prompting professional organizations to develop screening guidelines. The aim of this paper is to review common breast imaging findings in transgender women, recent data on the association between feminizing hormone therapy and breast cancer, and guidelines for breast cancer screening. Knowing these unique imaging features in transgender women is essential for providing competent care and reducing health care disparities.
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Affiliation(s)
- Thomas Lienhoop
- Department of Radiology, University of Illinois Hospital and Health Sciences System, 1740 W Taylor St, Chicago, IL 60612, USA.
| | - Lauren Green
- Department of Radiology, University of Illinois Hospital and Health Sciences System, 1740 W Taylor St, Chicago, IL 60612, USA.
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