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Cuq J, Lapoirie M, Plotton I, Fraison E, Neuville P, Oriol S. [Transmasculine people: Gender affirming hormonal therapy, sexual and reproductive health prevention and care, a medical review and follow-up suggestions]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00263-0. [PMID: 39097191 DOI: 10.1016/j.gofs.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/23/2024] [Accepted: 06/17/2024] [Indexed: 08/05/2024]
Abstract
Transmasculine individuals have a poor access to health care, mostly regarding the sexual and reproductive health. Despite a lack of official guidelines, they need a gynecological follow-up, the aim of this review was to describe it. The present study involved an exhaustive search of MEDLINE, 68 articles were included to analyze the impact of hormonal therapy, prevention, and care regarding sexual and reproductive health of transmasculine individuals. Despite a lack of solid data, the global literature agrees that transmasculine individuals require sexual and reproductive health care. Care must be adapted to each pathway and may be impacted by gender-affirming care. The cancer risk does not seem to be increased in this population, particularly in relation to hormonal therapy. Prevention programs do not differ from those offered to cis women in the absence of gender-affirming surgeries. Transmasculine individuals require follow-up and care adapted to their needs and their pathways. Healthcare professionals must be trained to provide such care.
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Affiliation(s)
- Juliette Cuq
- Hospices civils de Lyon, université Claude-Bernard, Lyon, France.
| | - Marion Lapoirie
- Service de médecine de la reproduction, hôpital Lyon Est, Lyon, France
| | - Ingrid Plotton
- Service de médecine de la reproduction, hôpital Lyon Est, Lyon, France
| | - Eloise Fraison
- Service de médecine de la reproduction, hôpital Lyon Est, Lyon, France
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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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3
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Tewari S, Ferrando CA. Breast Cancer Screening Referral Patterns and Compliance in Transgender Male Patients. Transgend Health 2024; 9:136-142. [PMID: 38585250 PMCID: PMC10998013 DOI: 10.1089/trgh.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Screening guidelines for breast cancer (BC) in transgender male (TM) patients are not well defined. This study describes referral patterns and compliance with referral for BC screening among TM patients receiving care at a tertiary care center. Methods This was a retrospective cohort study of TM patients, 40-74 years of age, presenting for care between 2017 and 2020. The electronic medical record was queried for medical history and cancer screening data. Compliance with referral and screening was defined as occurring within 2 years of when screening would be expected. Results Of the 266 patients identified, 45 met inclusion criteria. One (2.2%) had a history of BC, 0 (0%) had hereditary BC risk, and 11 (24.4%) had a family history of BC. Of the patients, 18 (40%) were referred for BC screening, of whom 13 (72.2%) were compliant with screening. Ten (55.6%) were referred by a primary care provider, 2 (11.1%) were referred by a transgender medicine specialist, and 6 (33.3%) were referred by both. Of the cohort, 27 (60%) had undergone masculinizing mastectomy. Six (22.2%) of these patients were referred for screening, of whom 0 (0%) had pre-screening clinical findings indicating need for screening. Of the 18 (40%) patients who had not undergone masculinizing mastectomy, 12 (66.7%) were referred for BC screening. Conclusions There was heterogeneity in referral patterns for BC screening between TM patients who had undergone masculinizing mastectomy and those who had not. BC screening guidelines should be established for TM patients who have undergone masculinizing mastectomy.
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Affiliation(s)
- Surabhi Tewari
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cecile A. Ferrando
- Center of Urogynecology and Pelvic Reconstructive Surgery, Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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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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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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Panichella JC, Araya S, Nannapaneni S, Robinson SG, You S, Gubara SM, Gebreyesus MT, Webster T, Patel SA, Hamidian Jahromi A. Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery. World J Clin Oncol 2023; 14:265-284. [PMID: 37583948 PMCID: PMC10424092 DOI: 10.5306/wjco.v14.i7.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/19/2023] Open
Abstract
BACKGROUND Literature focused on cancer screening and management is lacking in the transgender population. AIM To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming (TGNC) patients. METHODS We performed a systematic search of PubMed on January 5th, 2022, with the following terms: "TGNC", OR "transgender", OR "gender non-conforming", OR "gender nonbinary" AND "cancer screening", AND "breast cancer", AND "cervical cancer", AND "uterine cancer", AND "ovarian cancer", AND "prostate cancer", AND "testicular cancer", AND "surveillance", AND "follow-up", AND "management". 70 unique publications were used. The findings are discussed under "Screening" and "Management" categories. RESULTS Screening: Current cancer screening recommendations default to cis-gender protocols. However, long-term gender-affirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection. The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer. Management: Prior to undergoing Gender Affirmation Surgery (GAS), discussion should address cancer screening and management in the organs remaining in situ. Cancer treatment in this population requires consideration for chemotherapy, radiation, surgery and/or reconstruction. Modification of hormone therapy is decided on a case-by-case basis. The use of prophylactic vs aesthetic techniques in surgery is still debated. CONCLUSION When assessing transgender individuals for GAS, a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential. Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social, medical, surgical and gender affirming surgery related specifications. Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes. A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS. Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address. We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature. Further research is required to ensure more comprehensive and individualized care for this population.
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Affiliation(s)
- Juliet C Panichella
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Sthefano Araya
- Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Siddhartha Nannapaneni
- Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Samuel G Robinson
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Susan You
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Sarah M Gubara
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Maria T Gebreyesus
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Theresa Webster
- Department of Plastic Surgery, Temple University, Philadelphia, PA 18045, United States
| | - Sameer A Patel
- Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Alireza Hamidian Jahromi
- Division of Plastic and Reconstructive Surgery, Temple University Hospitals, Philadelphia, PA 19140, United States
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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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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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9
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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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Kelley JT, McMullen-Tabry ER, Skala SL. Reproductive Organ Pathology of Individuals Undergoing Gender-Affirming Surgery. Surg Pathol Clin 2022; 15:421-434. [PMID: 35715169 DOI: 10.1016/j.path.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As gender-affirming surgeries become more routine, it is increasingly important for pathologists to recognize the expected histologic changes seen in various tissues secondary to gender-affirming hormone therapy. For example, exogenous testosterone-related squamous atrophy or transitional cell metaplasia of the cervix may be confused for high-grade squamous intraepithelial lesion. In addition to distinguishing between benign and dysplastic/malignant features, pathologists should be mindful of the phrasing of their reports and aim to use objective, nongendered language.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Emily R McMullen-Tabry
- Department of Pathology, Grand Traverse Pathology, PLLC, 1105 6th Street, Traverse City, MI 49684, USA
| | - Stephanie L Skala
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
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Parmeshwar N, Song S, Alcon A, Kim EA. The Incidence of Breast Cancer After Gender-Affirming Mastectomy in Transmen. Ann Plast Surg 2022; 88:S332-S336. [PMID: 35180758 DOI: 10.1097/sap.0000000000003083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of breast cancer in transmale patients and their continued risk after gender-affirming mastectomy (GAM) has not been well established. Plastic surgeons who offer GAM are often one of the few medical professionals sought out by this population, placing them in a unique position to not only deliver surgical care but also improve access to preventative cancer care. METHODS We reviewed the senior author's experience with GAMs over the past 5 years for any incidence of breast cancer noted after or at time of surgery. We subsequently performed a thorough review of the literature for cases of breast cancer in transmen, to provide a comprehensive overview of screening, therapy, and postoperative surveillance practices. RESULTS We identified 2 cases of breast cancer (ages 49 and 54 years) found on routine examination of pathology specimens after GAM at our institution. Both patients had been taking hormone therapy for the past 1 year. Pathology specimen revealed low-grade estrogen receptor-/progesterone receptor-positive ductal carcinoma in situ in 1 patient, and estrogen receptor-/progesterone receptor-positive invasive ductal carcinoma in the other. Both patients were referred to oncology for appropriate treatment, and both elected to continue their exogenous hormone therapy for personal reasons.Review of the literature demonstrated 36 other cases of documented breast cancer in transmen. Sixty-seven percent (24) were found after GAM, and of those, 50% were incidentally found on pathology specimen. At least 50% were found to be either estrogen-, progesterone-, or androgen receptor-positive cancers. At least 17% of cases documented continued use of masculinizing hormone therapy after cancer diagnosis. CONCLUSIONS Most documented cases of breast cancer in transmen were diagnosed after gender-affirming surgery, which would suggest residual breast tissue does pose some risk for breast cancer. In addition, those diagnosed with cancer may elect to continue exogenous testosterone therapy despite potential added risks with hormone-receptor positivity. These cases highlight the need for agreement in current screening practices, surgical recommendations, and continuation of masculinizing hormone therapy.Plastic surgeons have the unique opportunity to educate these patients on appropriate breast cancer-related surveillance both before and after chest surgery.
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Affiliation(s)
- Nisha Parmeshwar
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco
| | - Siyou Song
- University of California San Francisco, School of Medicine, San Francisco, CA
| | - Andre Alcon
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco
| | - Esther A Kim
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco
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Patel H, Raghuram A, McClure KE, Alcon A, DeStefano L, Srinivasa DR. A Comprehensive Analysis of Breast Malignancies in Transgender Patients: A Systematic Review of Breast Cancer Incidence and Pathology with Provider Survey Results on Long-Term Screening. Transgend Health 2022. [DOI: 10.1089/trgh.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Harsh Patel
- Department of Plastics and Reconstructive Surgery at Cedars-Sinai Medical Center, University of California Los Angeles (UCLA), Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | | | - Kelsey E. McClure
- Division of Plastic and Reconstructive Surgery at University of California San Francisco (UCSF), San Francisco, California, USA
| | - Andre Alcon
- Division of Plastic and Reconstructive Surgery at University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lauren DeStefano
- Department of Surgery at Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhivya R. Srinivasa
- Department of Plastics and Reconstructive Surgery at Cedars-Sinai Medical Center, University of California Los Angeles (UCLA), Los Angeles, California, USA
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14
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Schultz JJ, Naides AI, Bai D, Shulzhenko NO, Keith JD. Pathological Evaluation of Breast Specimens in Transgender Chest Masculinization: Incidental Findings and Effect of Prior Chest Binding and Androgen Therapy in 74 Consecutive Patients. Transgend Health 2022; 6:353-357. [PMID: 34993306 DOI: 10.1089/trgh.2020.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The rate of masculinizing chest surgery for gender affirmation continues to increase. With a paucity of literature on pathological evaluation of breast specimens in this patient population, there is a need for these data and for protocols on the handling of these specimens. Methods: A retrospective chart review was performed between 2015 and 2020 on all patients who underwent chest masculinization surgery for gender dysphoria by the senior author (J.D.K.). Inclusion criteria were any patient with sex assigned female at birth who underwent removal of breast and/or nipple areolar complex tissue for gender affirmation. Patient demographics were recorded. Bilateral breast tissue was sent for routine pathology in all cases and findings were recorded. A p-value of <0.05 was considered significant. Results: Seventy-four consecutive patients and 148 breast specimen reports were identified from a database and included in the study. The mean age was 26 years (15-49). Thirty-nine patients had a known history of chest wall binding and 60 patients had undergone preoperative androgen therapy. There was no invasive or in situ carcinoma found in any breast tissue specimens. Thirty-four patients had a benign lesion in one or both breast specimens. Atypical lobular hyperplasia was found in one patient's specimen. A history of chest wall binding was not correlated with any benign lesions (p=0.79) or stromal fibrosis (p=0.94). A history of testosterone use was not correlated with any benign lesions (p=0.35) or stromal fibrosis (p=0.20). Conclusions: The prevalence (1.4%) of significant breast pathology and of benign findings (46%) in our study closely correlates with the rates in the literature. We found no correlation between significant breast pathology or benign lesions and a history of chest wall binding or preoperative androgen therapy. We recommend all breast specimens removed during chest masculinization surgery be sent for pathological evaluation.
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Affiliation(s)
- Jerette J Schultz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Alexandra I Naides
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Di Bai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Nikita O Shulzhenko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Jonathan D Keith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.,East Coast Advanced Plastic Surgery, Livingston, New Jersey, USA
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15
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Parmeshwar N, Alcon A, Kim EA. A Dual-Surgeon Approach to Breast Cancer Surgery in a Transmale. Ann Plast Surg 2021; 87:633-638. [PMID: 33723981 DOI: 10.1097/sap.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT With increasing numbers of gender-affirming chest surgery, new questions regarding breast cancer management and surgical practice arise. Guided by our case report, we present a comprehensive review of breast cancer surgery in a transman to educate both plastic and breast surgeons on various factors to consider when caring for these patients.Our case involves a 31-year-old transmale patient who presented for plastic surgery consultation for gender-affirming mastectomy but was subsequently found to have a right breast mass. This is the first case in the literature of a transmale on hormone therapy with breast cancer interested in gender-affirming surgery, thus requiring a dual-surgeon approach for oncologic and gender-affirming mastectomy. With a multidisciplinary patient-centered approach involving breast surgery, plastic surgery, medical oncology, and radiology, we devised a surgical plan to safely remove his breast tissue with consideration for his gender-affirming goals. He underwent a right skin-sparing mastectomy with sentinel node biopsy and left prophylactic skin-sparing mastectomy through skin markings by the plastic surgeon, with bilateral free nipple grafts. Final pathology confirmed estrogen and progesterone receptor-positive and androgen receptor-positive invasive ductal carcinoma with clear margins and negative sentinel node. The patient did not require adjuvant chemotherapy or radiation but was started on adjuvant hormone therapy targeting his hormone receptor positive cancer. He elected to stay on low-dose masculinizing hormone therapy with continued surveillance examinations.We follow our case with a review of the current literature involving breast cancer in transmales to explore current screening practices, surgical recommendations, adjuvant therapies, continuation of masculinizing hormone therapy, and postoperative surveillance guidelines in the hopes of informing plastic surgeons in having these discussions with their transmale patients and thus improving informed cancer care for this population.
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Affiliation(s)
- Nisha Parmeshwar
- From the Division of Plastic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
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16
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A Review of Breast Cancer Risk Factors in Adolescents and Young Adults. Cancers (Basel) 2021; 13:cancers13215552. [PMID: 34771713 PMCID: PMC8583289 DOI: 10.3390/cancers13215552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Cancer diagnosed in patients between the ages of 15 and 39 deserves special consideration. Diagnoses within this cohort of adolescents and young adults include childhood cancers which present at an older age than expected, or an early presentation of cancers that are typically observed in older adults, such as breast cancer. Cancers within this age group are associated with worse disease-free and overall survival rates, and the incidence of these cases are rising. Knowing an individual’s susceptibility to disease can change their clinical management and allow for the risk-testing of relatives. This review discusses the risk factors that contribute to breast cancer in this unique cohort of patients, including inherited genetic risk factors, as well as environmental and lifestyle factors. We also describe risk models that allow clinicians to quantify a patient’s lifetime risk of developing disease. Abstract Cancer in adolescents and young adults (AYAs) deserves special consideration for several reasons. AYA cancers encompass paediatric malignancies that present at an older age than expected, or early-onset of cancers that are typically observed in adults. However, disease diagnosed in the AYA population is distinct to those same cancers which are diagnosed in a paediatric or older adult setting. Worse disease-free and overall survival outcomes are observed in the AYA setting, and the incidence of AYA cancers is increasing. Knowledge of an individual’s underlying cancer predisposition can influence their clinical care and may facilitate early tumour surveillance strategies and cascade testing of at-risk relatives. This information can further influence reproductive decision making. In this review we discuss the risk factors contributing to AYA breast cancer, such as heritable predisposition, environmental, and lifestyle factors. We also describe a number of risk models which incorporate genetic factors that aid clinicians in quantifying an individual’s lifetime risk of disease.
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Andrews AR, Kakadekar A, Greene DN, Khalifa MA, Santiago V, Schmidt RL. Histologic Findings in Surgical Pathology Specimens From Individuals Taking Masculinizing Hormone Therapy for the Purpose of Gender Transition: A Systematic Scoping Review. Arch Pathol Lab Med 2021; 146:766-779. [PMID: 34559874 DOI: 10.5858/arpa.2020-0774-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Transgender men and transmasculine persons experience a discordance between the female sex they were assigned at birth and their gender. They may choose to take hormone therapy and/or undergo surgery to masculinize the body. Understanding the common (and less common) histologic changes present in patients taking masculinizing hormones will empower pathologists to better serve this unique patient population. OBJECTIVE.— To summarize histologic findings in surgical pathology specimens from persons taking masculinizing hormones as a part of gender transition. DATA SOURCES.— A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender men from January 1946 to January 2021. CONCLUSIONS.— Publication in this area has markedly increased in the last 2 decades. However, most of the studies identified were descriptive and case reports describing changes seen in specimens removed as a part of masculinizing surgical procedures. Benign histologic findings include stromal hyalinization and epithelial atrophy in the breast, polycystic ovarian syndrome-like changes in the ovary, and transitional cell metaplasia in the cervix. The most commonly reported neoplastic finding was adenocarcinoma of the breast, with rare cases of ovarian, endometrial, cervical, vaginal, pituitary, pancreatic, and cardiovascular neoplasia also reported. Ongoing research in this area is needed to better characterize the histologic findings in persons taking masculinizing hormones to provide a deeper understanding of the effect of these treatments on different tissues and facilitate better patient management.
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Affiliation(s)
- Alicia R Andrews
- From the Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada (Andrews, Kakadekar)
| | - Archan Kakadekar
- From the Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada (Andrews, Kakadekar)
| | - Dina N Greene
- Kaiser Permanente Washington Laboratories, Seattle, Washington (Greene)
| | - Mahmoud A Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Khalifa, Santiago)
| | - Victor Santiago
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Khalifa, Santiago)
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City (Schmidt)
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18
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Salibian AA, Axelrod DM, Smith JA, Fischer BA, Agarwal C, Bluebond-Langner R. Oncologic Considerations for Safe Gender-Affirming Mastectomy: Preoperative Imaging, Pathologic Evaluation, Counseling, and Long-Term Screening. Plast Reconstr Surg 2021; 147:213e-221e. [PMID: 33565823 DOI: 10.1097/prs.0000000000007589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY There remain significant gaps in the evidence-based care of patients undergoing gender-affirming mastectomy with regard to implications for breast cancer development and screening. The current clinical evidence does not demonstrate an increased risk of breast cancer secondary to testosterone therapy in transgender patients. Gender-affirmation mastectomy techniques vary significantly with regard to the amount of residual breast tissue left behind, which has unknown implications for the incidence of postoperative breast cancer and need for screening. Subcutaneous mastectomy should aim to remove all gross breast parenchyma, although this is limited in certain techniques. Tissue specimens should also be routinely sent for pathologic analysis. Several cases of incidental breast cancer after subcutaneous mastectomy have been described. There is little evidence on the need for or types of postoperative cancer screening. Chest awareness is an important concept for patients that have undergone subcutaneous mastectomies, as clinical examination remains the most common reported method of postmastectomy malignancy detection. In patients with greater known retained breast tissue, such as those with circumareolar or pedicled techniques, consideration may be given to alternative imaging modalities, although the efficacy and cost-utility of these techniques must still be proven. Preoperative patient counseling on the risk of breast cancer after gender-affirming mastectomy in addition to the unknown implications of residual breast tissue and long-term androgen exposure is critical. Patient awareness and education play an important role in shared decision-making, as further research is needed to define standards of medical and oncologic care in this population.
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Affiliation(s)
- Ara A Salibian
- From the Hansjörg Wyss Department of Plastic Surgery, the Department of Surgery, and the Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health; the Advanced Center for Plastic Surgery; and the Division of Plastic Surgery, University of Utah
| | - Deborah M Axelrod
- From the Hansjörg Wyss Department of Plastic Surgery, the Department of Surgery, and the Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health; the Advanced Center for Plastic Surgery; and the Division of Plastic Surgery, University of Utah
| | - Julia A Smith
- From the Hansjörg Wyss Department of Plastic Surgery, the Department of Surgery, and the Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health; the Advanced Center for Plastic Surgery; and the Division of Plastic Surgery, University of Utah
| | - Beverly A Fischer
- From the Hansjörg Wyss Department of Plastic Surgery, the Department of Surgery, and the Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health; the Advanced Center for Plastic Surgery; and the Division of Plastic Surgery, University of Utah
| | - Cori Agarwal
- From the Hansjörg Wyss Department of Plastic Surgery, the Department of Surgery, and the Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health; the Advanced Center for Plastic Surgery; and the Division of Plastic Surgery, University of Utah
| | - Rachel Bluebond-Langner
- From the Hansjörg Wyss Department of Plastic Surgery, the Department of Surgery, and the Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health; the Advanced Center for Plastic Surgery; and the Division of Plastic Surgery, University of Utah
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19
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Clarke CN, Cortina CS, Fayanju OM, Dossett LA, Johnston FM, Wong SL. Breast Cancer Risk and Screening in Transgender Persons: A Call for Inclusive Care. Ann Surg Oncol 2021; 29:2176-2180. [PMID: 34097159 DOI: 10.1245/s10434-021-10217-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 01/10/2023]
Abstract
The Society of Surgical Oncology is committed to reducing health disparities adversely affecting sexual and gender minorities. Transgender persons represent a socially disadvantaged group who frequently experience discrimination and receive disparate care, resulting in suboptimal cancer outcomes. The rate of breast cancer development in transgender individuals differs from rates observed in their cisgender counterparts, however there is little evidence to quantify these differences and guide evidence-based screening and prevention. There is no consensus for breast cancer screening guidelines in transgender patients. In this review, we discuss barriers to equitable breast cancer care, risk factors for breast cancer development, and existing data to support breast cancer screening in transgender men and women.
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Affiliation(s)
- Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Sandra L Wong
- Department of Surgery, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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20
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Baker GM, Guzman-Arocho YD, Bret-Mounet VC, Torous VF, Schnitt SJ, Tobias AM, Bartlett RA, Fein-Zachary VJ, Collins LC, Wulf GM, Heng YJ. Testosterone therapy and breast histopathological features in transgender individuals. Mod Pathol 2021; 34:85-94. [PMID: 32939016 PMCID: PMC7854981 DOI: 10.1038/s41379-020-00675-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022]
Abstract
Testosterone therapy (TT) is administered to enhance masculinization in transgender individuals. The long-term effect of exogenous testosterone on breast tissues remains unclear. Our study evaluated the modulation of breast morphology by TT in transgender individuals with special attention to duration of TT. We reviewed 447 breast surgical specimens from gender affirming chest-contouring surgery, and compared histopathological findings including degree of lobular atrophy, and atypical and non-atypical proliferations between subjects who did (n = 367) and did not (n = 79) receive TT. TT for one patient was unknown. TT for >12 months was associated with seven histopathological features. Longer duration of TT was significantly associated with higher degrees of lobular atrophy (p < 0.001). This relationship remained significant after accounting for age at surgery, ethnicity, body mass index, and presurgical oophorectomy (adjusted p < 0.001). Four types of lesions were more likely to be absent in breast tissues exposed to longer durations of TT: cysts (median = 16.2 months; p < 0.01; adjusted p = 0.01), fibroadenoma (median = 14.8 months; p = 0.02; adjusted p = 0.07), pseudoangiomatous stromal hyperplasia (median = 17.0 months; p < 0.001; adjusted p < 0.001), and papillomas (median = 14.7 months; p = 0.04; adjusted p = 0.20). Columnar cell change and mild inflammation were also less likely to occur in subjects receiving TT (p < 0.05), but were not linked to the duration of TT. Atypia and ductal carcinoma in situ were detected in 11 subjects (2.5%) all of whom received TT ranging from 10.1 to 64.1 months. The incidental findings of high-risk lesions and carcinoma as well as the risk of cancer in residual breast tissue after chest-contouring surgery warrant the consideration of culturally sensitive routine breast cancer screening protocols for transgender men and masculine-centered gender nonconforming individuals. Long-term follow-up studies and molecular investigations are needed to understand the breast cancer risk of transgender individuals who receive TT.
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Affiliation(s)
- Gabrielle M Baker
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yaileen D Guzman-Arocho
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vanessa C Bret-Mounet
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vanda F Torous
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Stuart J Schnitt
- Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Dana-Farber Cancer Institute-Brigham and Women’s Hospital, Boston, MA, USA
| | - Adam M Tobias
- Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard A Bartlett
- Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Valerie J Fein-Zachary
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Laura C Collins
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gerburg M Wulf
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yujing J Heng
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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21
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Abstract
PURPOSE OF REVIEW We aim to conduct a systematic review of the literature, document all reported cases of breast cancer development in cis men and female-to-male (FtM) transgender men undergoing testosterone replacement therapy (TRT), and determine if testosterone poses a substantial risk of breast cancer development and recurrence. RECENT FINDINGS A systematic search through December 2019 was performed. Out of 1890, 15 studies were eligible for inclusion in the final analyses. In total, 22 patients have developed breast cancer while on testosterone treatment. Four cases were cis men, whereas 18 cases were FtM. Age ranged from 18 to 61 years. Testosterone treatment duration ranged from 5 weeks up to 25 years. SUMMARY There is a relatively higher incidence of BCa in FtM on CSH therapy compared with cis men on TRT. Because of the small sample size of reported cases, we cannot delineate the exact relationship between testosterone therapy and BCa development. Additionally, we have limited data to suggest that TRT should or should not be contraindicated in cis men and FtM with a prior history of breast cancer.
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22
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Kopetti C, Schaffer C, Zaman K, Liapi A, di Summa PG, Bauquis O. Invasive Breast Cancer in a Trans Man After Bilateral Mastectomy: Case Report and Literature Review. Clin Breast Cancer 2020; 21:e154-e157. [PMID: 33341378 DOI: 10.1016/j.clbc.2020.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Camille Kopetti
- Département de Chirurgie Plastique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Clara Schaffer
- Département de Chirurgie Plastique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Khalil Zaman
- Departement d'oncologi, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Aikaterini Liapi
- Departement d'oncologi, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pietro Giovanni di Summa
- Département de Chirurgie Plastique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olivier Bauquis
- Département de Chirurgie Plastique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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23
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Fledderus AC, Gout HA, Ogilvie AC, van Loenen DKG. Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening. Breast 2020; 53:92-100. [PMID: 32679529 PMCID: PMC7375644 DOI: 10.1016/j.breast.2020.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup. METHODS We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included. RESULTS We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing. CONCLUSION Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.
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Affiliation(s)
- Anne C Fledderus
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, Amsterdam, the Netherlands.
| | - H Antoine Gout
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Aernout C Ogilvie
- Department of Internal Medicine, Medical Oncology, Onze Lieve Vrouwe Hospital, Jan Tooropstraat 164, Amsterdam, the Netherlands
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24
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Defreyne J, Aers XP, Collet SM, Wiepjes CM, Fisher AD, Schreiner T, Den Heijer M, Kaufman JM, T'Sjoen GG. Lower Serum Estradiol Levels in Assigned Female at Birth Transgender People with Initiation of Testosterone Therapy: Results from the European Network for the Investigation of Gender Incongruence. LGBT Health 2020; 7:71-81. [DOI: 10.1089/lgbt.2019.0260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | | | - Sarah M. Collet
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Chantal M. Wiepjes
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VUmc, Amsterdam, the Netherlands
| | - Alessandra D. Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Thomas Schreiner
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Martin Den Heijer
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VUmc, Amsterdam, the Netherlands
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy G.R. T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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25
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Fundytus A, Saad N, Logie N, Roldan Urgoiti G. Breast cancer in transgender female‐to‐male individuals: A case report of androgen receptor‐positive breast cancer. Breast J 2019; 26:1007-1012. [DOI: 10.1111/tbj.13655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Adam Fundytus
- Department of Oncology University of Calgary/Tom Baker Cancer Calgary AB Canada
| | - Nathalie Saad
- Department of Endocrinology University of Calgary Calgary AB Canada
| | - Natalie Logie
- Department of Radiation Oncology University of Calgary/Tom Baker Cancer Calgary AB Canada
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26
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Berro T, Zayhowski K, Field T, Channaoui N, Sotelo J. Genetic counselors’ comfort and knowledge of cancer risk assessment for transgender patients. J Genet Couns 2019; 29:342-351. [DOI: 10.1002/jgc4.1172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Tala Berro
- Division of Medical Sciences Boston University School of Medicine Boston MA USA
| | - Kimberly Zayhowski
- Department of Genetics Stanford University School of Medicine Stanford CA USA
| | | | | | - Jilliane Sotelo
- Center for Cancer Genetics and Prevention Dana Farber Cancer Institute Boston MA USA
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27
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Chotai N, Tang S, Lim H, Lu S. Breast cancer in a female to male transgender patient 20 years post‐mastectomy: Issues to consider. Breast J 2019; 25:1066-1070. [DOI: 10.1111/tbj.13417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/26/2018] [Accepted: 08/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Niketa Chotai
- Department of Radiodiagnosis Tan Tock Seng Hospital Singapore Singapore
| | - Serene Tang
- Department of General Surgery Tan Tock Seng Hospital Singapore Singapore
| | - Hollie Lim
- Department of Radiodiagnosis Tan Tock Seng Hospital Singapore Singapore
| | - Sarah Lu
- Department of General Surgery Tan Tock Seng Hospital Singapore Singapore
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28
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Abstract
Prescribing gender-affirming hormonal therapy in transgender men (TM) not only induces desirable physical effects but also benefits mental health. In TM, testosterone therapy is aimed at achieving cisgender male serum testosterone to induce virilization. Testosterone therapy is safe on the short term and middle term if adequate endocrinological follow-up is provided. Transgender medicine is not a strong part of the medical curriculum, although a large number of transgender persons will search for some kind of gender-affirming care. Because hormonal therapy has beneficial effects, all endocrinologists or hormone-prescribing physicians should be able to provide gender-affirming hormonal care.
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Affiliation(s)
- Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - Guy T'Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
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29
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Testosterone and Breast Cancer in Transmen: Case Reports, Review of the Literature, and Clinical Observation. Clin Breast Cancer 2019; 19:e271-e275. [DOI: 10.1016/j.clbc.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/26/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022]
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Histopathologic findings in breast surgical specimens from patients undergoing female-to-male gender reassignment surgery. Mod Pathol 2019; 32:346-353. [PMID: 30310177 DOI: 10.1038/s41379-018-0117-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/21/2018] [Accepted: 08/03/2018] [Indexed: 11/08/2022]
Abstract
Breast reduction surgery or mastectomy following administration of androgen therapy is part of the female-to-male gender reassignment process. Details regarding the histopathologic findings in breast tissue from patients undergoing female-to-male gender reassignment surgery are limited. We reviewed hematoxylin and eosin-stained sections of breast tissue from 148 patients who underwent breast reduction surgery or mastectomy as part of the female-to-male gender reassignment process at our institution between January 2014 and May 2017. The spectrum of histologic features in each case was catalogued. The median patient age was 27 years (range 18-60 years). Lobular atrophy was seen to some degree in 73% of cases and was prominent in 42%. A predominantly fibrotic stroma was seen in 45% of cases and areas resembling the fibrous stage of gynecomastia were seen in 41%. Other features included variably ectatic ducts in 96% of cases, cysts in 42%, apocrine metaplasia in 32%, fibroadenomatous change in 27%, usual ductal hyperplasia in 26%, and pseudoangiomatous stromal hyperplasia in 19%. Five cases (3%) demonstrated atypical hyperplasia (atypical ductal hyperplasia in 2; atypical lobular hyperplasia in 2; both atypical ductal hyperplasia and atypical lobular hyperplasia in 1). One case demonstrated high grade ductal carcinoma in situ. No invasive carcinomas were identified. In conclusion, the majority of breast specimens from patients undergoing female-to-male gender reassignment demonstrate at least some degree of lobular atrophy as well as ectatic ducts, fibrous stroma, and areas resembling the fibrous stage of gynecomastia. Only rare cases showed atypical lesions; the clinical significance of these lesions in this setting is uncertain.
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Breast Cancer Development in a Transgender Male Receiving Testosterone Therapy. Case Rep Endocrinol 2018; 2018:3652602. [PMID: 30693115 PMCID: PMC6332954 DOI: 10.1155/2018/3652602] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/23/2018] [Indexed: 12/21/2022] Open
Abstract
Context To describe a case of invasive ductal carcinoma of the breast in a transgender male receiving testosterone therapy for gender-affirming treatment. Case Description A 28-year-old transgender male receiving intramuscular testosterone was found to have a breast mass on ultrasound after self-exam revealed a palpable breast lump. Ultrasound-guided breast biopsy revealed estrogen receptor/progesterone receptor (ER/PR) negative, human epidermal growth factor receptor-2 (HER-2) positive, invasive ductal carcinoma of the left breast. He underwent neoadjuvant and adjuvant chemotherapy along with bilateral mastectomy. At patient request, his testosterone injections were permanently discontinued. Conclusion Fewer than 20 cases of breast cancer in transgender male patients have been reported in medical literature. While studies have shown increased risk of breast cancer in postmenopausal women with higher testosterone levels, data regarding premenopausal women is conflicting and little is known about breast cancer risk in transgender individuals receiving gender-affirming hormone therapy (GAHT), with inconclusive results regarding correlation between testosterone therapy and breast cancer. More research is required to evaluate whether a possible increased risk of breast cancer exists for transgender men receiving gender-affirming therapy.
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Treskova I, Hes O, Bursa V. Long-term hormonal therapy resulting in breast cancer in female-to-male transsexual: Case report. Medicine (Baltimore) 2018; 97:e13653. [PMID: 30593135 PMCID: PMC6314692 DOI: 10.1097/md.0000000000013653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Testosterone is important for the development of secondary sexual characteristics in female-to-male transsexuals. On the contrary, it can increase the risk of breast cancer. PATIENT CONCERNS We present a rare case of breast cancer in female-to-male transsexual patient after long-term hormonal therapy. DIAGNOSIS Breast cancer in female-to-male transsexual patient. INTERVENTIONS The patient underwent mastectomy and chemotherapy. OUTCOMES The patient had local recurrence of the disease and he underwent re-excision, radiotherapy and the tamoxifen treatment. After this treatment, the patient is in the remission from the disease. LESSONS Breast cancer in transsexuals appears to be rare. However, there is a potential risk that testosterone exposure can increase the risk of developing breast cancer by the stimulation of breast tissue. There is limited published literature on the risk of breast cancer in transsexual patients.
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Affiliation(s)
| | - Ondrej Hes
- Department of Pathology, University Hospital in Plzen, Charles University in Prague, Alej Svobody, Plzen, Czech Republic
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McFarlane T, Zajac JD, Cheung AS. Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals-A systematic review. Clin Endocrinol (Oxf) 2018; 89:700-711. [PMID: 30107028 DOI: 10.1111/cen.13835] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancers are a leading cause of death worldwide, and transgender individuals are no exception. The effects of gender-affirming hormone therapy (GAHT) on sex hormone-dependent tumours are unclear. Therefore, this review seeks to determine whether tumour risk in transgender individuals differs from the general population, to guide clinical screening recommendations. METHODS We performed a systematic review based on the PRISMA guidelines. MEDLINE, Embase and PsycINFO databases were searched for studies examining tumour incidence, prevalence or cancer-related mortality in transgender individuals. All English peer-reviewed publications were included if histological type and temporal relation to GAHT were reported. Case reports were included if there were ≥2 cases of the same histological type. RESULTS The search strategy identified 307 studies. Excluding those that did not meet inclusion criteria, 43 studies (7 cohort studies, 2 cross-sectional studies and 34 case reports) were reviewed. Retrospective cohort studies suggest no increase in risk of tumour development in transgender individuals receiving GAHT compared to the general population. Notably, the mean ages of cohorts were young and were treated with GAHT for insufficient durations to assess tumour risk. Case reports raise potential associations between high-dose oestradiol and anti-androgen therapy with prolactinoma and meningioma, respectively. CONCLUSIONS Further longitudinal studies are required to assess the risk of GAHT and hormone-dependent tumour development. Until further evidence is available, tumour screening should be based on guidelines for the general population and the presence of organs in transgender individuals rather than gender identity or hormonal therapy status.
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Affiliation(s)
- Thomas McFarlane
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Ada S Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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Eismann J, Heng YJ, Fleischmann-Rose K, Tobias AM, Phillips J, Wulf GM, Kansal KJ. Interdisciplinary Management of Transgender Individuals at Risk for Breast Cancer: Case Reports and Review of the Literature. Clin Breast Cancer 2018; 19:e12-e19. [PMID: 30527351 DOI: 10.1016/j.clbc.2018.11.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/23/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Julia Eismann
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kristin Fleischmann-Rose
- Department of Surgical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam M Tobias
- Department of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jordana Phillips
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Gerburg M Wulf
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Kari J Kansal
- Department of Surgical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Stone JP, Hartley RL, Temple-Oberle C. Breast cancer in transgender patients: A systematic review. Part 2: Female to Male. Eur J Surg Oncol 2018; 44:1463-1468. [DOI: 10.1016/j.ejso.2018.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/27/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022] Open
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Nikolić D, Granić M, Ivanović N, Zdravković D, Nikolić A, Stanimirović V, Zdravković M, Dikić S, Nikolić M, Djordjević M. Breast cancer and its impact in male transsexuals. Breast Cancer Res Treat 2018; 171:565-569. [DOI: 10.1007/s10549-018-4875-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/01/2018] [Indexed: 11/25/2022]
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Joint R, Chen ZE, Cameron S. Breast and reproductive cancers in the transgender population: a systematic review. BJOG 2018; 125:1505-1512. [DOI: 10.1111/1471-0528.15258] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 01/02/2023]
Affiliation(s)
- R Joint
- The University of Edinburgh; Edinburgh UK
| | - ZE Chen
- Chalmers Sexual Health Clinic; Edinburgh UK
| | - S Cameron
- Chalmers Sexual Health Clinic; Edinburgh UK
- Obstetrics and Gynaecology; University of Edinburgh; Royal Infirmary of Edinburgh; Edinburgh UK
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Van Renterghem SMJ, Van Dorpe J, Monstrey SJ, Defreyne J, Claes KEY, Praet M, Verbeke SLJ, T'Sjoen GGR, Van Bockstal MR. Routine histopathological examination after female-to-male gender-confirming mastectomy. Br J Surg 2018; 105:885-892. [DOI: 10.1002/bjs.10794] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/22/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
Abstract
Background
The number of transmen seeking gender-confirming surgery has risen steadily throughout the last decade. Pathologists are increasingly confronted with transmale mastectomy specimens. It is not clear whether routine histopathological examination is useful. This study explored the possible benefit of routine investigation through detailed description of lesions encountered in mastectomy specimens after female-to-male gender-confirming surgery.
Methods
Breast tissue from a cohort of transmen was reviewed. The presence of benign and malignant breast lesions was recorded. The number of terminal duct–lobule units (TDLUs) per ten low-power fields (LPFs) was quantified. Information on hormone therapy and morphometry was retrieved for selected patients.
Results
The cohort included 344 subjects with a mean age of 25·8 (range 16–61) years at the time of surgery; the age at surgery decreased significantly over time. Older individuals presented with a significantly higher number of breast lesions. The number of TDLUs per LPF was lower in heavier breasts, but did not correlate with age. Breast lesions, either benign or malignant, were present in 166 individuals (48·3 per cent). Invasive breast cancer was found in two (0·6 per cent); one tumour was an unexpected finding. The number of breast lesions encountered on histopathological examination increased significantly when more tissue blocks were taken.
Conclusion
The discovery of an unexpected breast cancer in a 31-year-old transman emphasizes the importance of thorough routine histopathological examination of mastectomy specimens. The number of tissue blocks taken should be based on age and breast weight.
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Affiliation(s)
| | - J Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - S J Monstrey
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - J Defreyne
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent, Belgium
| | - K E Y Claes
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - M Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - S L J Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - G G R T'Sjoen
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent, Belgium
| | - M R Van Bockstal
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
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Abstract
PURPOSE This review will inform radiologists about the evidence base regarding radiographic imaging for transgender individuals and considerations for providing culturally sensitive care for this population. FINDINGS Transgender individuals are increasingly referred for both screening and diagnostic breast imaging. It is important that the clinic environment is welcoming, the medical staff utilize accepted terminology and patients are able to designate their gender and personal history to ensure appropriate care. Hormone and surgical treatments used for transition by many transgender women and men may change the approach to imaging. SUMMARY Although not yet evidence-based, screening mammography is currently suggested for transgender women with risk factors, including those receiving hormone treatment over 5 years. The risk for breast cancer in transgender individuals is still being defined.
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Affiliation(s)
- Emily B. Sonnenblick
- Department of Radiology, Icahn School of Medicine at Mt Sinai, One Gustav Levy Place, New York, NY 10029 USA
| | - Ami D. Shah
- Department of Radiology, Icahn School of Medicine at Mt Sinai, One Gustav Levy Place, New York, NY 10029 USA
| | - Zil Goldstein
- Department of Medicine, Center for Transgender Medicine and Surgery at Mt. Sinai , 275 Seventh Avenue, New York, NY 10011 USA
| | - Tamar Reisman
- Department of Medicine, Icahn School of Medicine at Mt. Sinai, 275 Seventh Avenue, New York, NY 10011 USA
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