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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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2
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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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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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Andrews AR, Kakadekar A, Schmidt RL, Murugan P, Greene DN. Histologic Findings in Surgical Pathology Specimens From Individuals Taking Feminizing Hormone Therapy for the Purpose of Gender Transition: A Systematic Scoping Review. Arch Pathol Lab Med 2021; 146:252-261. [PMID: 33983412 DOI: 10.5858/arpa.2020-0704-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Transgender women experience health disparities in all areas of medicine. Within surgical pathology, knowledge gaps relating to the concepts of transgender care exist. Medical transition for transgender women and transfeminine persons may involve hormone therapy and/or surgery to feminize the body. Understanding the common histologic changes in specimens from feminizing surgeries, as well as other specimens from patients on feminizing hormone therapy, will aid surgical pathologists in providing better care to this unique patient population. OBJECTIVE.— To summarize histologic findings in surgical pathology specimens from transgender women taking feminizing hormones. 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 women from 1946 to 2019. CONCLUSIONS.— Much of the literature to date describing histologic findings in transgender women comes from the examination of genitourinary specimens removed during feminizing surgeries. Common benign changes associated with feminizing hormone therapy include the development of acini and lobules in the breast, testicular tubular changes, and squamous metaplasia of the prostate and urethra. Neoplastic cases include breast adenocarcinoma and fibroepithelial lesions, testicular germ cell tumors, prostatic adenocarcinoma, anal squamous cell carcinoma, pituitary adenomas, and meningiomas. Additional studies assessing the findings in other organ systems as well as population-based studies assessing rates of neoplasia are needed. However, future research relies on engagement within the surgical pathology community as well as collaboration with clinicians and patients to achieve optimal results.
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Affiliation(s)
- Alicia R Andrews
- From the Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada (Andrews, Kakadekar)
| | - Archan Kakadekar
- From the Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada (Andrews, Kakadekar)
| | - Robert L Schmidt
- the Department of Pathology, University of Utah, Salt Lake City (Schmidt)
| | - Paari Murugan
- the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Murugan)
| | - Dina N Greene
- the Department of Laboratory Medicine, University of Washington, Seattle (Greene)
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5
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Abstract
Male breast cancer is a rarely encountered disease, when compared with female breast cancer, often detected in more advanced stage at the time of diagnosis, and associated with more lymph node metastasis rates, more estrogen receptors positivity, and less human epidermal growth factor receptor-2 expression (HER-2) rates. Surgical management also shows some difference, where the most common operative technique of male breast cancer patients is mastectomy and/or axillary surgery. Triple-negative breast cancer is less frequent than other subtypes and is associated with poorer prognosis. This is because of its association with higher histopathological grade than that in other types of breast cancer. Only fewer treatment options are available compared to hormone-positive, HER-2 positive breast cancer. We are present a case of 71-year-old gentleman with triple-negative breast cancer.
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Affiliation(s)
- Qasif Qavi
- Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Firas Alkistawi
- Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Shashi Kumar
- Surgery, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Rizwan Ahmed
- Surgery, Princess Royal University Hospital, Orpington, GBR
| | - Abdalla Saad Abdalla Al-Zawi
- Breast Surgery, Anglia Ruskin University, Chelmsford, GBR.,Breast Surgery, Basildon and Thurrock University Hospital, Basildon, GBR.,General Surgery, Mid and South Essex NHS Foundation Trust, Basildon, GBR
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6
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Ozkara San E. The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development. Nurs Forum 2020; 55:621-630. [PMID: 32608020 DOI: 10.1111/nuf.12478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Disparities experienced by transgender patients, especially in cancer care, leads to poorer outcomes and overall health. Simulation, using transgender simulated patients (SPs) with a focus on cancer care can be an effective way to foster cultural competence nursing education. METHODS Guided by the National League for Nursing (NLN)/Jeffries Simulation Theory and Cultural Competence and Confidence Model, this grant funded pretest (n = 48) and posttest (n = 41) comparison group, quasi-experimental study aimed to understand changes in students' transcultural self-efficacy (TSE) following the transgender-simulated patient simulation (TSPS) focusing on an oncological emergency management. Developed by following recommended guidelines and standards, the TSPS had content validity review and pilot testing. It aimed to improve students' knowledge, skills, and attitudes with regard to providing culturally congruent nursing care. The statistical methods included paired sample t-tests, independent t-tests, and correlation analyses. RESULTS Students who participated in the TSPS intervention had significantly higher posttest TSE scores (P < .05). DISCUSSION SP methodology can be an effective way to foster cultural congruence in nursing care. The findings contribute to the importance of continuous efforts for the inclusion of lesbian, gay, bisexual, transgender, queer (LGBTQ) topic in nursing education to enhance culturally congruent care.
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Affiliation(s)
- Eda Ozkara San
- Center for Excellence in Healthcare Simulation, College of Health Professions, Lienhard School of Nursing, Pace University, New York, New York
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8
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de Blok CJM, Wiepjes CM, Nota NM, van Engelen K, Adank MA, Dreijerink KMA, Barbé E, Konings IRHM, den Heijer M. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ 2019; 365:l1652. [PMID: 31088823 PMCID: PMC6515308 DOI: 10.1136/bmj.l1652] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population. DESIGN Retrospective, nationwide cohort study. SETTING Specialised tertiary gender clinic in Amsterdam, the Netherlands. PARTICIPANTS 2260 adult trans women (male sex assigned at birth, female gender identity) and 1229 adult trans men (female sex assigned at birth, male gender identity) who received gender affirming hormone treatment. MAIN OUTCOME MEASURES Incidence and characteristics (eg, histology, hormone receptor status) of breast cancer in transgender people. RESULTS The total person time in this cohort was 33 991 years for trans women and 14 883 years for trans men. In the 2260 trans women in the cohort, 15 cases of invasive breast cancer were identified (median duration of hormone treatment 18 years, range 7-37 years). This was 46-fold higher than in cisgender men (standardised incidence ratio 46.7, 95% confidence interval 27.2 to 75.4) but lower than in cisgender women (0.3, 0.2 to 0.4). Most tumours were of ductal origin and oestrogen and progesterone receptor positive, and 8.3% were human epidermal growth factor 2 (HER2) positive. In 1229 trans men, four cases of invasive breast cancer were identified (median duration of hormone treatment 15 years, range 2-17 years). This was lower than expected compared with cisgender women (standardised incidence ratio 0.2, 95% confidence interval 0.1 to 0.5). CONCLUSIONS This study showed an increased risk of breast cancer in trans women compared with cisgender men, and a lower risk in trans men compared with cisgender women. In trans women, the risk of breast cancer increased during a relatively short duration of hormone treatment and the characteristics of the breast cancer resembled a more female pattern. These results suggest that breast cancer screening guidelines for cisgender people are sufficient for transgender people using hormone treatment.
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Affiliation(s)
- Christel J M de Blok
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
- Department of Endocrinology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Chantal M Wiepjes
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
- Department of Endocrinology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Nienke M Nota
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
- Department of Endocrinology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Klaartje van Engelen
- Department of Clinical Genetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Muriel A Adank
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Koen M A Dreijerink
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
- Department of Endocrinology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Ellis Barbé
- Department of Pathology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Inge R H M Konings
- Department of Oncology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
| | - Martin den Heijer
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
- Department of Endocrinology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Netherlands
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9
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Ammari T, Sluiter EC, Gast K, Kuzon WM. Female-to-Male Gender-Affirming Chest Reconstruction Surgery. Aesthet Surg J 2019; 39:150-163. [PMID: 29945235 DOI: 10.1093/asj/sjy098] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There is an increased demand for gender affirmation surgery. Chest contouring, or "top" surgery, is especially important in the female-to-male (FtM) transgender population. This Continuing Medical Education (CME) article critically appraises the available literature on top surgery to allow plastic surgeons to understand current practices and determine the best surgical technique using a decision algorithm and the patient's preoperative anatomy and characteristics. Because a single best surgical approach does not exist due to significant variance in preoperative patient anatomy, and in order to provide a useful framework for decision making, surgical approaches described are categorized as: approach 1-remote incision procedures without skin excision; approach 2-procedures with periareolar skin excision; and approach 3-mastectomy procedures with skin excision other than periareolar skin excision. Decision algorithms that help determine the most suitable surgical technique for individual patients are reviewed. Data on complication rates and patient satisfaction will improve informed consent discussions and create realistic patient expectations.
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Affiliation(s)
- Tareq Ammari
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Emily C Sluiter
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Katherine Gast
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - William M Kuzon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
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10
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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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11
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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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12
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Hartley RL, Stone JP, Temple-Oberle C. Breast cancer in transgender patients: A systematic review. Part 1: Male to female. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1455-1462. [DOI: 10.1016/j.ejso.2018.06.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/22/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
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Goldberg JE, Moy L, Rosenkrantz AB. Assessing Transgender Patient Care and Gender Inclusivity of Breast Imaging Facilities Across the United States. J Am Coll Radiol 2018; 15:1164-1172. [PMID: 29933975 DOI: 10.1016/j.jacr.2018.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate transgender patient care, gender inclusivity, and transgender health-related policies at breast imaging facilities across the United States. METHODS A survey on breast imaging facilities' policies and practices regarding transgender care was distributed to the membership of the Society of Breast Imaging, consisting of approximately 2,500 breast radiologists across the United States. The survey was conducted by e-mail in January 2018. RESULTS There were 144 survey respondents. Responses showed that 78.5% of facilities have gender-neutral patient bathrooms, 9.0% have a separate waiting area for transgender patients, and 76.4% do not have dominant pink hues in their facilities, although 54.2% have displays with female gender content. Also, 58.0% of intake forms do not ask patients to provide their gender identity, although 25.9% automatically populate with female phrases. Within the electronic health record, 32.9% lack a distinct place to record patients' preferred names and 54.9% lack a distinct place to record patients' gender pronouns. The majority (73.4%) do not have explicit policies related to the care of transgender patients. Only 14.7% of facilities offer lesbian, gay, bisexual, and transgender training. CONCLUSION Our national survey demonstrates that many breast imaging facilities do not have structures in place to consistently use patients' preferred names and pronouns, nor provide inclusive environments for transgender patients. All breast imaging facilities should recognize the ways in which their practices may intensify discrimination, exclusivity, and stigma for transgender patients and should seek to improve their transgender health competencies and foster more inclusive environments.
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Affiliation(s)
- Julia E Goldberg
- Department of Radiology, NYU Langone Medical Center, New York, New York.
| | - Linda Moy
- Department of Radiology, NYU Langone Medical Center, New York, New York
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14
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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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15
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O'Bryan J, Wolf-Gould C, Matsuo Y. Mammary Myofibroblastoma in a Transgender Patient on Feminizing Hormones: Literature Review and Case Report. Transgend Health 2018; 3:1-9. [PMID: 29344575 PMCID: PMC5770133 DOI: 10.1089/trgh.2017.0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Purpose: Defining the risk of neoplasia associated with gender-affirming hormone therapy (GAHT) is a priority for transgender medical research. The purposes of this article are to present a unique case of breast neoplasia in a transgender individual and to review the existing evidence base on GAHT as a potential risk for breast pathology. Methods: We present the case of a 76-year-old transgender patient who developed an estrogen receptor-positive mammary myofibroblastoma (MFB) after 13 months of treatment on feminizing hormones. To our knowledge, this is the first reported case of MFB occurring in a transgender individual. A literature review was conducted to identify all reported cases of breast neoplasia among transgender individuals receiving feminizing GAHT. Information was abstracted from each of the included cases to describe the existing body of literature and to compare published cases to the case reported in this study. Results: We identified a total of 19 malignant and 3 benign cases of breast neoplasia among transgender women. Ours is the first reported case of MFB in a transgender individual receiving feminizing hormones and the first reported case of breast neoplasia associated with GAHT administered via the estradiol patch. Conclusion: This case reinforces the need for additional reporting of breast neoplasia presenting in transgender individuals treated with feminizing hormones. The relationship between estrogen exposure and breast neoplasia in the transgender population remains poorly defined, and additional research is needed to define risks and inform clinical practice.
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Affiliation(s)
- Jane O'Bryan
- Bassett Healthcare/Research Institute, Cooperstown, New York
| | - Carolyn Wolf-Gould
- The Gender Wellness Center/Susquehanna Family Practice, AO Fox Hospital/Bassett Healthcare Network, Oneonta, New York
| | - Yoshiro Matsuo
- Department of Hematology/Oncology, AO Fox Hospital/Bassett Healthcare Network, Oneonta, New York
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16
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Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol 2017; 13:1333-1344. [DOI: 10.2217/fon-2017-0482] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.
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Affiliation(s)
- Alec W Gibson
- Medical Scientist Training Program & Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, NY, USA
| | - Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, Troy, NY, USA
| | - Shilpen Patel
- Department of Radiation Oncology & Department of Global Health, University of Washington, Seattle, WA, USA
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Mattingly AE, Kiluk JV, Lee MC. Clinical Considerations of Risk, Incidence, and Outcomes of Breast Cancer in Sexual Minorities. Cancer Control 2017; 23:373-382. [PMID: 27842326 DOI: 10.1177/107327481602300408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer is a leading cause of cancer-related mortality in women. Limited research exists on the impact of sexual orientation on overall risk of and mortality from breast cancer. We sought to summarize the medical literature on breast cancer in sexual minority women and identify possible disparities in this population. METHODS A comprehensive literature search was conducted for English-language studies in peer-reviewed medical journals that referenced breast cancer and sexual minority, lesbian, bisexual, or transgender individuals. Articles published between January 2000 and November 2015 were included. They were reviewed for relevance to breast cancer risk stratification, breast cancer mortality, breast reconstruction, and transgender issues. RESULTS Behavioral risks, reproductive risks, and risks associated with decreased access to health care may all affect outcomes for sexual minorities with breast cancer. Limited studies have mixed results regarding mortality associated with breast cancer in sexual minorities due to an inconsistent reporting of sexual orientation. CONCLUSIONS Overall, the research examining breast cancer in sexual minority women remains limited. This finding is likely due to limitations in the reporting of sexual orientation within large databases, thus making broader-scale research difficult.
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Affiliation(s)
- Anne E Mattingly
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA.
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18
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Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev 2017; 39:93-107. [PMID: 28486701 PMCID: PMC5868281 DOI: 10.1093/epirev/mxw003] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022] Open
Abstract
Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.
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Affiliation(s)
- Hayley Braun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Janice Brockman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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19
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Pivo S, Montes J, Schwartz S, Chun J, Kiely D, Hazen A, Schnabel F. Breast Cancer Risk Assessment and Screening in Transgender Patients. Clin Breast Cancer 2016; 17:e225-e227. [PMID: 28428098 DOI: 10.1016/j.clbc.2016.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/03/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah Pivo
- School of Medicine, New York University Langone Medical Center, New York, NY
| | - Jennifer Montes
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Shira Schwartz
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Jennifer Chun
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Deirdre Kiely
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Alexes Hazen
- Department of Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Freya Schnabel
- Department of Surgery, New York University Langone Medical Center, New York, NY.
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20
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Corman V, Potorac I, Manto F, Dassy S, Segers K, Thiry A, Bours V, Daly AF, Beckers A. Breast cancer in a male-to-female transsexual patient with a BRCA2 mutation. Endocr Relat Cancer 2016; 23:391-7. [PMID: 27000661 DOI: 10.1530/erc-16-0057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 12/14/2022]
Abstract
Breast cancer is rare in male patients. Certain predisposing factors, be they genetic (e.g., BRCA2 gene mutations) or hormonal (imbalance between estrogen and androgen levels), have been implicated in male breast cancer pathophysiology. Male-to-female (MtF) transsexualism is a condition that generally involves cross-sex hormone therapy. Anti-androgens and estrogens are used to mimic the female hormonal environment and induce the cross-sex secondary characteristics. In certain situations, the change in the hormonal milieu can be disadvantageous and favor the development of hormone-dependent pathologies, such as cancer. We report a case of a MtF transgender patient who developed breast cancer after 7 years of cross-sex hormonal therapy. The patient was found to be BRCA2 positive, and suffered recurrent disease. The patient was unaware of being a member of an established BRCA2 mutation-positive kindred. This represents the first case of a BRCA2 mutation predisposing to breast cancer in a MtF transgender patient.
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Affiliation(s)
- Vinciane Corman
- Department of EndocrinologyCentre Hospitalier Universitaire de Liege, Université de Liège, Liège, Belgium
| | - Iulia Potorac
- Department of EndocrinologyCentre Hospitalier Universitaire de Liege, Université de Liège, Liège, Belgium
| | | | - Sarah Dassy
- Department of OncologySt Nikolaus-Hospital, Eupen, Belgium
| | - Karin Segers
- Department of Human GeneticsCentre Hospitalier Universitaire de Liege, Université de Liège, Liège, Belgium
| | - Albert Thiry
- Department of Anatomo-pathologyCentre Hospitalier Universitaire de Liège, Université de Liège, Liège, Belgium
| | - Vincent Bours
- Department of Human GeneticsCentre Hospitalier Universitaire de Liege, Université de Liège, Liège, Belgium
| | - Adrian F Daly
- Department of EndocrinologyCentre Hospitalier Universitaire de Liege, Université de Liège, Liège, Belgium
| | - Albert Beckers
- Department of EndocrinologyCentre Hospitalier Universitaire de Liege, Université de Liège, Liège, Belgium
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21
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MacCarthy S, Reisner SL, Nunn A, Perez-Brumer A, Operario D. The Time Is Now: Attention Increases to Transgender Health in the United States but Scientific Knowledge Gaps Remain. LGBT Health 2015; 2:287-91. [PMID: 26788768 PMCID: PMC4716649 DOI: 10.1089/lgbt.2014.0073] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Attention to transgender health has dramatically increased in the U.S. Scientific knowledge gaps in empirical research, however, remain and act as barriers to achieving transgender-related health equity. We conducted a search using PubMed and PsycINFO to identify gaps in empirical, peer-reviewed publications related to adult transgender health in the U.S. between 1981 and 2013. We synthesized these findings and commented on opportunities for improving health research. Reducing health disparities and advancing transgender-related health equity requires greater investment in research that addresses current gaps to more comprehensively respond to the diverse health needs of transgender people.
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Affiliation(s)
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Amy Nunn
- School of Public Health, Brown University, Providence, Rhode Island
| | - Amaya Perez-Brumer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island
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22
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Quinn GP, Sanchez JA, Sutton SK, Vadaparampil ST, Nguyen GT, Green BL, Kanetsky PA, Schabath MB. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin 2015; 65:384-400. [PMID: 26186412 PMCID: PMC4609168 DOI: 10.3322/caac.21288] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022] Open
Abstract
This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.
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Affiliation(s)
- Gwendolyn P. Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Corresponding Author: Gwendolyn P. Quinn, Ph.D, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612, | Fax: 1-813-449-8019
| | - Julian A. Sanchez
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
| | - Giang T. Nguyen
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - B. Lee Green
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Diversity and Communication Relations, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Peter A. Kanetsky
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Cancer Epidemiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Matthew B. Schabath
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Cancer Epidemiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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23
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Teoh ZH, Archampong D, Gate T. Breast cancer in male-to-female (MtF) transgender patients: is hormone receptor negativity a feature? BMJ Case Rep 2015; 2015:bcr-2015-209396. [PMID: 25994431 DOI: 10.1136/bcr-2015-209396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 41-year-old male-to-female (MtF) transgender patient presented with a symptomatic tender lump in the left breast. There was no family history of breast cancer. She had been receiving estrogen therapy for 14 years to maintain her secondary sexual characteristics. Triple assessment revealed a 13 mm triple-negative grade 3 invasive ductal carcinoma. The tumour was completely excised following a left wide local excision and sentinel lymph node biopsy. There was no regional lymph node involvement. She was referred to the oncologist for adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Zhi Hao Teoh
- Breast Surgery Unit, Wrexham Maelor Hospital, Wrexham, UK
| | | | - Tim Gate
- Wrexham Maelor Hospital, Wrexham, UK
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