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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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2
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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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Piñar-Gutiérrez A, Dueñas Disotuar S, de Lara-Rodríguez I, Amuedo-Domínguez S, González-Cejudo C, Tejero-Delgado J, Mangas-Cruz MÁ. Difficulties of gender affirming treatment in trans women with BRCA1+ mutation: A case report. ENDOCRINOL DIAB NUTR 2024; 71:144-148. [PMID: 38555112 DOI: 10.1016/j.endien.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 04/02/2024]
Abstract
Gender affirming treatment in transgender women is based on a combination of antiandrogens and estrogens, with the latter maintained over the long term. When prescribing these treatments, we must consider the possibility of developing estrogen-dependent breast cancer. In transgender women, a breast cancer incidence of 4.1 per 100,000 has been estimated, which would increase the risk by 46% in relation to cisgender men but decrease it by 70% in relation to cisgender women. It is known that certain gene mutations such as BRCA1 imply an increased risk of breast cancer, but at present the risk in transgender women with BRCA1 treated with estrogens is not well established. We present the case of a transgender woman with a family history of breast cancer and BRCA1 mutation and the therapeutic decisions made in a multidisciplinary team. Following this case, we review and discuss the published literature.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Suset Dueñas Disotuar
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Irene de Lara-Rodríguez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; UGC de Ginecología, Oncología Ginecológica y Patología mamaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Carmen González-Cejudo
- UGC de Ginecología, Oncología Ginecológica y Patología mamaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Tejero-Delgado
- UGC de Ginecología, Oncología Ginecológica y Patología mamaria, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Salvetti B, Kidde E. Gender-Affirming Care in a Transgender Young Woman With Li-Fraumeni Syndrome: A Case Report. J Pediatr Health Care 2024; 38:270-274. [PMID: 38429040 DOI: 10.1016/j.pedhc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 03/03/2024]
Abstract
The number of youths who identify with a gender different from their sex designated at birth is increasing. Youth account for about 4% of all cancer diagnoses in the United States. Some youths may want gender-affirming medical treatment, such as puberty blockers and/or hormone therapy, which may exacerbate cancer and/or increase cancer development risk. No studies assess the impact of estrogen-based treatment in gender-diverse youth with a history of Li-Fraumeni syndrome. This case report will discuss gender-affirming care and shared decision-making in a youth with a history of Li-Fraumeni syndrome and increased risk for breast cancer.
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Valentini V, Bucalo A, Conti G, Celli L, Porzio V, Capalbo C, Silvestri V, Ottini L. Gender-Specific Genetic Predisposition to Breast Cancer: BRCA Genes and Beyond. Cancers (Basel) 2024; 16:579. [PMID: 38339330 PMCID: PMC10854694 DOI: 10.3390/cancers16030579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Among neoplastic diseases, breast cancer (BC) is one of the most influenced by gender. Despite common misconceptions associating BC as a women-only disease, BC can also occur in men. Additionally, transgender individuals may also experience BC. Genetic risk factors play a relevant role in BC predisposition, with important implications in precision prevention and treatment. The genetic architecture of BC susceptibility is similar in women and men, with high-, moderate-, and low-penetrance risk variants; however, some sex-specific features have emerged. Inherited high-penetrance pathogenic variants (PVs) in BRCA1 and BRCA2 genes are the strongest BC genetic risk factor. BRCA1 and BRCA2 PVs are more commonly associated with increased risk of female and male BC, respectively. Notably, BRCA-associated BCs are characterized by sex-specific pathologic features. Recently, next-generation sequencing technologies have helped to provide more insights on the role of moderate-penetrance BC risk variants, particularly in PALB2, CHEK2, and ATM genes, while international collaborative genome-wide association studies have contributed evidence on common low-penetrance BC risk variants, on their combined effect in polygenic models, and on their role as risk modulators in BRCA1/2 PV carriers. Overall, all these studies suggested that the genetic basis of male BC, although similar, may differ from female BC. Evaluating the genetic component of male BC as a distinct entity from female BC is the first step to improve both personalized risk assessment and therapeutic choices of patients of both sexes in order to reach gender equality in BC care. In this review, we summarize the latest research in the field of BC genetic predisposition with a particular focus on similarities and differences in male and female BC, and we also discuss the implications, challenges, and open issues that surround the establishment of a gender-oriented clinical management for BC.
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Affiliation(s)
- Virginia Valentini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Agostino Bucalo
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Giulia Conti
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Ludovica Celli
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Virginia Porzio
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Carlo Capalbo
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
- Medical Oncology Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Valentina Silvestri
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Laura Ottini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
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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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Bullock Morse A, Emerson ND, Bursch B. Gender-Affirming Care Recommendations for Health Providers Treating Gender Diverse Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2023; 12:795-798. [PMID: 36880958 DOI: 10.1089/jayao.2022.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- Amy Bullock Morse
- MemorialCare Miller Children's and Women's Hospital Long Beach, Long Beach, California, USA
| | - Natacha D Emerson
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brenda Bursch
- Psychiatry and Biobehavioral Sciences and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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8
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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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Bybee SG, Wilson CM. Why Good Cancer Care Means Gender-Affirming Care for Transgender Individuals With Gendered Cancers: Implications for Research, Policy, and Practice. J Clin Oncol 2023; 41:3591-3594. [PMID: 37224435 PMCID: PMC10325736 DOI: 10.1200/jco.22.01857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Sara G. Bybee
- University of Utah College of Nursing, Salt Lake City, UT
| | - Christina M. Wilson
- University of Alabama at Birmingham School of Nursing and Heersink School of Medicine, Division of Gynecologic Oncology, Birmingham, AL
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Baker GM, Bret-Mounet VC, Xu J, Fein-Zachary VJ, Tobias AM, Bartlett RA, Clohessy JG, Vlachos IS, Massicott ES, Wulf GM, Schnitt SJ, Heng YJ. Toker Cell Hyperplasia in the Nipple-Areolar Complex of Transmasculine Individuals. Mod Pathol 2023; 36:100121. [PMID: 36889065 PMCID: PMC10293043 DOI: 10.1016/j.modpat.2023.100121] [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: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
We previously reported breast histopathologic features associated with testosterone therapy in transmasculine chest-contouring surgical specimens. During that study, we observed a high frequency of intraepidermal glands in the nipple-areolar complex (NAC) formed by Toker cells. This study reports Toker cell hyperplasia (TCH)-the presence of clusters of Toker cells consisting of at least 3 contiguous cells and/or glands with lumen formation-in the transmasculine population. Increased numbers of singly dispersed Toker cells were not considered TCH. Among the 444 transmasculine individuals, 82 (18.5%) had a portion of their NAC excised and available for evaluation. We also reviewed the NACs from 55 cisgender women who were aged <50 years old and had full mastectomies. The proportion of transmasculine cases with TCH (20/82; 24.4%) was 1.7-fold higher than cisgender women (8/55; 14.5%) but did not achieve significance (P = .20). However, in cases with TCH, the rate of gland formation is 2.4-fold higher in transmasculine cases, achieving borderline significance (18/82 vs 5/55; P = .06). Among transmasculine individuals, TCH was significantly more likely to be present in those with higher body mass index (P = .03). A subset of 5 transmasculine and 5 cisgender cases were stained for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), androgen receptor (AR), cytokeratin 7, and Ki67. All 10 cases were cytokeratin 7+ and Ki67-; 9 out of 10 cases were AR+. Toker cells in transmasculine cases demonstrated variable expression of ER, PR, and HER2. For cisgender cases, Toker cells were consistently ER+, PR-, and HER2-. In conclusion, there is a higher rate of TCH in the transmasculine than cisgender population, particularly among transmasculine individuals with high body mass index and taking testosterone. To our knowledge, this is the first study to demonstrate that Toker cells are AR+. Toker cell features display variable ER, PR, and HER2 immunoreactivity. The clinical significance of TCH in the transmasculine population remains to be elucidated.
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Affiliation(s)
- Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Vanessa C Bret-Mounet
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jingxiong Xu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Valerie J Fein-Zachary
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam M Tobias
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Richard A Bartlett
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - John G Clohessy
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ioannis S Vlachos
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Erica S Massicott
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gerburg M Wulf
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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11
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Bagwell AK, Nauta AC, Peters BR. Comprehensive Reconstructive Care for Patients of All Gender Identities After Cancer of the Breast. Ann Plast Surg 2023; 90:528-530. [PMID: 36881742 DOI: 10.1097/sap.0000000000003528] [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: 03/09/2023]
Abstract
ABSTRACT Breast cancer can affect anyone; therefore, it affects people of all gender identities. Reconstructive options after breast cancer must then address the needs of all people. Our institution is unique in its provision of both high-level comprehensive breast and gender affirmation care. In our practice, patients have expressed gender diverse identities during their breast cancer reconstructive journey. In these cases, goals have deviated from traditional breast restoration, gravitating toward gender-affirming mastectomy, or results often seen with "top surgery." We present a framework for the administration of breast cancer care and discussions of reconstruction from a lens of gender inclusivity. Breast cancer is a diagnosis that has been gendered, resulting in the erasure and exclusion of reconstructive needs for people affected by breast cancer that are not cisgender women. This is illustrated through the case of a nonbinary individual seen in breast cancer clinic for multifocal ductal carcinoma in situ. Our standard review of options of "going flat," implant-based reconstruction, and autologous reconstruction led to initial confusion given their early exploration of gender identity co-occurring with a new diagnosis of breast cancer. These scenarios can be challenging when viewed solely from the perspective of a breast reconstructive surgeon or a gender-affirming surgeon alone. Both perspectives are often needed. Our gender-affirming and breast reconstructive teams have discussed methods to identify patients who require more robust discussion of gender identity and reconstructive options in the setting of breast cancer, such as chest masculinization. By adding gender-affirming surgeons to the list of providers available to counsel breast cancer patients, we may be able to better provide early education on all reconstructive options and appropriately address the needs of transgender and gender diverse people affected by breast cancer.
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Affiliation(s)
| | - Allison C Nauta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Blair R Peters
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR
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12
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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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14
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Ramsey I, Kennedy K, Sharplin G, Eckert M, Peters MDJ. Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:174-194. [PMID: 37114110 PMCID: PMC10128429 DOI: 10.1080/26895269.2022.2155289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.
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Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Micah D. J. Peters
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
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Figueiras-Graillet LM. Cancer and cardiotoxicity in the transgender population. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2023; 93:23-25. [PMID: 37992701 PMCID: PMC10665106 DOI: 10.24875/acm.m23000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023] Open
Abstract
The relationship between cancer diagnosis and cardiovascular diseases is complex, with newly diagnosed patients facing a higher risk of coronary disease, heart failure, and atrial fibrillation. Compared to the general population, they have two to six times more risk of dying from cardiovascular causes. Cardiovascular complications arising from chemotherapy and radiotherapy, along with social and healthcare access disparities, complicate the collection of accurate data on the incidence of cancer and cardiotoxicity in marginalized populations. Among the LGBTQ community, certain types of cancer are more prevalent, and hormone administration for gender affirmation is also under study. The delay in cancer screening in the transgender population results in late detections and deaths from cancer. Research on cancer in the transgender population and cardiotoxicity is limited, but special attention is needed to develop detection and prevention strategies in specific situations, such as hormone-dependent tumors.
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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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Goyal P, Jain P, Agrawal C, Jain SB, Talwar V, Batra U, Goyal S, Maheshwari U, Chaudhari K, Goel V, BP A, Doval DC. Breast Cancer in Transgenders: Narrative Review. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0041-1740140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractThe molecular pathogenesis of breast cancer (BC), the second most common cancer, varies significantly between sexes, with minimal data in the transgender population. The overall prevalence of BC in transgenders is estimated to be 0.02%. Besides experiencing social disparities, transgenders have to face a lot of discrimination in the healthcare system. Adversities faced, along with the urge to identify with physical attributes to the gender felt by them, forces transgenders to use non-prescribed hormones. Gender affirming hormone therapy (GAHT) is a key feature of transition-related care, rehabbing mental health, and the quality of life of transgenders, but at the expense of their health. Studies have reported that GAHT is associated with severe health conditions such as cancer in transgenders. Estrogens and testosterone are associated with a moderate risk of developing BC. The types of BC diagnosed in transgenders after cross-sex hormone therapy include invasive ductal and neuroendocrine carcinoma, in addition to tubular adenocarcinoma. Although diagnosed at an age earlier compared with ciswomen, BC screening recommendations for transgenders are the same as for ciswomen. This review studies in detail the types of transgenders, their characteristics, different types of breast cancers associated, issues faced while treatment, and their best possible solutions. We also hope to have well-designed research in the future, which will fill the existing gaps in knowledge and provide scientific insight into the transgender population and issues related to their health. There are no international guidelines on screening and management of transgender patients but it appears that breast screening before cosmetic mastectomy, exposure to hormonal therapy for more than 5 years, and as per natal women screening guidelines should be offered to the patient with detailed discussion on the harms and benefits of the same.
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Affiliation(s)
- Pankaj Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Praveen Jain
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Chaturbhuj Agrawal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | | | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Udip Maheshwari
- Department of Medical Oncology, Mumbai Oncocare Center, Mumbai, Maharashtra, India
| | - Krushna Chaudhari
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Varun Goel
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Amrith BP
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
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McClurg DP, Urquhart G, McGoldrick T, Chatterji S, Miedzybrodzka Z, Speirs V, Elsberger B. Analysis of the Clinical Advancements for BRCA-Related Malignancies Highlights the Lack of Treatment Evidence for BRCA-Positive Male Breast Cancer. Cancers (Basel) 2022; 14:3175. [PMID: 35804947 PMCID: PMC9264767 DOI: 10.3390/cancers14133175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
Male breast cancer (MBC) is a rare disease that accounts for less than 1% of all breast cancers and male malignancies. Despite recognised clinico-pathological and molecular differences to female breast cancer (FBC), the clinical management of MBC follows established FBC treatment strategies. Loss of function mutations in the DNA damage response genes BRCA1 and BRCA2, have been strongly implicated in the pathogenesis of MBC. While there have been extensive clinical advancements in other BRCA-related malignancies, including FBC, improvements in MBC remain stagnant. Here we present a review that highlights the lack of treatment evidence for BRCA-related MBC and the required national and global collaborative effort to address this unmet need. In doing so, we summarise the transformative clinical advancements with poly(ADP-ribose) polymerase (PARP) inhibitors in other BRCA-related cancers namely, FBC and prostate cancer.
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Affiliation(s)
- Dylan P. McClurg
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Gordan Urquhart
- Aberdeen Royal Infirmary, Department of Oncology, Foresterhill Road, Aberdeen AB25 2ZN, UK; (G.U.); (T.M.)
| | - Trevor McGoldrick
- Aberdeen Royal Infirmary, Department of Oncology, Foresterhill Road, Aberdeen AB25 2ZN, UK; (G.U.); (T.M.)
| | - Subarnarekha Chatterji
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Zosia Miedzybrodzka
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Valerie Speirs
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Beatrix Elsberger
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
- Aberdeen Royal Infirmary, Breast Unit, Foresterhill Road, Aberdeen AB25 2ZN, UK
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20
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Current Practices in the Pathologic Assessment of Breast Tissue in Transmasculine Chest Surgery. Plast Reconstr Surg 2022; 150:516e-525e. [PMID: 35749739 DOI: 10.1097/prs.0000000000009399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND No guidelines exist regarding management of breast tissue for transmasculine and gender-nonconforming individuals. This study aims to investigate the experiences and practices regarding perioperative breast cancer risk management among the American Society of Plastic Surgery (ASPS) surgeons performing chest masculinization surgery. METHODS An anonymous online 19 question survey was sent to 2517 US-based ASPS members in October 2019. RESULTS A total of 69 responses were analyzed. High volume surgeons were more likely from academic centers (OR 4.88 CI 1.67 - 15.22; p=0.005). Age ≥40 (85.5%, n=59) and family history of breast cancer in first-degree relatives (68.1%, n=47) or family with a diagnosis before age 40 (71.0%, n=49) were the most common indications for preoperative imaging. 27.5% (n=19) of the respondents routinely excise all macroscopic breast tissue, with 30.4% (n=21) routinely leaving breast tissue. 73.9% (n=51) of respondents routinely send specimens to pathology. There was no significant correlation between surgical volume or type of practice and odds of sending specimens to pathology. High patient costs and patient reluctance (39.1%, n=27, and 35.3%, n=24, respectively) were the most often cited barriers for sending specimens to pathology. 8.7% (n=6) of respondents have found malignant or premalignant lesions in masculinizing breast specimens. CONCLUSION Large variation was found among surgeons' perioperative management of chest masculinizing surgery patients regarding preoperative cancer screening, pathologic assessment of resected tissue, and postoperative cancer surveillance. Standardization of care and further studies are needed to document risk, incidence, and prevalence of breast cancer in the transmasculine population before and after surgery.
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21
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Efficacy of the Whole-Course Case Management Model on Compliance and Satisfaction of Breast Cancer Patients with Whole-Course Standardized Treatment. JOURNAL OF ONCOLOGY 2022; 2022:2003324. [PMID: 35783153 PMCID: PMC9249505 DOI: 10.1155/2022/2003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
Objective To explore the influence of the whole-course case management model on the compliance and satisfaction of breast cancer patients with the whole-course standardized treatment. Methods Eighty breast cancer patients admitted to our hospital between April 2020 and June 2021 were assigned to receive either conventional nursing (routine group, n = 40) or whole-process case management (experimental group, n = 40) according to different nursing methods. Outcome measures included self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, adverse reactions, treatment compliance, and nursing satisfaction. Results After nursing, the SAS and SDS scores of the experimental group were significantly lower than those of the routine group (P < 0.05). The whole case management mode was associated with a significantly lower incidence of adverse reactions versus routine nursing (P < 0.05). The whole case management resulted in higher compliance of patients versus routine nursing (P < 0.05). The experimental group had a significantly higher nursing satisfaction versus the routine group (P < 0.05). Conclusion The whole-process case management mitigates patients' negative emotions, strengthens their treatment compliance, lowers the incidence of postoperative adverse reactions, and improves nursing satisfaction, which may provide a viable nursing alternative for patients with breast cancer.
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22
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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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The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer. JOURNAL OF ONCOLOGY 2022; 2022:1794288. [PMID: 35342395 PMCID: PMC8942700 DOI: 10.1155/2022/1794288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the application of professional whole-process case management during nursing in patients with triple-negative breast cancer. Methods This study recruited 60 patients with triple-negative breast cancer who were diagnosed and treated at Department of Breast Surgery in our hospital assessed for eligibility between June 2018 and June 2020, and we assigned them at a ratio of 1 : 1 via the random number table method to receive either general nursing (control group) or professional whole-process case management plus general nursing (observation group). We analyzed and evaluated the hospitalization, the indwelling time of drainage tube, complications, recovery, quality of life, posttraumatic growth, and nursing satisfaction between these two groups at registration, discharge, and the sixth month after surgery, respectively. Results Professional whole-process case management achieved a shorter duration of drainage tube placement and hospitalization and a lower incidence of postoperative complications versus general nursing (P < 0.05). Moreover, the observation group had got better recovery (P < 0.05) and a better quality of life at discharge and 6 months after surgery (P < 0.05). Professional whole-process case management obtained higher scores of posttraumatic growth and higher nursing satisfaction versus general nursing (P < 0.05). Conclusion Whole-process case management promotes the postoperative recovery of patients with triple-negative breast cancer and shortens the duration of drainage tube indwelling and hospitalization, which lowers the incidence of postoperative complications, improves their quality of life, and enhances nursing satisfaction.
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Kronk CA, Everhart AR, Ashley F, Thompson HM, Schall TE, Goetz TG, Hiatt L, Derrick Z, Queen R, Ram A, Guthman EM, Danforth OM, Lett E, Potter E, Sun SD, Marshall Z, Karnoski R. Transgender data collection in the electronic health record: Current concepts and issues. J Am Med Inform Assoc 2022; 29:271-284. [PMID: 34486655 PMCID: PMC8757312 DOI: 10.1093/jamia/ocab136] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/13/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
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Affiliation(s)
- Clair A Kronk
- Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Avery R Everhart
- Population, Health, and Place Program, Spatial Sciences Institute, University of Southern California, Los Angeles, California, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Florence Ashley
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Hale M Thompson
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, Illinois, USA
| | - Theodore E Schall
- Berman Institute of Bioethics, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Teddy G Goetz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurel Hiatt
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Zackary Derrick
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Roz Queen
- Health Information Science, School of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - A Ram
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
| | - E Mae Guthman
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, USA
| | - Olivia M Danforth
- Department of Family Medicine, Samaritan Health Services Geary St. Clinic, Albany, Oregon, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emery Potter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Simón(e) D Sun
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Center for Neural Science, New York University, New York, New York, USA
- Department of Neuroscience and Physiology, Neuroscience Institute, NYU Grossman Medical Center, New York, New York, USA
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Ryan Karnoski
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
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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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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: 1] [Impact Index Per Article: 0.3] [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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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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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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Routine Screening for Transgender and Gender Diverse Adults Taking Gender-Affirming Hormone Therapy: a Narrative Review. J Gen Intern Med 2021; 36:1380-1389. [PMID: 33547576 PMCID: PMC8131455 DOI: 10.1007/s11606-021-06634-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Despite the growing number of adult transgender and gender diverse (TGD) patients seeking health services, there are many unknowns regarding how routine screening recommendations should be applied to TGD persons receiving gender-affirming hormone therapy (GAHT). Patients taking GAHT may have disease risks that differ from what is expected based on their sex assigned at birth or affirmed gender identity. We discuss two patient cases, one transgender man and one transgender woman who present for routine medical care, to review several conditions that may be impacted by the hormones utilized in masculinizing and feminizing GAHT and for which screening recommendations are available for TGD adults: cardiovascular risk factors, osteoporosis, breast cancer, cervical cancer, and prostate cancer. We reviewed the TGD-specific screening recommendations from several major medical organizations and programs and found them to be largely based upon expert opinion due to a lack of evidence. The goal of this narrative review is to assist healthcare professionals in counseling and screening their TGD patients when and where appropriate. Not all TGD adults have the ability or need to receive routine medical care from a specialized TGD health clinic; therefore, it is essential for all healthcare professionals involved in routine and gender-affirming care to have knowledge about these conditions and screenings.
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Ahmadabadi F, Saghebjoo M, Hedayati M, Hoshyar R, Huang CJ. Treatment-induced tumor cell apoptosis following high-intensity interval training and saffron aqueous extract in mice with breast cancer. Physiol Int 2021. [PMID: 33861725 DOI: 10.1556/2060.2021.00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
This study was to investigate whether high-intensity interval training (HIIT) and saffron aqueous extract (SAE) would provide a synergistic effect to improve tumor volume reduction and also modulate pro- and anti-apoptotic protein expression in tumor tissue of 4T1 breast cancer-bearing mice. Female mice following induction of breast cancer through injection of 4T1 cell lines were randomly divided into four groups: (1) HIIT, (2) SAE, (3) HIIT+ SAE, and (4) control. The tumor volume was significantly lower in the HIIT, SAE, and HIIT+SAE groups than in the controls. The protein level of caspase-3 in the HIIT and the SAE groups was higher than in the control and the HIIT+SAE groups. The Bax protein level in the SAE group was higher than in the control. The HIIT+SAE group showed a lower level of Bax than the HIIT and the SAE groups. The protein level of Bcl-2 was higher in the HIIT+SAE vs. both the HIIT and the SAE groups. Finally, the ratio of Bax/Bcl-2 was significantly higher in the HIIT and the SAE groups than in the HIIT+SAE and control groups. These findings indicate that a combination of HIIT and SAE interventions does not improve the apoptotic induction in tumor tissue, while both HIIT and SAE treatments may mediate apoptotic pathway as evinced by the elevated ratio of Bax/Bcl-2 and caspase-3 levels during tumor progression in breast cancer-bearing mice.
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Affiliation(s)
- F Ahmadabadi
- 1Department of Exercise Physiology, Faculty of Sport Sciences, University of Birjand, Birjand, Islamic Republic of Iran
| | - M Saghebjoo
- 1Department of Exercise Physiology, Faculty of Sport Sciences, University of Birjand, Birjand, Islamic Republic of Iran
| | - M Hedayati
- 2Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - R Hoshyar
- 3Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Islamic Republic of Iran
| | - C-J Huang
- 4Exercise Biochemistry Laboratory, Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL, 33431, USA
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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: 18] [Impact Index Per Article: 6.0] [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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Stafford A, Shobieri A, Stamatakos M, Edmiston K. Ductal carcinoma in situ in the male-to-female transgender population. Breast J 2020; 26:2439-2440. [PMID: 33274801 DOI: 10.1111/tbj.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Arielle Stafford
- Department of Surgery, Schar Cancer Institute, Inova Health System, Falls Church, VA, USA
| | - Abbas Shobieri
- Department of Urogynecology, Inova Health System, Falls Church, VA, USA
| | | | - Kirsten Edmiston
- Department of Surgery, Schar Cancer Institute, Inova Health System, Falls Church, VA, USA
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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: 24] [Impact Index Per Article: 6.0] [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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Coelingh Bennink HJT, Egberts JFM, Mol JA, Roes KCB, van Diest PJ. Breast Cancer and Major Deviations of Genetic and Gender-related Structures and Function. J Clin Endocrinol Metab 2020; 105:5864415. [PMID: 32594127 DOI: 10.1210/clinem/dgaa404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022]
Abstract
We have searched the literature for information on the risk of breast cancer (BC) in relation to gender, breast development, and gonadal function in the following 8 populations: 1) females with the Turner syndrome (45, XO); 2) females and males with congenital hypogonadotropic hypogonadism and the Kallmann syndrome; 3) pure gonadal dysgenesis (PGD) in genotypic and phenotypic females and genotypic males (Swyer syndrome); 4) males with the Klinefelter syndrome (47, XXY); 5) male-to-female transgender individuals; 6) female-to-male transgender individuals; 7) genotypic males, but phenotypic females with the complete androgen insensitivity syndrome, and 8) females with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome (müllerian agenesis). Based on this search, we have drawn 3 major conclusions. First, the presence of a Y chromosome protects against the development of BC, even when female-size breasts and female-level estrogens are present. Second, without menstrual cycles, BC hardly occurs with an incidence comparable to males. There is a strong correlation between the lifetime number of menstrual cycles and the risk of BC. In our populations the BC risk in genetic females not exposed to progesterone (P4) is very low and comparable to males. Third, BC has been reported only once in genetic females with MRKH syndrome who have normal breasts and ovulating ovaries with normal levels of estrogens and P4. We hypothesize that the oncogenic glycoprotein WNT family member 4 is the link between the genetic cause of MRKH and the absence of BC women with MRKH syndrome.
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Affiliation(s)
| | | | - Jan A Mol
- Faculty of Veterinary Medicine, University of Utrecht, GA Utrecht, the Netherlands
| | - Kit C B Roes
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Centre, GA Nijmegen, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, GA Utrecht, the Netherlands
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Meng C, Zou Y, Hong W, Bao C, Jia X. Estrogen-regulated PTTG1 promotes breast cancer progression by regulating cyclin kinase expression. Mol Med 2020; 26:33. [PMID: 32272902 PMCID: PMC7146910 DOI: 10.1186/s10020-020-00161-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/25/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The present study aims to investigate the effects of pituitary tumor transforming gene (PTTG) 1 on breast cancer and its underlying mechanism. METHODS GEO data set was applied to analyze the relationship between PTTG1 and survival status and the TCGA breast cancer dataset was used to explore its possible targets. The stable cell lines including PTTG1 knockdown cells, estrogen receptor (ESR) 1 knockdown cells, and PTTG1 overexpression cells were constructed. MTT was used to determine cell viabilities. Propidium iodide (PI) staining and flow cytometry were used to analyze the cell cycle. Quantitative polymerase chain reaction (qPCR) was employed to determine the mRNA expressions. Points mutations and luciferase reporter assays were used to determine the binding sites of estrogen. RESULTS PTTG1 was associated with poor survival rates in breast cancer. In vitro study demonstrated that PTTG1 affected cell viabilities of MCF7 and T47D cells. Besides, PTTG1 affected cell cycle arrest of breast cancer cells. Overexpression of PTTG1 led to more breast cancer cells distributed in S phase. The levels of PTTG1 were associated with estrogen and further results showed that the levels of PTTG1 were positively correlated to tamoxifen resistance. Two genes including CCNA2 and CCNB2 were identified to be possible targets of PTTG1. CONCLUSION Estrogen-regulated PTTG1 promotes the development of breast cancer cells by the regulation of the cell cycle.
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Affiliation(s)
- Chunhui Meng
- Department of General Surgery, Heze Municipal Hospital, Caozhou Road, Heze, 274000, Shandong, China
| | - Yan Zou
- Department of General Surgery, Heze Municipal Hospital, Caozhou Road, Heze, 274000, Shandong, China
| | - Weiwei Hong
- Department of General Surgery, Heze Municipal Hospital, Caozhou Road, Heze, 274000, Shandong, China
| | - Chunhua Bao
- Department of Oncology, Heze Municipal Hospital, Caozhou Road, Heze, 274000, Shandong, China
| | - Xiaofeng Jia
- Department of Oncology, Heze Municipal Hospital, Caozhou Road, Heze, 274000, Shandong, China.
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Chowdhry DN, O'Connell AM. Breast Imaging in Transgender Patients. JOURNAL OF BREAST IMAGING 2020; 2:161-167. [PMID: 38424892 DOI: 10.1093/jbi/wbz092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 03/02/2024]
Abstract
In the United States, at least 1.4 million adults identify as transgender. Despite growing national awareness, the transgender population experiences disparities in breast care access and breast health outcomes. One of the challenges of breast care delivery to transgender patients is the lack of evidence-based screening guidelines, which is likely partly due to the infrequency of transgender breast cancer cases. Several gender-affirming hormonal and surgical interventions are available that impact the imaging appearance of the breasts and the risk of breast cancer. Breast imaging radiologists should be familiar with the imaging appearance of expected findings and potential complications following gender-affirming interventions. It has been shown that the incidence of breast cancer in transgender women is higher than in natal males but still lower than in natal females, implying that estrogen supplementation confers an increased breast cancer risk. It is proposed that transgender women follow the screening guidelines for natal females if they have risk factors for breast cancer and received hormone therapy for > 5 years. However, further research is necessary, especially in transgender women who have no risk factors or received hormone therapy for ≤ 5 years. The breast cancer risk of presurgical transgender men is considered equivalent to that of natal females, but the risk markedly decreases following bilateral mastectomy. It is proposed that transgender men follow the screening guidelines for natal females if they have any preserved breast tissue, or that they undergo annual chest wall and axillary physical exam if they are status post bilateral mastectomy.
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Affiliation(s)
- Divya N Chowdhry
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY
| | - Avice M O'Connell
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY
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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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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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Baker GM, Pyle ME, Tobias AM, Bartlett RA, Phillips J, Fein-Zachary VJ, Wulf GM, Heng YJ. Establishing a Cohort of Transgender Men and Gender Nonconforming Individuals to Understand the Molecular Impact of Testosterone on Breast Physiology. Transgend Health 2019; 4:326-330. [PMID: 31750394 PMCID: PMC6863056 DOI: 10.1089/trgh.2019.0040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To characterize a cohort of transgender men and masculine-centered gender nonconforming individuals who underwent gender-affirming chest-contouring surgeries at our institution between 2013 and 2018. Methods: Demographics, medical history, and breast histopathological assessment for 340 patients were retrieved from medical records. Results: Most of our patients were white, non-Hispanic (75.0%), were taking testosterone (83.2%), and opted for chest-contouring surgery after 12–14 months of testosterone therapy. Ten patients were parous (2.9%). Seventy-nine (23.2%) and 27 (7.9%) patients had a family history of breast cancer or ovarian cancer, respectively. One transgender man was incidentally diagnosed with ductal carcinoma in situ at chest-contouring surgery. Conclusion: Future studies on this cohort will provide valuable insights about the impact of testosterone on breast physiology.
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Affiliation(s)
- Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael E Pyle
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam M Tobias
- Department of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Richard A Bartlett
- Department of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jordana Phillips
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Valerie J Fein-Zachary
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gerburg M Wulf
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Iwamoto SJ, Defreyne J, Rothman MS, Van Schuylenbergh J, Van de Bruaene L, Motmans J, T’Sjoen G. Health considerations for transgender women and remaining unknowns: a narrative review. Ther Adv Endocrinol Metab 2019; 10:2042018819871166. [PMID: 31516689 PMCID: PMC6719479 DOI: 10.1177/2042018819871166] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW's health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.
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Affiliation(s)
- Sean J. Iwamoto
- University of Colorado School of Medicine, Division of Endocrinology, Metabolism and Diabetes, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Justine Defreyne
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Micol S. Rothman
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- UCHealth Integrated Transgender Program, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
- Center for Research on Culture and Gender, Ghent University, Ghent, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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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: 159] [Impact Index Per Article: 31.8] [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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