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Berner AM, Atkinson SE. The implications of hormone treatment for cancer risk, screening and treatment in transgender individuals. Best Pract Res Clin Endocrinol Metab 2024:101909. [PMID: 38964988 DOI: 10.1016/j.beem.2024.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
There is evidence that gender-affirming hormone treatment (GAHT) for transgender individuals modulates their risk for specific malignancies including breast and prostate cancer, and meningiomas. However, there is insufficient data to make precise risk estimates accounting for age and inherited cancer risk. As such, screening recommendations remain broad. Even less evidence exists for best practice in the management of active or historical cancers in the transgender population. Guidance is therefore mainly extrapolated from cisgender populations but with considerations of the significant benefits of GAHT in the face of any hormonal risk. Clinical experience, the multidisciplinary team and shared decision making with the patient are vital in providing person-centred care, while further research is acquired.
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Affiliation(s)
- Alison May Berner
- Barts Cancer Institute, Queen Mary University of London, United Kingdom; Gender Identity Clinic London, Tavistock and Portman NHS Trust, United Kingdom.
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2
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Suarez A, Bisschops J, Lampen-Sachar K. Breast Cancer Screening Recommendations for Transgender Patients: A Review. Mayo Clin Proc 2024; 99:630-639. [PMID: 38569812 DOI: 10.1016/j.mayocp.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 04/05/2024]
Abstract
Shifting societal attitudes trending toward increased acceptance of transgender people has contributed to a growth in the population of individuals who openly identify as transgender as well as an increase in utilization of gender-affirming surgeries. Therefore, health care providers should work toward increasing their knowledge with respect to the health care needs of the transgender population, particularly given that these individuals often face discrimination in the health care system. Moreover, transgender breast cancer screening rates lag behind breast cancer screening rates for cisgender individuals. We attempt to clarify important terminology about the transgender population and introduce the concept of equity-centered language. We review current transgender breast cancer screening guidelines by using PubMed, Google Scholar, and Google with search terms that included transgender breast cancer guidelines, transgender breast cancer screening guidelines, and transgender cancer screening guidelines. Searches were not filtered based on year of publication, language of publication, or geographic location. We compare the various guidelines as they pertain to both transgender men and transgender women and offer special considerations for upholding inclusivity in the health care field. An easy-to-reference summary of the current transgender breast cancer screening guidelines and the major points of this article were compiled into an original infographic that health care providers can reference to ensure that appropriate care is being offered.
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Affiliation(s)
| | - Julia Bisschops
- Florida International University Herbert Wertheim College of Medicine, Miami
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3
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LaRosa MX, Chikarmane SA, Yu RN, Grimstad F, Chow JS. Peri-surgical imaging of intersex and gender diverse youths. Pediatr Radiol 2024:10.1007/s00247-024-05900-0. [PMID: 38520560 DOI: 10.1007/s00247-024-05900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
This publication provides an overview of current imaging indications and practices for patients undergoing gender-affirming surgery, with an emphasis on the importance of tailored, patient-specific care. Gender-affirming surgeries are performed with personalized approaches at various stages of life for those with intersex traits or differences in sex development (I/DSD) and transgender and gender diverse (TGD) individuals. For I/DSD patients, ultrasound, genitography, or MRI occurs during infancy and puberty to evaluate genital and gonadal anatomy. Facial harmonization involves bony and soft tissue modifications, guided by maxillofacial computerized tomography (CT) with three-dimensional reconstruction. Ultrasound is the main modality in assessing hormone-related and post-surgical changes in the chest. Imaging for genital reconstruction uses cross-sectional images and fluoroscopy to assess neoanatomy and complications.
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Affiliation(s)
- Michelle X LaRosa
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Main Building, 2nd Floor, Boston, MA, 02115, USA.
| | - Sona A Chikarmane
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard N Yu
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Frances Grimstad
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
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4
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Sartoretti E, Largiadèr S, Sartoretti T, Laures S, Walter MA, Monti E, Füchsel I, Dettling M, Pfister S, Dubsky P, Ort A, Sartoretti-Schefer S, Meissnitzer M, Hergan K, Forstner R, Matoori S, Bech- Hohenberger R, Froehlich JM, Plümecke T, Harder D, Koh DM, Gutzeit A. Understanding the needs of women undergoing breast ultrasound: Are male radiologists still needed? PLoS One 2023; 18:e0291007. [PMID: 37939048 PMCID: PMC10631629 DOI: 10.1371/journal.pone.0291007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION A trend towards less male radiologists specializing in breast ultrasound was observed. A common notion in the field of breast radiology is, that female patients feel more comfortable being treated by female radiologists. The aim of the study was to understand and report the needs of women undergoing breast ultrasound with regards to the sex of the radiologist performing the investigation. METHODS Informed consent was obtained from all patients prior to inclusion in a prospective bi-center quality study. At center 1 (72 patients), the women were examined exclusively by female radiologists, at center 2 (100 patients) only by male radiologists. After the examination the patients were asked about their experiences and their wishes for the future. RESULTS Overall, women made no distinction between female and male radiologists; 25% of them wanted a female radiologist and 1.2% wanted a male radiologist. The majority (74%) stated that it made no difference whether a female or male radiologist performed the examination. The majority of women in group 2, who were investigated exclusively by male radiologists, stated that they had no preferences with regard to the sex of the radiologist (93%); 5% of the women wished to be investigated solely by a female radiologist and 2% exclusively by a male radiologist. DISCUSSION The majority of women undergoing breast ultrasound are unconcerned about the radiologist's sex. It would appear that women examined by male radiologists are less selective about the sex of the examining radiologist. TRIAL REGISTRATION Written informed consent was obtained from all patients. All patient data were anonymized. The physicians had no access to any further personal data. National regulations did not require dedicated ethics approval with anonymized lists or retrospective questionnaires.
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Affiliation(s)
- Elisabeth Sartoretti
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Selina Largiadèr
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Thomas Sartoretti
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simin Laures
- Institute of Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Martin Alexander Walter
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Eva Monti
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Ina Füchsel
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Mira Dettling
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stephan Pfister
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Peter Dubsky
- St. Anna Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alexander Ort
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Matthias Meissnitzer
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
| | | | - John M. Froehlich
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Tino Plümecke
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Dow Mu Koh
- Department of Radiology, Royal Marsden Hospital, Surrey, United Kingdom
| | - Andreas Gutzeit
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- St. Anna Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
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5
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Hodan R, Rodgers-Fouche L, Chittenden A, Dominguez-Valentin M, Ferriss J, Gima L, Hamnvik OPR, Idos GE, Kline K, Koeller DR, Long JM, McKenna D, Muller C, Thoman M, Wintner A, Bedrick BS. Cancer surveillance for transgender and gender diverse patients with Lynch syndrome: a practice resource of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer. Fam Cancer 2023; 22:437-448. [PMID: 37341816 DOI: 10.1007/s10689-023-00341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
Transgender and gender diverse (TGD) populations with hereditary cancer syndromes face unique obstacles to identifying and obtaining appropriate cancer surveillance and risk-reducing procedures. There is a lack of care provider knowledge about TGD health management. Lynch syndrome (LS) is one of the most common hereditary cancer syndromes, affecting an estimated 1 in 279 individuals. There are no clinical guidelines specific for TGD individuals with LS, highlighting a need to improve the quality of care for this population. There is an urgent need for cancer surveillance recommendations for TGD patients. This commentary provides recommendations for cancer surveillance, risk-reducing strategies, and genetic counseling considerations for TGD patients with LS.
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Affiliation(s)
- Rachel Hodan
- Cancer Genetics, Stanford Health Care and Department of Pediatrics (Genetics), Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Linda Rodgers-Fouche
- Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Anu Chittenden
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mev Dominguez-Valentin
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
| | - James Ferriss
- Department of Gynecology and Obstetrics, Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lauren Gima
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, CA, USA
| | - Ole-Petter R Hamnvik
- Center for Transgender Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Gregory E Idos
- Division of Gastroenterology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin Kline
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Diane R Koeller
- Division of Cancer Genetics and Prevention, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jessica M Long
- Division of Hematology and Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Danielle McKenna
- Division of Hematology and Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Charles Muller
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA
| | - Maxton Thoman
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Bronwyn S Bedrick
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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6
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Mehta TS, Thompson J, Applegate JM, Wahab RA. Cultural Competence in the Care of LGBTQ+ Patients: A Primer for Breast/Chest Centers. JOURNAL OF BREAST IMAGING 2023; 5:473-479. [PMID: 38416897 DOI: 10.1093/jbi/wbad012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 03/01/2024]
Abstract
The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health-related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels.
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Affiliation(s)
- Tejas S Mehta
- UMass Memorial Medical Center, Department of Radiology, Worcester, MA, USA
| | | | - Julia M Applegate
- The Ohio State University, Department of Women's, Gender and Sexuality Studies, Columbus, OH, USA
| | - Rifat A Wahab
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH, USA
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7
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Villalba MD, Letter HP, Robinson KA, Maimone S. Breast cancer in a transgender woman undergoing gender-affirming exogenous hormone therapy. Radiol Case Rep 2023; 18:2511-2513. [PMID: 37214332 PMCID: PMC10199399 DOI: 10.1016/j.radcr.2023.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Gender-affirming hormone therapy may be utilized by transgender women hoping to induce feminizing changes and suppress the effects of endogenous testosterone. It is well established that exogenous hormone use increases risk of breast cancer in cisgender women; however, a link in the transgender population is less clear. Our case presents a transgender woman undergoing gender-affirming exogenous hormone therapy who subsequently developed breast cancer. We review the available literature regarding risks of exogenous hormone therapy with regards to breast cancer development. Additionally, we present current societal guidelines and recommendations for screening in this population.
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Pratt-Chapman ML, Astorino J, Goyal S, Schmit B, Yap ML, Bajaj S, Angiulo E. Radiology and radiation oncology considerations for transgender and intersex patients: A qualitative study. J Med Imaging Radiat Oncol 2023; 67:185-192. [PMID: 36790031 DOI: 10.1111/1754-9485.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION In this qualitative study, we explored experiences of radiologists and radiation oncologists in providing clinical care to transgender, gender diverse (TGD), and intersex patients by asking about comfort level, relevant past training and training gaps, and clinical recommendations for TGD and intersex patient care. METHODS A purposive sample of radiology and radiation oncology professionals (n = 16) from diverse practice settings were interviewed on a videoconferencing platform. Transcripts were auto-populated and checked manually for accuracy. Two coders used a mix of deductive and inductive coding to identify key themes. Member checking was conducted with interviewees. RESULTS Participants reported major gaps in training, knowledge, and confidence related to all aspects of TGD and intersex patient care. Recommendations for improvements included training that encompassed key terminology, how to conduct a physical exam on TGD and intersex patients, radiology and radiation oncology adaptations for TGD and intersex patients, and care coordination among multi-disciplinary oncology team members and gender affirming care providers. Exposure to diverse TGD and intersex persons in personal and professional life contributed to higher levels of comfort among providers in caring for TGD and intersex patients. CONCLUSION Gaps in knowledge and limited confidence characterized the sample. Training at all levels is needed to improve radiology and radiation oncology care for TGD and intersex patients.
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Affiliation(s)
- Mandi L Pratt-Chapman
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.,Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Joseph Astorino
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Sharad Goyal
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Berndt Schmit
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), UNSW Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Sydney, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Shiv Bajaj
- GW Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Emily Angiulo
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
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Stowell JT. Invited Commentary: Making Headway in Care Delivery for Transgender Patients in Radiology. Radiographics 2023; 43:e220194. [PMID: 36602926 DOI: 10.1148/rg.220194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Justin T Stowell
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
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10
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Hayward JH. Updates in Transgender Breast Imaging. Semin Ultrasound CT MR 2023; 44:23-34. [PMID: 36792271 DOI: 10.1053/j.sult.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender patients are seen in breast imaging centers for routine screening mammography and diagnostic imaging of the symptomatic breast. This comprehensive review of transgender breast imaging aims to update the radiologist on appropriate terminology, breast cancer risk in different patient populations, screening guidelines, and diagnostic scenarios. The chapter concludes with practical tips on how to optimize the patient experience.
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Affiliation(s)
- Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco.
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11
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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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12
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Wolters EA, Rabe KE, Siegel L, Butts J, Klein ME. Histopathologic Features of Breast Tissue From Transgender Men and Their Associations With Androgen Therapy. Am J Clin Pathol 2022; 159:43-52. [PMID: 36469057 PMCID: PMC9825198 DOI: 10.1093/ajcp/aqac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/20/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVES To assess the histopathologic features of breast tissue of transgender men (TM) undergoing gender-affirming bilateral mastectomies in relation to androgen therapy (AT). METHODS We reviewed 374 transgender bilateral mastectomy cases from 2017 to 2020. Of these, 314 (84.4%) patients received preoperative AT. We compared these with 127 cases of cisgender females undergoing elective breast reduction. RESULTS Breast specimens from TM on AT, compared with cisgender women, showed a median higher gross percentage of fibrous tissue (P < .001), reduced lobular density (P = .004), higher amount of lobular atrophy (P < .001), and lower incidence of cysts (P < .001), apocrine metaplasia (P < .001), calcifications (P < .001), columnar cell change (P = .002), and atypia (P = .003). Each additional month of AT was associated with a 2% decrease in the odds of having nonapocrine cysts (P = .02), a 5% decrease in the odds of having usual ductal hyperplasia (P = .007), and a 0.14% decrease in median lobular density (95% confidence interval, -0.18 to -0.05). CONCLUSIONS In this study, breast specimens from TM, particularly with a history of AT, had a higher proportion of fibrous tissue, fewer lobules, and a higher degree of lobular atrophy than cisgender females. Rare cases of atypia were not predicted by preoperative imaging or gross findings, supporting routine microscopic evaluation of these specimens.
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Affiliation(s)
- Emily A Wolters
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimmie E Rabe
- Pathology Department, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Lianne Siegel
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Jessica Butts
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Sudhakar D, Huang Z, Zietkowski M, Powell N, Fisher AR. Feminizing gender‐affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks. Neurourol Urodyn 2022. [DOI: 10.1002/nau.25097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022]
Affiliation(s)
| | - Zhong Huang
- Pritzker School of Medicine University of Chicago Chicago Illinois USA
| | - Maeson Zietkowski
- Pritzker School of Medicine University of Chicago Chicago Illinois USA
| | - Natasha Powell
- Pritzker School of Medicine University of Chicago Chicago Illinois USA
| | - Andrew R. Fisher
- Department of Obstetrics and Gynecology University of Chicago Chicago Illinois USA
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14
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An Update on the General Features of Breast Cancer in Male Patients—A Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12071554. [PMID: 35885460 PMCID: PMC9323942 DOI: 10.3390/diagnostics12071554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022] Open
Abstract
Male breast cancers are uncommon, as men account for less than 1 percent of all breast carcinomas. Among the predisposing risk factors for male breast cancer, the following appear to be significant: (a) breast/chest radiation exposure, (b) estrogen use, diseases associated with hyper-estrogenism, such as cirrhosis or Klinefelter syndrome, and (c) family health history. Furthermore, there are clear familial tendencies, with a higher incidence among men who have a large number of female relatives with breast cancer and (d) major inheritance susceptibility. Moreover, in families with BRCA mutations, there is an increased risk of male breast cancer, although the risk appears to be greater with inherited BRCA2 mutations than with inherited BRCA1 mutations. Due to diagnostic delays, male breast cancer is more likely to present at an advanced stage. A core biopsy or a fine needle aspiration must be performed to confirm suspicious findings. Infiltrating ductal cancer is the most prevalent form of male breast cancer, while invasive lobular carcinoma is extremely uncommon. Male breast cancer is almost always positive for hormone receptors. A worse prognosis is associated with a more advanced stage at diagnosis for men with breast cancer. Randomized controlled trials which recruit both female and male patients should be developed in order to gain more consistent data on the optimal clinical approach.
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15
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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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16
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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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17
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Smetherman D, Biggs K, Fayanju OM, Grosskreutz S, Khan Z, Malak S, Moseley T, Smith-Graziani D, Valero V, Lightfoote J. Racial and Ethnic Disparities in Breast Cancer: A Collaboration Between the American College of Radiology Commissions on Women and Diversity and Breast Imaging. JOURNAL OF BREAST IMAGING 2021; 3:712-720. [PMID: 38424936 DOI: 10.1093/jbi/wbab081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 03/02/2024]
Abstract
Since the 1980s, the mortality rate from breast cancer in the United States has dropped almost 40%. The quality of life and survival gains from early detection and improved treatment have not been shared equally by all ethnic groups, however. Many factors, including social determinants of health, unequal access to screening and oncologic care, and differences in incidence, tumor biology, and risk factors, have contributed to these unequal breast cancer outcomes. As breast radiologists approach their own patients, they must be aware that minority women are disproportionately affected by breast cancer at earlier ages and that non-Hispanic Black and Hispanic women are impacted by greater severity of disease than non-Hispanic White women. Guidelines that do not include women younger than 50 and/or have longer intervals between examinations could have a disproportionately negative impact on minority women. In addition, the COVID-19 pandemic could worsen existing disparities in breast cancer mortality. Increased awareness and targeted efforts to identify and mitigate all of the underlying causes of breast cancer disparities will be necessary to realize the maximum benefit of screening, diagnosis, and treatment and to optimize quality of life and mortality gains for all women. Breast radiologists, as leaders in breast cancer care, have the opportunity to address and reduce some of these disparities for their patients and communities.
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Affiliation(s)
- Dana Smetherman
- Ochsner Health, Department of Radiology, New Orleans, LA, USA
| | - Kelly Biggs
- James E. Van Zandt, VA Medical Center, Department of Radiology, Altoona, PA, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
| | | | - Zahra Khan
- Medina Global, Strategic Planning and Health Policy, Cambridge, MA, USA
| | - Sharp Malak
- St. Bernard's Healthcare, Department of Radiology, Jonesboro, AR, USA
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Departments of Breast Surgical Oncology and Breast Imaging, Houston, TX, USA
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Breast Medical Oncology Department, Houston, TX, USA
| | - Johnson Lightfoote
- Pomona Valley Hospital Medical Center, Department of Radiology, Pomona, CA, USA
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18
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Gao Y, Karimova EJ, Phillips J, Fein-Zachary V, Dialani V, Mehta TS, Mehta R, Slanetz PJ. Injected Breast Materials: Review of Imaging Features and Characteristics. JOURNAL OF BREAST IMAGING 2021; 3:727-739. [PMID: 38424927 DOI: 10.1093/jbi/wbab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 03/02/2024]
Abstract
In the United States, silicone and saline breast implants with their familiar radiologic appearance are the mainstays of breast augmentation. However, less well-known sequelae of unconventional injected materials introduced for cosmetic and noncosmetic purposes may also be encountered on breast imaging-for example, free silicone, paraffin and/or oil, polyacrylamide gel, autologous fat, and hyaluronic acid, which are encountered in the setting of breast augmentation. Breast injection of go-yak is not cosmetic but also results in characteristic imaging findings. Breast changes due to extravasation of chemotherapy or interstitial brachytherapy can mimic the appearance of injected noncosmetic materials. Because many of these materials can mimic or obscure imaging findings of breast cancer, it is important to recognize their varied appearances and the limitations of imaging alone in delineating breast injection material from cancer. Given the relatively uncommon incidence of injected materials into the breast, this article aims to review the imaging appearance in order to aid radiologists in maximizing cancer detection and ensuring optimal patient management.
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Affiliation(s)
- Yukun Gao
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - E Jane Karimova
- Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA
| | - Jordana Phillips
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | | | - Vandana Dialani
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Tejas S Mehta
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Rashmi Mehta
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
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19
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Pollack EB, O’Keefe MC. Breast Imaging in Special Populations: Indications and Findings in Pregnant and Lactating, Male, and Transgender Patients. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Current State of Membership Diversity Among North American Radiology Societies: Analysis of Public Information on Society Websites. Acad Radiol 2021; 28:1541-1547. [PMID: 32771316 DOI: 10.1016/j.acra.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Diversity is an identified priority amongst governing medical bodies. We systematically analyzed public membership diversity data posted by North American radiology societies. MATERIALS AND METHODS Two independent study members reviewed North American radiology society websites to collect public data on membership diversity, specifically related to gender, race, and sexual orientation or gender identity, and categorized data using a coding system. Supplemental searches were conducted to confirm findings. Study team members created accounts on each society website to identify whether diversity data was collected during member enrollment. RESULTS We reviewed a total of 26 society websites, with median 1500 members (range 110-54,600). We categorized five societies as "diversity leaders" based on having diversity statement(s), diversity initiatives, and diversity publication(s). While 62%, 8%, and 0% of societies collected data on gender, race, and sexual orientation or gender identity, respectively, no societies posted membership composition of these groups. Fourty-six percent of societies had membership diversity statement(s) on their webpages. Fifty-four percent had initiative(s) targeted at diversity (23% had multiple). Fifty percent had membership diversity publication(s). Sexual orientation and gender identity minority members were least frequently specified as beneficiaries of diversity statements, initiatives, and publications. Societies with larger memberships were more likely to have membership diversity initiatives (p = 0.01), journal articles on membership diversity (p = 0.005), and be "diversity leaders" (p = 0.02). CONCLUSION Public support of membership diversity by many North American radiology societies, especially those with fewer members, is lacking. Identified "diversity leaders" can serve as models for societies aiming to establish their commitment to diversity.
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21
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Luehmann N, Ascha M, Chwa E, Hackenberger P, Termanini K, Benning C, Sama D, Felt D, Beach LB, Gupta D, Kulkarni SA, Jordan SW. A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients. Ann Surg Oncol 2021; 29:1707-1717. [PMID: 34704183 DOI: 10.1245/s10434-021-10932-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/24/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center. METHODS Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed. RESULTS Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2 years (42.3-62.6). Most patients had no family history of breast cancer (n = 163, 64.4%) and were on hormone therapy (n = 191, 75.5%). Most patients where White (n = 164, 64.8%), employed (n = 113, 44.7%), and had public insurance (n = 128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses. CONCLUSION Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.
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Affiliation(s)
- Natalie Luehmann
- Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mona Ascha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Paige Hackenberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kareem Termanini
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Danny Sama
- Information Services, Northwestern Memorial HealthCare, Chicago, IL, USA
| | - Dylan Felt
- Feinberg School of Medicine Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Lauren B Beach
- Feinberg School of Medicine Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Dipti Gupta
- Division of Breast Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Swati A Kulkarni
- Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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22
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Perry H, Fang AJ, Tsai EM, Slanetz PJ. Imaging Health and Radiology Care of Transgender Patients: A Call to Build Evidence-Based Best Practices. J Am Coll Radiol 2021; 18:475-480. [PMID: 33663757 DOI: 10.1016/j.jacr.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/22/2022]
Abstract
Transgender people have a gender identity that differs from their natal sex and experience many forms of discrimination, including within the health care field. Although transgender patients only comprise 0.6% of the adult US population, they frequently require imaging evaluation. Few published articles provide data-driven research on optimizing education of the radiology care team and delivery of inclusive and respectful imaging care to this vulnerable population; existing data suggest prior areas of success and prior areas of failure. Here, we offer specific recommendations on how radiology care team members can better serve transgender patients and begin generating much needed evidence-based best practices to improve their imaging health and care.
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Affiliation(s)
- Hannah Perry
- Co-Division Chief/Medical Director of Breast Imaging, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont.
| | - Adam J Fang
- Division Director of Breast Imaging, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Erin M Tsai
- President, Vermont Radiological Society, University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Priscilla J Slanetz
- Vice Chair of Academic Affairs and Associate Program Director, Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center, Boston, Massachusetts
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23
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Clarke CN, Cortina CS, Fayanju OM, Dossett LA, Johnston FM, Wong SL. Breast Cancer Risk and Screening in Transgender Persons: A Call for Inclusive Care. Ann Surg Oncol 2021; 29:2176-2180. [PMID: 34097159 DOI: 10.1245/s10434-021-10217-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 01/10/2023]
Abstract
The Society of Surgical Oncology is committed to reducing health disparities adversely affecting sexual and gender minorities. Transgender persons represent a socially disadvantaged group who frequently experience discrimination and receive disparate care, resulting in suboptimal cancer outcomes. The rate of breast cancer development in transgender individuals differs from rates observed in their cisgender counterparts, however there is little evidence to quantify these differences and guide evidence-based screening and prevention. There is no consensus for breast cancer screening guidelines in transgender patients. In this review, we discuss barriers to equitable breast cancer care, risk factors for breast cancer development, and existing data to support breast cancer screening in transgender men and women.
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Affiliation(s)
- Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Sandra L Wong
- Department of Surgery, The Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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24
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Davis KM, Monga N, Sonubi C, Asumu H, DeBenedectis CM, Spalluto LB. Educational Strategies to Achieve Equitable Breast Imaging Care. JOURNAL OF BREAST IMAGING 2021; 3:231-239. [PMID: 38424828 DOI: 10.1093/jbi/wbaa082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 03/02/2024]
Abstract
As the population of the United States becomes increasingly diverse, radiologists must learn to both understand and mitigate the impact of health disparities. Significant health disparities persist in radiologic care, including breast imaging. Racial and ethnic minorities, women from lower socioeconomic status, those living in rural areas, and the uninsured bear a disproportionate burden of breast cancer morbidity and mortality. Currently, there is no centralized radiology curriculum focusing on breast health disparities available to residents, breast imaging fellows, or practicing breast radiologists. While patient-, provider-, and system-level initiatives are necessary to overcome disparities, our purpose is to describe educational strategies targeted to breast imaging radiologists at all levels to provide equitable care to a diverse population. These strategies may include, but are not limited to, diversifying the breast imaging workforce, understanding the needs of a diverse population, cultural sensitivity and bias training, and fostering awareness of the existing issues in screening mammography access, follow-up imaging, and clinical care.
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Affiliation(s)
- Katie M Davis
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | - Natasha Monga
- Case Western Reserve University - The MetroHealth System, Department of Radiology, Cleveland, OH
| | | | - Hazel Asumu
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | | | - Lucy B Spalluto
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research, Education, and Clinical Center, Nashville, TN
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25
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Patel MM, Parikh JR. Patient Diversity in Breast Imaging: Barriers and Potential Solutions. JOURNAL OF BREAST IMAGING 2021; 3:98-105. [PMID: 38424834 DOI: 10.1093/jbi/wbaa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 03/02/2024]
Abstract
Recent reports have highlighted disparities in breast cancer care related to patient diversity. Breast radiologists represent the face of breast imaging and are key players in advocating for patients to reduce these disparities. Diversity-related barriers for breast imaging patients, as they journey from screening to survivorship, include impediments to access and quality of care, gaps in communication, and lack of knowledge in both providers and patients. Potential strategies for overcoming these specific barriers include "culturally tailored" nurse navigators, mobile mammography, improved communication, patient and provider education, and breast radiologist involvement in advocacy efforts promoting diversity. As current trends in recommendations and guidelines for breast imaging include more numerous and advanced imaging modalities, it is important to acknowledge and address diversity-related disparities.
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Affiliation(s)
- Miral M Patel
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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26
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27
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Swamy N, Rohilla M, Raichandani S, Bryant-Smith G. Epidemiology of male breast diseases: A 10-year institutional review. Clin Imaging 2020; 72:142-150. [PMID: 33249401 DOI: 10.1016/j.clinimag.2020.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review breast imaging utilization and epidemiology of breast diseases in male patients referred to our breast center. MATERIAL AND METHODS A retrospective analysis of all male patients who underwent breast imaging at our institution over a 10 year period (03/14/2008 to 03/13/2018) was performed. Patient history, imaging findings, biopsy reports, surgical interventions and follow-up data were reviewed. RESULTS Over the 10 year period, 143 male patients (0.1% of referred breast center patients) underwent breast imaging (versus 139,134 female patients). Mean age was 57.4 years (SD 19.7, median 59, range 21-92 years). The most common indication for referral was a palpable breast mass (98%). The most common diagnosis was gynecomastia (72%). Of the 20 (14%) patients who underwent core biopsy; 1 (0.7%) had breast cancer and the remaining 19 had benign pathologies. Follow-up imaging was recommended for 22 (15.4%) patients, of whom 15 (68%) were lost to follow-up. Two patients under the age of 25 years inadvertently underwent initial mammography instead of ultrasound. CONCLUSION The epidemiology of breast diseases in our male patient population mirrors that of the general male population worldwide; with an overwhelming 99.3% cases falling into benign category. Two-thirds of our male patients for whom short interval follow up was recommended were lost to follow-up, signifying the need for a more proactive approach in ensuring their compliance. It is important to increase awareness among referring clinicians and general radiologists regarding male breast imaging recommendations so that the appropriate imaging study is performed.
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Affiliation(s)
- Nayanatara Swamy
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street - Slot 556, Little Rock, AR 72205-7199, United States of America.
| | | | - Surbhi Raichandani
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street - Slot 556, Little Rock, AR 72205-7199, United States of America.
| | - Gwendolyn Bryant-Smith
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street - Slot 556, Little Rock, AR 72205-7199, United States of America.
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28
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Nazarian M, Bluebond-Langner R, Smereka P, Zhao L, Ream J, Hindman N. Spectrum of imaging findings in gender-affirming genital surgery: Intraoperative photographs, normal post-operative anatomy, and common complications. Clin Imaging 2020; 69:63-71. [PMID: 32659682 DOI: 10.1016/j.clinimag.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/30/2020] [Accepted: 06/26/2020] [Indexed: 01/03/2023]
Abstract
Gender-affirming surgery is becoming more accessible, and radiologists must be familiar with both terminology and anatomy following gender-affirming surgical procedures. This essay will review the most common gender-affirming genital surgeries, their post-operative anatomy, and common complications by providing intraoperative photographs, illustrations, and cross-sectional images. Routine radiologic imaging recommendations for transgender patients will also be reviewed.
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Affiliation(s)
- Matthew Nazarian
- NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
| | | | - Paul Smereka
- NYU Langone Medical Center, 560 First Avenue, New York, NY 10016, USA.
| | - Lee Zhao
- NYU Langone Medical Center, 222 E 41st St, New York, NY 10017, USA.
| | - Justin Ream
- NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
| | - Nicole Hindman
- NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
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