1
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Smart AC, Liu KX, Domogauer JD, Rodriguez-Russo C, Jones B, Dickstein DR, Mancias JD, Shiloh RY, Wintner A, Zietman AL, Marshall DC, Dyer MA, Russo AL. Gender-Affirming Surgery and Cancer: Considerations for Radiation Oncologists for Pelvic Radiation in Transfeminine Patients. Int J Radiat Oncol Biol Phys 2023; 117:301-311. [PMID: 37230432 PMCID: PMC10527783 DOI: 10.1016/j.ijrobp.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
Access to gender-affirming surgery is increasing for many transgender and nonbinary people in the United States, and radiation oncologists must be equipped to care for patients who have undergone such surgery in the region of their planned radiation treatment field. There are no guidelines for radiation treatment planning after gender-affirming surgery, and most oncologists do not receive training in the unique needs of transgender people with cancer. We review common gender-affirming genitopelvic surgeries for transfeminine people, including vaginoplasty, labiaplasty, and orchiectomy, and summarize the existing literature on the treatment of cancers of the neovagina, anus, rectum, prostate, and bladder in these patients. We also describe our systematic treatment approach and rationale for pelvic radiation treatment planning.
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Affiliation(s)
- Alicia C Smart
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Kevin X Liu
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason D Domogauer
- Department of Radiation Oncology, New York University Langone Health, New York University, New York, New York
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brianna Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph D Mancias
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Ron Y Shiloh
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Aiven Dyer
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea L Russo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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2
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Tian J, Janbey S, Hassanesfahani M, Bhatia S, Louis MA, Khan N. Kaposi sarcoma presenting as small bowel obstruction. J Surg Case Rep 2023; 2023:rjad385. [PMID: 37416496 PMCID: PMC10319745 DOI: 10.1093/jscr/rjad385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
Kaposi sarcoma (KS) is a low-grade tumor of the vascular endothelium. The majority of individuals affected have advanced human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The disease typically manifests as cutaneous lesions but reports have shown that systemic disease is not uncommon. Because gastrointestinal KS is often asymptomatic, it is likely underdiagnosed. Those with symptoms can present with vague abdominal pain, nausea/vomiting or anemia. Rarely the tumors can cause bowel obstruction or perforation. We present a case of small bowel obstruction cause by KS tumors in a young transgender male to female patient with poorly controlled AIDS, supported by literature review of the clinical presentation, diagnosis and treatment recommendations.
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Affiliation(s)
- Jane Tian
- Correspondence address. Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA. Tel: 510-415-8916; Fax: 718-670-4449; E-mail:
| | - Selma Janbey
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA
| | | | - Shubham Bhatia
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA
| | - Martine A Louis
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA
| | - Noman Khan
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA
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3
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Zigras T, Mayrand MH, Bouchard C, Salvador S, Eiriksson L, Almadin C, Kean S, Dean E, Malhotra U, Todd N, Fontaine D, Bentley J. Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations. Curr Oncol 2023; 30:5652-5679. [PMID: 37366908 DOI: 10.3390/curroncol30060425] [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: 05/11/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made.
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Affiliation(s)
- Tiffany Zigras
- Trillium Health Partners, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Marie-Hélène Mayrand
- Département d'obstétrique-gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Celine Bouchard
- Clinique de Researche en Sante des femmes, Quebec City, QC G1V 3M7, Canada
| | - Shannon Salvador
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Lua Eiriksson
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Chelsea Almadin
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC H3Z 2H5, Canada
| | - Sarah Kean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Winnipeg, MB R3J 3T7, Canada
| | - Erin Dean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Winnipeg, MB R3J 3T7, Canada
| | - Unjali Malhotra
- Office of the Chief Medical Officer, First Nations Health Authority, West Vancouver, BC V7T 1A2, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology UBC, Vancouver, BC V5Z 4E1, Canada
| | - Daniel Fontaine
- Department of Pathology and Laboratory Medicine, Valley Regional Hospital, Kentville, NS B4N 5E3, Canada
| | - James Bentley
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS B3H 4R2, Canada
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4
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Leone AG, Trapani D, Schabath MB, Safer JD, Scout NFN, Lambertini M, Berardi R, Marsoni S, Perrone F, Cinieri S, Miceli R, Morano F, Pietrantonio F. Cancer in Transgender and Gender-Diverse Persons: A Review. JAMA Oncol 2023; 9:556-563. [PMID: 36757703 DOI: 10.1001/jamaoncol.2022.7173] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Importance Transgender and gender-diverse individuals face unique challenges, including barriers to health care access and inequities in treatment, that may influence cancer risk and outcomes. Observations In this narrative review, a scoping review was conducted focusing on primary and secondary prevention and epidemiology of cancer, barriers to health care services, and health care practitioners' knowledge about specific issues pertaining to transgender and gender-diverse individuals. PubMed, the Cochrane Library, and Embase, were reviewed for citations from their inception to December 31, 2021. This review revealed that transgender and gender-diverse people had a high prevalence of tobacco consumption and alcohol use and high rates of infection with human papillomavirus (HPV) and HIV. Transgender and gender-diverse individuals were less likely to adhere to cancer screening programs and had a higher incidence of HIV- and HPV-associated cancers. Social and economic determinants seemed to drive these disparities in risk factors and outcomes. A lack of knowledge about gender minorities' health needs among health care practitioners was evidenced, and it represented a major hurdle to cancer prevention, care, and survivorship for transgender and gender-diverse individuals. Discrimination, discomfort caused by gender-labeled oncological services, stigma, and lack of cultural sensitivity of health care practitioners were other barriers met by transgender and gender-diverse persons in the oncology setting. Conclusions and Relevance The findings suggest that transgender and gender-diverse peoples' needs in the cancer care continuum are not optimally addressed. Effective solutions are needed to offer the best care to every patient in a person-centric and gender diversity-sensitive environment.
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Affiliation(s)
| | - Dario Trapani
- European Institute of Oncology, IRCCS, Milan, Italy.,Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York.,Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
| | - N F N Scout
- National LGBT Cancer Network, Providence, Rhode Island
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, Unità Operativa Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Marsoni
- IFOM, FIRC Institute of Molecular Oncology, Milan, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - Rosalba Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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5
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Wells J, Flowers L, Mehta CC, Chandler R, Knott R, McDonnell Holstad M, Watkins Bruner D. Follow-Up to High-Resolution Anoscopy After Abnormal Anal Cytology in People Living with HIV. AIDS Patient Care STDS 2022; 36:263-271. [PMID: 35727648 PMCID: PMC9464048 DOI: 10.1089/apc.2022.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Current expert recommendations suggest anal cytology followed by high-resolution anoscopy (HRA) for biopsy and histological confirmation may be beneficial in cancer prevention, especially in people living with HIV (PLWH). Guided by the social ecological model, the purpose of this study was to examine sociodemographic and clinical variables, individual-level factors (depression, HIV/AIDS-related stigma, and health beliefs) and interpersonal-level factors (social support) related to time to HRA follow-up after abnormal anal cytology. We enrolled 150 PLWH from a large HIV community clinic, with on-site HRA availability, in Atlanta, GA. The median age was 46 years (interquartile range of 37-52), 78.5% identified as African American/Black, and 88.6% identified as born male. The average length of follow-up to HRA after abnormal anal cytology was 380.6 days (standard deviation = 317.23). Only 24.3% (n = 39) of the sample had an HRA within 6 months after an abnormal anal cytology, whereas 57% of the sample had an HRA within 12 months. HIV/AIDS-related stigma [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.33-0.90] and health motivation (OR 0.80, 95% CI 0.67-0.95) were associated with time to HRA follow-up ≤6 months. For HRA follow-up ≤12 months, we found anal cytology [high-grade squamous intraepithelial lesions/atypical squamous cells of undetermined significance cannot exclude HSIL (HSIL/ASCUS-H) vs. low-grade squamous intraepithelial lesions (LSIL) OR = 0.05, 95% CI 0.00-0.70; atypical squamous cells of undetermined significance (ASCUS) vs. LSIL OR = 0.12, 95% CI 0.02-0.64] and health motivation (OR = 0.86, 95% CI 0.65-0.99) were associated. Findings from this study can inform strategies to improve follow-up care after abnormal anal cytology at an individual and interpersonal level in efforts to decrease anal cancer morbidity and mortality.
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Affiliation(s)
- Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.,Address correspondence to: Jessica Wells, PhD, RN, WHNP-BC, FAAN, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, RM. 230, Atlanta, GA 30324, USA
| | - Lisa Flowers
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Robert Knott
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Deborah Watkins Bruner
- Office of the Senior Vice President of Research, Emory University, Atlanta, Georgia, USA
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6
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LoSchiavo C, Greene RE, Halkitis PN. Human Papillomavirus Prevalence, Genotype Diversity, and Risk Factors Among Transgender Women and Nonbinary Participants in the P18 Cohort Study. AIDS Patient Care STDS 2020; 34:502-505. [PMID: 33207125 DOI: 10.1089/apc.2020.0213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Caleb LoSchiavo
- Departments of Health Behavior, Society and Policy & Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
| | - Richard E. Greene
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Perry N. Halkitis
- Departments of Health Behavior, Society and Policy & Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, New Jersey, USA
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, New Jersey, USA
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7
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Rich AJ, Scheim AI, Koehoorn M, Poteat T. Non-HIV chronic disease burden among transgender populations globally: A systematic review and narrative synthesis. Prev Med Rep 2020; 20:101259. [PMID: 33335828 PMCID: PMC7732872 DOI: 10.1016/j.pmedr.2020.101259] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 01/10/2023] Open
Abstract
Chronic disease is a growing concern for research, policy and clinical care. While the global burden of HIV for transgender populations has been comprehensively covered in recent systematic reviews, the same is not true for the burden of other chronic disease. The objective of this study was to review the literature on non-HIV chronic disease burden for transgender populations worldwide. A systematic review was conducted of Medline, Embase, CINAHL, PsycINFO and LGBT Life bibliographic databases for peer-reviewed scientific studies with non-HIV chronic disease prevalence data for transgender populations published any date up to February 15, 2019 without restriction on country or study design. A total of 93 studies and 665 datapoints were included in this review, comprising 48 distinct chronic disease outcomes in seven groups (cancer, cerebro/cardiovascular conditions, chronic liver and kidney disease, mental health and substance use conditions, metabolic and endocrine disorders, musculoskeletal and brain disorders, respiratory conditions, and unspecified and other conditions). The empirical literature on chronic disease among global transgender populations focuses on mental health morbidity, demonstrating an evidence gap on chronic physical health morbidity, particularly beyond that of sexual health. This review identified important gaps including in age-related conditions, inflammation-related disease and studies designed explicitly to investigate chronic disease burden among transgender populations. There is a need for high quality evidence in this area, including longitudinal population-based studies with appropriate comparison groups, and consistent measurement of both transgender status and chronic conditions.
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Affiliation(s)
- Ashleigh J. Rich
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
- Corresponding author.
| | - Ayden I. Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Mieke Koehoorn
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
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8
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Connolly D, Hughes X, Berner A. Barriers and facilitators to cervical cancer screening among transgender men and non-binary people with a cervix: A systematic narrative review. Prev Med 2020; 135:106071. [PMID: 32243938 DOI: 10.1016/j.ypmed.2020.106071] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
Cervical cancer mortality in the United Kingdom (UK) has decreased over the last decade, largely due to uptake of cervical cancer screening. However, only those with a female gender marker on their health records are invited, creating a significant barrier to gender minorities accessing screening. We undertook a systematic review to synthesise published literature on cervical cancer screening among eligible gender minorities, aiming to identify barriers and facilitators that might inform changes in UK policy and clinical practice. We conducted a broad search across Medline, Embase, PsycInfo and Global Health databases to 3rd January 2020 and included any original, peer-reviewed research, published in the English language that reported on cervical cancer screening among gender minorities assigned female at birth (AFAB). Twenty-seven studies were critically appraised and included in the final synthesis, which identified significant disparities in cervical cancer screening uptake between gender minorities AFAB and cis women. It revealed a lack of knowledge surrounding the relationship between gender minority status and cervical cancer risk among both service users and providers and highlighted significant barriers to access for gender minorities AFAB. Cervical cancer screening was not universally associated with dysphoria among gender minorities AFAB and we recommend that providers explore patients' preferences around screening, while avoiding assumptions. Providers should be proficient in examination techniques that maximise patient autonomy and minimise gender dysphoria or pain. Self-swabs for high-risk HPV may provide a more acceptable, evidence-based, alternative to Pap smears but there remains a need for further UK-specific research, to inform changes in policy.
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Affiliation(s)
- Dean Connolly
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK; Newham University Hospital, Barts Health NHS Trust, Glen Rd, London E13 8SL, UK.
| | - Xan Hughes
- St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Alison Berner
- Gender Identity Clinic, The Tavistock and Portman NHS Foundation Trust, 179-183 Fulham Palace Road, London W6 8QZ, UK; Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BE, UK
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9
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Boehmer U, Gereige J, Winter M, Ozonoff A, Scout N. Transgender individuals' cancer survivorship: Results of a cross-sectional study. Cancer 2020; 126:2829-2836. [PMID: 32134515 DOI: 10.1002/cncr.32784] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Transgender individuals' cancer prevalence and transgender cancer survivors' health needs have received scarce attention. The current study compared transgender and cisgender individuals' cancer prevalence and described the health needs of transgender cancer survivors. METHODS The authors used Behavioral Risk Factor Surveillance System data on 95,800 cisgender and transgender individuals who self-reported a cancer diagnosis. Using multiple logistic regression, they estimated cancer prevalence and calculated odds ratios with 95% confidence intervals of physical, psychological, overall health, and health behaviors of transgender survivors compared with cisgender survivors. RESULTS After adjusting for confounders, transgender men had a significantly higher (>2-fold) number of cancer diagnoses compared with cisgender men, but not cisgender women. Cancer prevalence among gender nonconforming individuals and transgender women was not significantly different from that of cisgender men and cisgender women. Gender nonconforming survivors had significantly greater physical inactivity, heavy episodic alcohol use, and depression compared with cisgender men and cisgender women. Transgender men survivors were significantly more likely to report poor physical health and greater medical comorbidities and were less likely to report smoking compared with cisgender men and cisgender women. Transgender women survivors were significantly more likely to report diabetes compared with cisgender men and cisgender women and were more likely to report cardiovascular disease compared with cisgender women. CONCLUSIONS Clinicians should be aware of the higher prevalence of cancer among transgender men and a potential survivorship bias among transgender individuals. Transgender survivors have considerable variation in their risk profile. Clinicians and health services can target gender nonconforming survivors' depression and health behaviors to improve survival and should address the complex comorbidities of transgender men and transgender women.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Jessica Gereige
- Section of Pulmonary, Allergy, Sleep, and Critical Care, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Al Ozonoff
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Nfn Scout
- National LGBT Cancer Network, Providence, Rhode Island
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10
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Abstract
Gender-affirming hormonal treatment (HT) in transgender people is considered safe in general, but the question regarding (long-term) risk on sex hormone-related cancer remains. Because the risk on certain types of cancer differs between men and women, and some of these differences are attributed to exposure to sex hormones, the cancer risk may be altered in transgender people receiving HT. Although reliable epidemiologic data are sparse, the available data will be discussed in this article. Furthermore, recommendations for cancer screening and prevention will be discussed as well as whether to withdraw HT at time of a cancer diagnosis.
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Affiliation(s)
- Christel J M de Blok
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
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