Breast cancer in a female to male transgender patient 20 years post‐mastectomy: Issues to consider

Abstract

The incidence of breast cancer reduces by almost 90% after bilateral mastectomy. This applies also to female‐to‐male (FtM) trans‐gender who undergo bilateral mastectomy as part of gender reassignment surgery (GRS). To date, there are only four reported cases in the literature on FtM transgender breast cancer. We present a case of a female‐to‐male transgender patient who was diagnosed with breast cancer 20 years after having bilateral mastectomy performed as part of GRS. We will describe all similar cases from literature and discuss some important issues related to transgender breast cancer.

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

“…(2003) [ 23 ] Case report 33 Yes (10 years after mastectomy) Negative 13 Ductal carcinoma Unknown ER+, PR+ Chotai et al. (2019) [ 24 ] Case report 58 Yes (20 years after mastectomy) Positive 10 Invasive ductal carcinoma grade 3 Unknown ER+, PR+, HER2+ De Blok et al. (2019) Describes four cases (n = 4) [ 20 ] Retrospective cohort study 30-50 (n = 2), >50 (n = 2) Yes (n = 3) (“several years after mastectomy”) and Yes, incidental finding (n = 1) Unknown Median 15; range 2-17 Ductal origin (n = 3) Unknown ER+(n = 2), PR+ (n = 2), HER2+ (n = 1), AR+ (n = 1) Eismann et al.…”

“…The JBI and CARE checklist recommend presenting the patient’s historical and current information as a visual timeline, but none of the studies did accordingly [8] . Eight case reports did not clearly describe the treatment outcomes of the breast cancer; no post-intervention clinical condition was reported [ 22 , 24 , 32 ], no harmful events as a result of interventions were described [ 22 , 24 , 25 , 30 , 32 , 33 ], or the patient had not completed treatment yet [ 26 ].

Fig.

…”

“…Nonetheless, breast tissue is often not radically removed when the indication for a subcutaneous mastectomy is sex reassignment for FtM transsexuals [ 36 ]. This may explain the seven rare cases describing breast cancer development after mastectomy [ 20 , 23 , 24 , 28 , 30 ]. The 23 subjects with breast cancer were relatively young (mean age 42 years).…”

A case of a trans‐masculine patient receiving testosterone with a history of estrogen receptor‐positive breast cancer

“…But because gender identity is not reported in cancer registries, there are only 22 reported cases of breast cancer in transgender men. [1][2][3][4] A recent Dutch cohort study found that transgender men have a 60-fold higher incidence of breast cancer compared to cisgender men and a 5-fold lower incidence compared to cisgender women; transgender men and women also developed breast cancer earlier than cisgender women. 4 Major discrepancies in risk factors for breast cancer in transgender patients arise from a tendency for transgender patients to avoid screening because of fear of discrimination, as well as discomfort with a procedure that may conflict with their gender identity.…”

“…Five of the patients received either a selective estrogen receptor modulator (SERM) or an aromatase inhibitor (AI) as part of their cancer treatment. 1,3 However, there are no documented cases of either of these drug classes being administered with testosterone therapy after cancer treatment was completed in order to mitigate the risk of recurrence in a patient with a past medical history of breast cancer (though this strategy has been previously discussed by others). 8 As an irreversible AI that blocks peripheral conversation of testosterone to estradiol, exemestane is a logical off-label option for reducing the risk of testosterone supplementation in a trans-masculine patient with a history of ER+ breast cancer.…”