Breast cancer in male-to-female (MtF) transgender patients: is hormone receptor negativity a feature?

Abstract

A 41-year-old male-to-female (MtF) transgender patient presented with a symptomatic tender lump in the left breast. There was no family history of breast cancer. She had been receiving estrogen therapy for 14 years to maintain her secondary sexual characteristics. Triple assessment revealed a 13 mm triple-negative grade 3 invasive ductal carcinoma. The tumour was completely excised following a left wide local excision and sentinel lymph node biopsy. There was no regional lymph node involvement. She was referred to the oncologist for adjuvant chemotherapy and radiotherapy.

Cancer in Transgender People: Evidence and Methodological Considerations

“…The current literature includes 15 reported cases of breast cancer in transwomen who received estrogen therapy (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53). Most reported cases were relatively young, with some patients presenting in their early 30s.…”

Breast and reproductive cancers in the transgender population: a systematic review

“…Of the 20 reported cases of breast cancer, 50% were invasive ductal carcinomas, 15% adenocarcinomas, 10% ductal carcinomas, 10% unspecified breast carcinomas, 5% ductal carcinoma in situ , 5% secretory carcinomas and the primary tumour was unconfirmed in 5%. Seventeen cases outlined ER positivity; 52.9% tested positive . Eleven studies reporting on 15 cases addressed PR positivity; 40% tested positive .…”

“…Seventeen cases outlined ER positivity; 52.9% tested positive . Eleven studies reporting on 15 cases addressed PR positivity; 40% tested positive . Two studies addressed AR positivity, with one case testing positive .…”

“…All but one of the transwomen had taken gender‐affirming hormones before diagnosis, with administration duration ranging 6–37 years. Six transwomen had undergone gender‐affirming breast surgery . Eight studies described how hormone continuation was affected by cancer diagnosis; five transwomen discontinued, one was advised to discontinue and two continued .…”

“…Eight studies described how hormone continuation was affected by cancer diagnosis; five transwomen discontinued, one was advised to discontinue and two continued . Sixteen studies described treatment regimens for breast cancer; one transwoman died before treatment commenced, one discharged herself before treatment began and 14 underwent treatment and one from an antidepressant (doxepin) overdose .…”