“…(2019) and Baker et al. (2019) [ 19 , 25 ] Case report and retrospective cohort study 29 Yes, incidental finding Positive 4 High-grade DCIS Negative ER+ Fundytus et al. (2019) [ 26 ] Case report 48 Yes, incidental finding Positive 19 Invasive ductal carcinoma Unknown ER+, PR+, AR+, HER2- Gooren et al.…”
Section: Resultsmentioning
confidence: 99%
“…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.…”
Background
Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup.
Methods
We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included.
Results
We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing.
Conclusion
Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.
“…(2019) and Baker et al. (2019) [ 19 , 25 ] Case report and retrospective cohort study 29 Yes, incidental finding Positive 4 High-grade DCIS Negative ER+ Fundytus et al. (2019) [ 26 ] Case report 48 Yes, incidental finding Positive 19 Invasive ductal carcinoma Unknown ER+, PR+, AR+, HER2- Gooren et al.…”
Section: Resultsmentioning
confidence: 99%
“…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.…”
Background
Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup.
Methods
We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included.
Results
We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing.
Conclusion
Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.
“…To date, 22 cases of breast cancer in trans women and 20 cases in trans men have been published. 16 17 18 19 However, reliable estimations of the risk in transgender people are lacking because of the heterogeneity in the population and study cohorts. 20 …”
ObjectiveTo investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population.DesignRetrospective, nationwide cohort study.SettingSpecialised tertiary gender clinic in Amsterdam, the Netherlands.Participants2260 adult trans women (male sex assigned at birth, female gender identity) and 1229 adult trans men (female sex assigned at birth, male gender identity) who received gender affirming hormone treatment.Main outcome measuresIncidence and characteristics (eg, histology, hormone receptor status) of breast cancer in transgender people.ResultsThe total person time in this cohort was 33 991 years for trans women and 14 883 years for trans men. In the 2260 trans women in the cohort, 15 cases of invasive breast cancer were identified (median duration of hormone treatment 18 years, range 7-37 years). This was 46-fold higher than in cisgender men (standardised incidence ratio 46.7, 95% confidence interval 27.2 to 75.4) but lower than in cisgender women (0.3, 0.2 to 0.4). Most tumours were of ductal origin and oestrogen and progesterone receptor positive, and 8.3% were human epidermal growth factor 2 (HER2) positive. In 1229 trans men, four cases of invasive breast cancer were identified (median duration of hormone treatment 15 years, range 2-17 years). This was lower than expected compared with cisgender women (standardised incidence ratio 0.2, 95% confidence interval 0.1 to 0.5).ConclusionsThis study showed an increased risk of breast cancer in trans women compared with cisgender men, and a lower risk in trans men compared with cisgender women. In trans women, the risk of breast cancer increased during a relatively short duration of hormone treatment and the characteristics of the breast cancer resembled a more female pattern. These results suggest that breast cancer screening guidelines for cisgender people are sufficient for transgender people using hormone treatment.
“…Brown et al observed numerically similar findings in their FtM cohort taking testosterone, but were unable to demonstrate significance in their results . In each of these studies, the absolute number of cases was low and to date there have only been 21 discrete cases of breast cancer reported in FtM transgender patients …”
Highlight the challenges associated with managing breast cancer in female‐to‐male (FtM) transgender individuals. This is a rare entity, requiring nuanced decision‐making regarding surgery as well as adjuvant therapies given the unique hormonal environment seen in individuals taking exogenous androgen as part of their gender identity. Contemporary case report derived from our clinical experience. Discussion focuses on a brief summation of all known cases of female‐to‐male breast cancer in FtM individuals described in the literature. A 48‐year‐old FtM transgender individual on exogenous testosterone for 19 years with stage IIA (pT1cN1M0), ER+(8/8), PR+(8/8), Androgen Receptor(AR)+(5%‐8%), Her‐2‐negative invasive ductal carcinoma of the breast. Due to AR positivity in tumor, cessation of testosterone was chosen after careful consideration of potential ramifications from both a cancer treatment as well as gender identity standpoint. Endocrinology consultation reassured the patient that identity affirming changes of facial hair growth and voice depth would persist after cessation of testosterone. Patient did not wish to undergo chemotherapy and as such was treated with combination of radiation to the axilla, adjuvant Anastrozole and testosterone cessation. Although breast cancer is rare in FtM transgender individuals, it can occur. Many FtM individuals take exogenous testosterone. It is important to test the tumor for the androgen receptor as this may have important implications for both gender identity and treatment. Additionally, the mastectomy commonly performed for “top” surgery in this population is not adequate for oncologic control by itself and at present there is no guidance regarding postsurgical screening in this population, especially in those individuals with a strong family history of breast cancer.
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