Breast Cancer in Transgenders: Narrative Review

Pankaj Goyal; Praveen Jain; Chaturbhuj Agrawal; Sneha Bothra Jain; Vineet Talwar; Ullas Batra; Sumit Goyal; Udip Maheshwari; Krushna Chaudhari; Varun Goel; Amrith BP; Dinesh Chandra Doval

doi:10.1055/s-0041-1740140

Indian Journal of Medical and Paediatric Oncology, Table of Contents

CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(01): 003-008
DOI: 10.1055/s-0041-1740140

Review Article

Breast Cancer in Transgenders: Narrative Review

Pankaj Goyal

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Praveen Jain

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Chaturbhuj Agrawal

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Sneha Bothra Jain

²Department of medical oncology, Action cancer hospital, New Delhi

,

Vineet Talwar

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Ullas Batra

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Sumit Goyal

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Udip Maheshwari

³Department of Medical Oncology, Mumbai Oncocare Center, Mumbai, Maharashtra, India

,

Krushna Chaudhari

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Varun Goel

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Amrith BP

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

,

Dinesh Chandra Doval

¹Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

› Author Affiliations

Abstract

The molecular pathogenesis of breast cancer (BC), the second most common cancer, varies significantly between sexes, with minimal data in the transgender population. The overall prevalence of BC in transgenders is estimated to be 0.02%. Besides experiencing social disparities, transgenders have to face a lot of discrimination in the healthcare system. Adversities faced, along with the urge to identify with physical attributes to the gender felt by them, forces transgenders to use non-prescribed hormones. Gender affirming hormone therapy (GAHT) is a key feature of transition-related care, rehabbing mental health, and the quality of life of transgenders, but at the expense of their health. Studies have reported that GAHT is associated with severe health conditions such as cancer in transgenders. Estrogens and testosterone are associated with a moderate risk of developing BC. The types of BC diagnosed in transgenders after cross-sex hormone therapy include invasive ductal and neuroendocrine carcinoma, in addition to tubular adenocarcinoma. Although diagnosed at an age earlier compared with ciswomen, BC screening recommendations for transgenders are the same as for ciswomen. This review studies in detail the types of transgenders, their characteristics, different types of breast cancers associated, issues faced while treatment, and their best possible solutions. We also hope to have well-designed research in the future, which will fill the existing gaps in knowledge and provide scientific insight into the transgender population and issues related to their health. There are no international guidelines on screening and management of transgender patients but it appears that breast screening before cosmetic mastectomy, exposure to hormonal therapy for more than 5 years, and as per natal women screening guidelines should be offered to the patient with detailed discussion on the harms and benefits of the same.

Keywords

transgenders - breast cancer - transwomen - transmen - gender-affirming hormone therapy

Full Text

References

References
1 Kiran T, Davie S, Singh D. et al. Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data. Can Fam Physician 2019; 65 (01) e30-e37
2 Sonnenblick EB, Shah AD, Goldstein Z, Reisman T. Breast imaging of transgender individuals: a review. Curr Radiol Rep 2018; 6 (01) 1
3 Sawant S.N. Transgender: status in India. Annals of Indian Psychiatry [serial online] 2017; [cited 2022 Jun 9] 1: 59-61 Available from: https://www.anip.co.in/text.asp?2017/1/2/59/220257
4 Feldman J, Brown GR, Deutsch MB. et al. Priorities for transgender medical and healthcare research. Curr Opin Endocrinol Diabetes Obes 2016; 23 (02) 180-187
5 Iwamoto SJ, Defreyne J, Rothman MS. et al. Health considerations for transgender women and remaining unknowns: a narrative review. Ther Adv Endocrinol Metab 2019; 10: 2042018819871166
6 Eismann J, Heng YJ, Fleischmann-Rose K. et al. Interdisciplinary management of transgender individuals at risk for breast cancer: case reports and review of the literature. Clin Breast Cancer 2019; 19 (01) e12-e19
7 Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol 2017; 5 (04) 291-300
8 de Blok CJM, Klaver M, Wiepjes CM. et al. Breast development in transwomen after 1 year of cross-sex hormone therapy: results of a prospective multicenter study. J Clin Endocrinol Metab 2018; 103 (02) 532-538
9 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
10 de Blok CJM, Wiepjes CM, Nota NM. et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ 2019; 365: l1652
11 Hartley RL, Stone JP, Temple-Oberle C. Breast cancer in transgender patients: a systematic review. part 1: male to female. Eur J Surg Oncol 2018; 44 (10) 1455-1462
12 Deutsch MB, Bhakri V, Kubicek K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol 2015; 125 (03) 605-610
13 Grynberg M, Fanchin R, Dubost G. et al. Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod Biomed Online 2010; 20 (04) 553-558
14 Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 2008; 93 (01) 19-25
15 Phillips J, Fein-Zachary VJ, Mehta TS, Littlehale N, Venkataraman S, Slanetz PJ. Breast imaging in the transgender patient. AJR Am J Roentgenol 2014; 202 (05) 1149-1156
16 Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health 2013; 103 (10) 1820-1829
17 Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health 2013; 103 (10) 1830-1836
18 Tollinche LE, Walters CB, Radix A. et al. The Perioperative Care of the Transgender Patient. Anesth Analg 2018; 127 (02) 359-366
19 Libman H, Safer JD, Siegel JR, Reynolds EE. Caring for the transgender patient: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2020; 172 (03) 202-209
20 Klein DA, Paradise SL, Goodwin ET. Caring for transgender and gender-diverse persons: what clinicians should know. Am Fam Physician 2018; 98 (11) 645-653
21 Shumer DE, Nokoff NJ, Spack NP. Advances in the care of transgender children and adolescents. Adv Pediatr 2016; 63 (01) 79-102
22 Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH. et al. ENDOCRINE TREATMENT OF GENDER-DYSPHORIC/GENDER-INCONGRUENT PERSONS: AN ENDOCRINE SOCIETY CLINICAL PRACTICE GUIDELINE. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 2017; Dec 23 (12) 1437
23 Shao T, Grossbard ML, Klein P. Breast cancer in female-to-male transsexuals: two cases with a review of physiology and management. Clin Breast Cancer 2011; 11 (06) 417-419
24 Sanchez NF, Sanchez JP, Danoff A. Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health 2009; 99 (04) 713-719
25 Randolph Jr JF. Gender-affirming hormone therapy for transgender females. Clin Obstet Gynecol 2018; 61 (04) 705-721
26 Transgender Care UCSF. Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. In: Deutsch MB. ed. 2nd ed. 2016. . Available at transcare.ucsf.edu/guidelines
27 Dekker MJ, Wierckx K, Van Caenegem E. et al. A European network for the investigation of gender incongruence: endocrine part. J Sex Med 2016; 13 (06) 994-999
28 Rossouw JE, Anderson GL, Prentice RL. et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002; 288 (03) 321-333
29 Beral V. Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. [abstract]. Lancet 2003; 362 (9382): 419-427
30 Colditz GA, Hankinson SE, Hunter DJ. et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. [abstract] N Engl J Med 1995; 332 (24) 1589-1593
31 McFarlane T, Zajac JD, Cheung AS. Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals-a systematic review. Clin Endocrinol (Oxf) 2018; 89 (06) 700-711
32 Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in transgender people: evidence and methodological considerations. Epidemiol Rev 2017; 39 (01) 93-107
33 Tongson K, Konovalova V, Dhawan N, Sharma S, Bahl J, Masri M. Breast cancer suspicion in a transgender male-to-female patient on hormone replacement therapy presenting with right breast mass: breast cancer risk assessment and presentation of a rare lesion. Case Rep Oncol Med 2017; 2017: 5172072
34 Connelly PJ, Marie Freel E, Perry C. et al. Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults. Hypertension 2019; 74 (06) 1266-1274
35 Barghouthi N, Turner J, Perini J. Breast cancer development in a transgender male receiving testosterone therapy. Case Rep Endocrinol 2018; 2018: 3652602
36 Fledderus AC, Gout HA, Ogilvie AC, van Loenen DKG. Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening. Breast 2020; 53: 92-100
37 Mattingly AE, Kiluk JV, Lee MC. Clinical considerations of risk, incidence, and outcomes of breast cancer in sexual minorities. Cancer Contr 2016; 23 (04) 373-382
38 Joint R, Chen ZE, Cameron S. Breast and reproductive cancers in the transgender population: a systematic review. BJOG 2018; 125 (12) 1505-1512
39 Teoh ZH, Archampong D, Gate T. Breast cancer in male-to-female (MtF) transgender patients: is hormone receptor negativity a feature?. BMJ Case Rep 2015; 2015: bcr2015209396
40 Evans A, Trimboli RM, Athanasiou A. et al; European Society of Breast Imaging (EUSOBI), with language review by Europa Donna–The European Breast Cancer Coalition. Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2018; 9 (04) 449-461
41 Smith RA, Andrews KS, Brooks D. et al. Cancer screening in the United States, 2018: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 2018; 68 (04) 297-316