Case Reports/Clinical Vignettes

Journal of General Internal Medicine

, Volume 25, Issue 2, pp 158-161

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Examining Patient Conceptions: A Case of Metastatic Breast Cancer in an African American Male to Female Transgender Patient

  • Amar DhandAffiliated withDepartment of Neurology, University of California San Francisco
  • , Gurpreet DhaliwalAffiliated withDepartment of Medicine, San Francisco Veterans Affairs Medical Center and University of California San FranciscoMedical Service (111), San Francisco Veterans Affairs Medical Center Email author 


An African American male to female transgender patient treated with estrogen detected a breast lump that was confirmed by her primary care provider. The patient refused mammography and 14 months later she was diagnosed with metastatic breast cancer with spinal cord compression. We used ethnographic interviews and observations to elicit the patient’s conceptions of her illness and actions. The patient identified herself as biologically male and socially female; she thought that the former protected her against breast cancer; she had fears that excision would make a breast tumor spread; and she believed injectable estrogens were less likely than oral estrogens to cause cancer. Analysis suggests dissociation between the patient’s social and biological identities, fear and fatalism around cancer screening, and legitimization of injectable hormones. This case emphasizes the importance of eliciting and interpreting a patient’s conceptions of health and illness when discordant understandings develop between patient and physician.


transgender breast cancer estrogen ethnography