Breast cancer and its impact in male transsexuals
Lesbian, gay, and bisexuals have unique healthcare needs. Breast cancer is leading cancer in women, worldwide, accounting for 25% of all cases. Annual incidence rates increased significantly in all countries and age groups. The occurrence of breast cancer is rare in transgender population. As they have very limited access to medical care, it is much less likely to pursue breast cancer screening than in other individuals not identified as transgender.
Review of the cases from literature
Up to date, only 13 cases of the breast cancer transsexuals (female to male) have been reported in six published papers worldwide. Histological examination of the breast tumor in female-to-male transgender showed progesterone/estrogen-positive invasive ductal carcinoma.
Gender identity describes a person’s inherent sense of being a woman, man, or of neither gender, whereas sexual orientation refers to how people identify their physical and emotional attraction to others. Gender reassignment surgery, as series of complex surgical genital and non-genital procedures, is recognized as the most effective treatment for patients with gender dysphoria. The two main principles of hormone therapy for transgender patients are to reduce endogenous hormone levels and their associated sex characteristics and replace them with hormones of the preferred sex. Breast cancer infrequently occurs in transgender patients. Even breast core biopsies can be difficult for interpreting after changes in breast tissue in female-to-male transsexuals following gender reassignment.
Reviewing the literature, so many different data concerning probability of breast cancer in sexual minority can be found. Breast cancer screening program should be offered to all transgender individuals according to national guidelines. Very important is to take into consideration a transgender person’s natal and surgical anatomy, unique clinical concerns for depression and anxiety, risk of suicide together with risk factors including experiences of harassment or physical or sexual violence, low education level, and unemployment. Understanding the need for mammography in these often marginalized groups is very important in addressing breast cancer disparities despite differences in insurance coverage in some countries and greater concern for the cancer of the breast in residual breast tissue. The best screening rule, ever, for breast cancer in male transsexuals and other similar population should be, besides surgical history and hormonal status, “Screen Now, Screen Regularly and Screen What You Have.”
KeywordsBreast cancer Transsexualism Screening Mammography
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
- 2.”World Cancer Report” (2014) World Health Organization. 2014. pp. Chapter 1.1. ISBN 92-832-0429-8Google Scholar
- 4.World Cancer Report (2008) International Agency for Research on CancerGoogle Scholar
- 5.Male Breast Cancer Treatment (2014) National Cancer InstituteGoogle Scholar
- 6.Dimitrova N, Znaor A, Agius D, Eser S, Sekerija M, Ryzhov A, Primic-Žakelj M, Coebergh JW, SEE + Working Group (2017) Breast cancer in South-Eastern European countries since 2000. Rising incidence and decreasing mortality at young and middle ages. Eur J Cancer 83:43–55Google Scholar
- 14.Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat 149(1):191–198Google Scholar
- 20.Spack NP (2013) Management of transgenderism. JAMA 309:474–484Google Scholar
- 21.National LGBT Health Education Center (2016) Achieving health equity for lesbian, gay, bisexual, and transgender (LGBT) people, Module 1. http://www.lgbthealtheducation.org/wp- content/uploads/Achieving-Health-Equity-for-LGBT-People-1.pdf. Accessed May 19, 2016
- 38.Center of Excellence for Transgender Health (2011) Primary care protocol for transgender patient care. Department of Family and Community Medicine, University of California, San FranciscoGoogle Scholar
- 40.Sherbourne Health Center (2009) Guidelines and protocols for comprehensive primary care for trans clients. Sherbourne Health Center, TorontoGoogle Scholar
- 42.Goodnight JE, Quagliana JM, Morton DL (1984) Failure of subcutaneous mastectomy to prevent the development of breast cancer. J SurgOncol 26(3):198–201Google Scholar
- 45.Holleb AI, Montgomery R, Farrow JH (1965) The hazard of incomplete simple mastectomy. SurgGynecol Obstet 121(4):819–822Google Scholar