Incidence of breast cancer in a cohort of 5,135 transgender veterans
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Transgender (TG) persons often receive, or self-treat, with cross-sex hormone (CSH) treatments as part of their treatment plans, with little known about their incidence of breast cancer. This information gap can lead to disparities in the provision of transgender health care. The purpose of the study was to examine the incidence of breast cancer in the largest North American sample of TG patients studied to date to determine their exposure to CSH, incidence of breast cancer, and to compare results with European studies in transsexual populations. We used Veterans Health Administration (VHA) data from 5,135 TG veterans in the United States from 1996 to 2013 to determine the incidence of breast cancer in this population. Chart reviews were completed on all patients who developed breast cancer. Age-standardized incidences of breast cancer from the general population were used for comparison. Person-years of exposure to known CSH treatment were calculated. Ten breast cancer cases were confirmed. Seven were in female-to-male patients, two in male-to-female patients, and one in a natal male with transvestic fetishism. Average age at diagnosis was 63.8 (SD = 8.2). 52 % received >1 dose of CSH treatment from VHA clinicians. All three males presented with late-stage disease were proved fatal. The overall incidence rate was 20.0/100,000 patient-years of VHA treatment (95 % CI 9.6–36.8), irrespective of VA CSH treatment. This rate did not differ from the expected rate in an age-standardized national sample, but exceeded that reported for smaller European studies of transsexual patients that were longer in duration. Although definitive conclusions cannot be made regarding breast cancer incidence in TG veterans who did or did not receive VA CSH due to the sample size and duration of observation, it appears that TG veterans do not display an increase in breast cancer incidence. This is consistent with European studies of longer duration that conclude that CSH treatment in gender dysphoric patients of either birth sex does not result in a greater incidence than the general population.
KeywordsTransgender Breast Cancer Veteran Gender identity Gender dysphoria Hormones
Walter Meyer, MD, provided helpful comments on a draft of this document. This work did not receive Grant funding.
Conflict of interest
The authors were not sponsored by any commercial entity or any agency other than their employer, the Veterans Health Administration, and therefore they have no conflicts of interest to report with respect to this work.
Ethical standards statement
This work was approved by the East Tennessee State University Institutional Review Board.
- 2.Benjamin H (1966) The transsexual phenomena. Julian Press, New YorkGoogle Scholar
- 12.U.S. Department of Veterans Affairs. National Center for Veterans Analysis and Statistics (2013) Trends in the utilization of VA programs and servicesGoogle Scholar
- 13.U.S. Veterans Affairs, Veterans Health Administration: VHA Directive 2011–026: Providing Health Care for Transgender and Intersex Veterans (2011). http://www.va.gov/vhapublications Accessed on 12 May 2014
- 14.U.S. Veterans Affairs, Veterans Health Administration: VHA Directive 2013-003: Providing Health Care for Transgender and Intersex Veterans (2013). http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863. Accessed on 12 May 2014
- 17.VA Information Resource Center: Vital Status File Date of Birth (DOB) and Sex Quality Review. Hines, IL: U.S. Dept. of Veterans Affairs, Health Services Research and Development Service, VA Information Resource Center. http://www.virec.research.va.gov/Reports/DI/DI-VSF-DOB-SEX-Sept-CY11-ER.pdf Accessed on 2 June 2014
- 18.World Health Organisation International Statistical Classification of Diseases and Related Health Problems, 9th Revision (ICD-9-CM) (1978) GenevaGoogle Scholar
- 19.Surveillance, epidemiology, and end results program, SEER incidence rates and U.S. Death Rates, Age-Adjusted and Age-Specific Rates, by Race and Sex (Breast) (2014). Washington, DC. National Cancer Institute. Accessed on 24 June 2014Google Scholar
- 20.Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER cancer statistics review, 1975–2010 National Cancer Institute: Bethesda, MD. http://seer.cancer.gov/csr/1975_2010/browse_csr.php?section=4&page=sect_04_table.18.html, based on November 2012 SEER data submission, posted to the SEER Web site, April 2013. Accessed on 9 July 2014
- 21.R Development Core Team (2010) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 22.Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K (2012) Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgenderism 13:165–232CrossRefGoogle Scholar
- 23.Makadon HJ, Mayer KH, Potter J (2007) Fenway guide to lesbian, gay, bisexual and transgender health, 1st ed. American College of Physicians, Philadelphia, PA, pp 3–22(35–36):331–392Google Scholar
- 27.American Cancer Society. Cancer facts and figures (2014). American Cancer Society, AtlantaGoogle Scholar
- 29.Guenel P, Cyr D, Sabroe S, Lynge E, Merletti F, Ahrens W, Baumgardt-Elms C, Menegoz F, Olsson H, Paulsen S, Simonato L, Wingren G (2004) Alcohol drinking may increase risk of breast cancer in men: a European population-based case-control study. Cancer Causes Control 15:571–580PubMedCrossRefGoogle Scholar
- 30.Collaborative group on Hormonal Factors in Breast Cancer (2002) Alcohol, tobacco and breast cancer-collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95,067 women without the disease. Br J Cancer 87:1234–1245PubMedCentralCrossRefGoogle Scholar
- 34.Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Koopersberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. J Am Med Assoc 288:321–333CrossRefGoogle Scholar
- 39.Shufelt CL, Braunstein GD (2008) Testosterone and the breast. Menopause Inter 14:117–122Google Scholar