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Breast cancer and its impact in male transsexuals

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Abstract

Introduction

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.

Discussion

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.

Conclusion

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.”

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References

  1. McNamara M, et NG H (2016) Best practices in LGBT care: A guide for primary care physicians. Clev Clin J Med 83(7):533–540

    Article  Google Scholar 

  2. ”World Cancer Report” (2014) World Health Organization. 2014. pp. Chapter 1.1. ISBN 92-832-0429-8

  3. Nikolic DV, Djordjevic ML, Granic M, Nikolic AT, Stanimirovic VV, Zdravkovic D, Jelic S (2012) Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy. World J Surg Oncol 10:280

    Article  PubMed  PubMed Central  Google Scholar 

  4. World Cancer Report (2008) International Agency for Research on Cancer

  5. Male Breast Cancer Treatment (2014) National Cancer Institute

  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 83:43–55

  7. Willemsen HW, Kaas R, Peterse JH, Rutgers EJ (1998) Breast carcinoma in residual breast tissue after prophylactic bilateral subcutaneous mastectomy. Eur J Surg Oncol 24(4):331–332

    Article  PubMed  CAS  Google Scholar 

  8. Gooren LJ (2014) Management of female-to-male transgender persons: medical and surgical management, life expectancy. Curr Opin Endocrinol Diabetes Obes 21(3):233–238

    Article  PubMed  Google Scholar 

  9. Ramos Boyero M (2008) Skin-sparing mastectomy: an alternative to conventional mastectomy in breast cancer. Cir Esp 84(4):181–187

    Article  PubMed  Google Scholar 

  10. Katayama Y, Motoki T, Watanabe S, et al (2015) A very rare case of breast cancer in a female-to-male transsexual. Breast Cancer. https://doi.org/10.1007/s12282-015-0661-4

    Article  PubMed  Google Scholar 

  11. Pivo S, Montes J, Schwartz S, Chun J, Kiely D, Hazen A, Schnabel F (2017) Breast cancer risk assessment and screening in transgender patients. Clin Breast Cancer 17(5): e225–e227

    Article  PubMed  Google Scholar 

  12. Burcombe RJ, Makris A, Pirtam M et al (2003) Breast cancer after bilateral subcutaneous mastectomy in female to male case. Breast 12:290–293

    Article  PubMed  CAS  Google Scholar 

  13. Bevers TB (2010) Breast cancer prevention. an update of the STAR trial. Curr Treat Options Oncol 11:66–69

    Article  PubMed  Google Scholar 

  14. Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat 149(1):191–198

  15. Bazzi AR, Whorms DS, King DS et al (2015) Adherence to mammography screening guidelines among transgender persons and sexual minority women. Am J Public Health 105:2356–2358

    Article  PubMed  PubMed Central  Google Scholar 

  16. Burcombe RJ, Makris A, Pittam M, Finer N (2003) Breast cancer after bilateral subcutaneous mastectomy in a female to male transsexual. Breast 12(4):290–293

    Article  PubMed  CAS  Google Scholar 

  17. Shao T, Grossbard LM, Klein P (2011) Breast cancer in Female to male transsexuals: two cases with a review of physiology and management. Clin Breast Cancer 11(6):417–419

    Article  PubMed  Google Scholar 

  18. Gooren LJ, van Trotsenburg MA, van Diest GiltayEj (2013) PJ.: Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med 10(12):3129–3134

    Article  PubMed  Google Scholar 

  19. Kotsopoulos J, Steve A (2017) Androgens and breast cancer. J Sex Med 14(5):741–746

    Article  Google Scholar 

  20. Spack NP (2013) Management of transgenderism. JAMA 309:474–484

    Google 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

  22. Selvaggi G, Bellringer J (2011) Gender reassignment surgery: an overview. Nat Rev Urol 8(5):274–282

    Article  PubMed  Google Scholar 

  23. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA et al (2009) Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94:3132–3133

    Article  PubMed  CAS  Google Scholar 

  24. Teoh ZT, Archampong D, Gate T (2015) Breast cancer in male to female (MtF) transgender patients:isformonereceptore negativity a feature? BMJ Case Rep. https://doi.org/10.1136/brc-2015-209396

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yager JD, Davidson NE (2006) Estrogen carcinogenesis in breast cancer. New Engl J Med 354:270–282

    Article  PubMed  CAS  Google Scholar 

  26. Secreto G, Zumoff B (2012) Role of androgen excess in the development of estrogen receptor-positive and estrogen receptor-negative breast cancer. Anticancer Res 32:3223–3228

    PubMed  Google Scholar 

  27. Hankinson SE et al (1998) Plasma sex steroid hormone levels and risk of breast cancer in postmenopausal women. J Natl Cancer Inst 90(17):1292–1299

    Article  PubMed  CAS  Google Scholar 

  28. Veronesi U, Pizzocaro G (1968) Breast cancer in women subsequent to cystic disease of the breast. Surg Gynecol Obstet 126(3):529–532

    PubMed  CAS  Google Scholar 

  29. Secreto G et al (1984) Increased androgenic activity and breast cancer risk in premenopausal women. Cancer Res 44(12 Pt 1):5902–5905

    PubMed  CAS  Google Scholar 

  30. James RE, Lukanova A, Dossus L, Becker S, Rinaldi S, Tjonneland A et al (2011) Postmenopausal serum sex steroids and risk of hormone receptor-positive and -negative breast cancer: a nested case-control study. Cancer Prev Res 4:1626–1635

    Article  CAS  Google Scholar 

  31. Diaz-Chico N, German Rodriguez B, Gonazalez F, Ramirez A, Bilbao R, Cabrera de Lekon C, et al (2007) Androgens and androgen receptors in breast cancer. J Steroid Bichem Mol Biol 105:1–15

    Article  CAS  Google Scholar 

  32. Adly L, Hill D, Sherman ME, Sturgeon SR, Fears T, Mies C et al (2006) Serum concentrations of estrogens, sex hormone-binding globulin, and androgens and risk of breast cancer in postmenopausal women. Int J Cancer 119:2702–2707

    Article  CAS  Google Scholar 

  33. Danforth KN, Eliassen AH, Tworoger SS, Missmer SA, Barbieri PL, Rosner BA et al (2010) The association of plasma androgen levels with breast, ovarian and endometrial cancer risk among postmenopausal women. Int J Cancer 126:199–207

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Mathwe H, Hamid B (2013) Context is everything:an unusual breast core biopsy case. Int J Surg Pathol 21(5):502–503

    Article  Google Scholar 

  35. Hartmann LC et al (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New Engl J Med 340(2):77–84

    Article  PubMed  CAS  Google Scholar 

  36. Meads C, Moore D (2013) Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies. BMC Public health 13:1127

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mays VM, Cochran SD (2001) Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 91:1869–1875

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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 Francisco

    Google Scholar 

  39. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA et al (2009) Endocrine treatment of trnassexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94(9):3132–3154

    Article  PubMed  CAS  Google Scholar 

  40. Sherbourne Health Center (2009) Guidelines and protocols for comprehensive primary care for trans clients. Sherbourne Health Center, Toronto

    Google Scholar 

  41. Eldar S, Meguid MM, Beatty JD (1984) Cancer of the breast after prophylactic subcutaneous mastectomy. Am J Surg 148(5):692–693

    Article  PubMed  CAS  Google Scholar 

  42. Goodnight JE, Quagliana JM, Morton DL (1984) Failure of subcutaneous mastectomy to prevent the development of breast cancer. J SurgOncol 26(3):198–201

    Google Scholar 

  43. Ziegler LD, Kroll SS (1991) Primary breast cancer after prophylactic mastectomy [clinical conference]. Am J Clin Oncol 14(5):451–454

    PubMed  CAS  Google Scholar 

  44. Bowers DG, Radlauer CB (1969) Breast cancer after prophylactic subcutaneous mastectomies and reconstruction with silastic prostheses. Plast Reconstr Surg 44(6):541–544

    Article  PubMed  Google Scholar 

  45. Holleb AI, Montgomery R, Farrow JH (1965) The hazard of incomplete simple mastectomy. SurgGynecol Obstet 121(4):819–822

    CAS  Google Scholar 

  46. Robertson Bazzi A, Whorms SD, King SD, Potter J (2015) Adherence to mamography screening guidelines among transgender persons and sexual minorities. Am J Public Health 105(11):2356–2358

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Dejan Nikolić, Miroslav Granić, Nebojša Ivanović, Darko Zdravković, Aleksandra Nikolić, Marija Zdravković, Srdjan Dikić, Marko Nikolić & Miroslav Djordjević

  2. University Medical Center Bežanijska kosa, Str. George Matheo bb, 11080, Belgrade, Serbia

    Dejan Nikolić, Miroslav Granić, Nebojša Ivanović, Darko Zdravković, Marija Zdravković & Srdjan Dikić

  3. Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia

    Aleksandra Nikolić

  4. Medicine and Medical Devices Agency of Republic of Serbia, Belgrade, Serbia

    Violeta Stanimirović

  5. Children’s Hospital, Belgrade, Serbia

    Miroslav Djordjević

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  1. Dejan Nikolić
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  2. Miroslav Granić
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  3. Nebojša Ivanović
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Correspondence to Dejan Nikolić.

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Nikolić, D., Granić, M., Ivanović, N. et al. Breast cancer and its impact in male transsexuals. Breast Cancer Res Treat 171, 565–569 (2018). https://doi.org/10.1007/s10549-018-4875-y

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