Abstract:Highlight the challenges associated with managing breast cancer in female‐to‐male (FtM) transgender individuals. This is a rare entity, requiring nuanced decision‐making regarding surgery as well as adjuvant therapies given the unique hormonal environment seen in individuals taking exogenous androgen as part of their gender identity. Contemporary case report derived from our clinical experience. Discussion focuses on a brief summation of all known cases of female‐to‐male breast cancer in FtM individuals descri… Show more
“…(2019) [ 19 , 25 ] Case report and retrospective cohort study 29 Yes, incidental finding Positive 4 High-grade DCIS Negative ER+ Fundytus et al. (2019) [ 26 ] Case report 48 Yes, incidental finding Positive 19 Invasive ductal carcinoma Unknown ER+, PR+, AR+, HER2- Gooren et al. (2013) [ 17 ] Retrospective cohort study 27 Yes, incidental finding Unknown 3 Tubular adenocarcinoma Unknown ER +, PR+ Gooren et al.…”
Section: Resultsmentioning
confidence: 99%
“…The JBI and CARE checklist recommend presenting the patient’s historical and current information as a visual timeline, but none of the studies did accordingly [8] . Eight case reports did not clearly describe the treatment outcomes of the breast cancer; no post-intervention clinical condition was reported [ 22 , 24 , 32 ], no harmful events as a result of interventions were described [ 22 , 24 , 25 , 30 , 32 , 33 ], or the patient had not completed treatment yet [ 26 ]. Fig.…”
Background
Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup.
Methods
We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included.
Results
We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing.
Conclusion
Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.
“…(2019) [ 19 , 25 ] Case report and retrospective cohort study 29 Yes, incidental finding Positive 4 High-grade DCIS Negative ER+ Fundytus et al. (2019) [ 26 ] Case report 48 Yes, incidental finding Positive 19 Invasive ductal carcinoma Unknown ER+, PR+, AR+, HER2- Gooren et al. (2013) [ 17 ] Retrospective cohort study 27 Yes, incidental finding Unknown 3 Tubular adenocarcinoma Unknown ER +, PR+ Gooren et al.…”
Section: Resultsmentioning
confidence: 99%
“…The JBI and CARE checklist recommend presenting the patient’s historical and current information as a visual timeline, but none of the studies did accordingly [8] . Eight case reports did not clearly describe the treatment outcomes of the breast cancer; no post-intervention clinical condition was reported [ 22 , 24 , 32 ], no harmful events as a result of interventions were described [ 22 , 24 , 25 , 30 , 32 , 33 ], or the patient had not completed treatment yet [ 26 ]. Fig.…”
Background
Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup.
Methods
We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included.
Results
We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing.
Conclusion
Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.
“…6 Incidental finding of breast carcinoma in the mastectomy specimen was observed in 1 patient in Gooren et al's series and in 1 patient reported by Fundytus et al in 2019. 6,7 In Fundytus et al's report, the patient underwent a previous breast reduction as GAS. Additional mastectomy for aesthetic purpose 15 years later revealed a BCa on histopathology.…”
Section: Discussionmentioning
confidence: 99%
“…Additional mastectomy for aesthetic purpose 15 years later revealed a BCa on histopathology. 7 In 2011, Shao et al published 2 cases of trans men under testosterone therapy who did not go through GAS but who developed carcinoma for which mastectomies were required. 8 In comparison with previously reported cases, our patient was the youngest patient with BCa after mastectomy, and his CSH treatment was short (2.5 years).…”
Section: Discussionmentioning
confidence: 99%
“…It is generally assumed that the risk of breast cancer (BCa) in trans men on testosterone therapy after bilateral mastectomy is minimal owing to the low level of estrogens and residual breast tissue. 4 The potential impact of CSH in the development of BCa remains controversial, [4][5][6][7][8][9] with 5 cases of breast carcinoma in trans men after a bilateral mastectomy reported in the literature. We present a case of BCa reported in a trans man after bilateral mastectomy and 2.5 years after initiation of testosterone therapy.…”
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