Considerations in Management for Trans and Gender Diverse Patients with Inherited Cancer Risk

Abstract

Purpose of Review To best support all patients with inherited cancer risk, we must broaden our scope of practice to consider the needs of the transgender and gender diverse (trans) community. We considered best practice for supporting trans patients including tailored risk assessments and management recommendations. Recent Findings There is limited literature considering trans patient care in cancer genetics. Small case studies have highlighted how medical transition and cancer risk–reducing options intersect with the need for individualised care. Studies have also shown that cancer genetics professionals do not feel prepared to support trans patients. Summary Patient-centred care for trans patients relies on a multidisciplinary team (MDT) engaged in shared decision-making. National guidelines are needed to standardise access to appropriate discussions around risk-reducing options and screening. International collaborative research is required to provide empiric data on the impact of gender-affirming treatments on cancer risk, and more experiential data is needed from trans patients accessing cancer genetics services. Finally, education and training in this area should be formally embedded for all cancer genetics professionals.

Transgender patients’ perspectives on their cancer genetic counseling experiences

“…Testosterone may have protective factors against breast cancer, though some evidence suggests an association between increased testosterone and breast cancer in cis women (Dimitrakakis et al., 2003; Dorgan et al., 2010; Eigėlienė et al., 2012; Kaaks et al., 2005; The Endogenous Hormones & Breast Cancer Collaborative Group, 2002). Ovarian, endometrial, prostate, and testicular cancers all also have the potential to be impacted by hormone therapies (Coad et al., 2021; von Vaupel‐Klein & Walsh, 2021).…”

“…Consequently, transgender patients lack clear information about both their cancer risk and the means of reducing this risk. This lack of information is especially evident regarding cancer risk and management for transgender individuals who carry a genetic risk factor (Coad et al., 2021).…”

“…(2019) examined genetic counselors’ comfort with cancer risk assessment for trans patients and found that most participants endorsed the need for more education on trans healthcare implications. These studies, among others in genetic counseling, found that gender identities and gender affirmation therapies impact risk assessment and care (Berro et al., 2019; Coad et al., 2021; Ruderman et al., 2021; von Vaupel‐Klein & Walsh, 2021; Zayhowski et al., 2019).…”

UK recommendations for the management of transgender and gender-diverse patients with inherited cancer risks

“…In addition, it was agreed that clinicians should be mindful not to ask for details of gender history where this is not relevant to care, and that questions about gender history should be asked clearly and directly, avoiding assumptions. Given the impact of gender-affirming treatment (GAT) on cancer risk, the relevance to family planning, and the potential for the intersection between gender care and clinical genetics [19], the consensus was reached that clinically relevant information can include details of GATs, gamete storage and care of gender identity specialists.…”

“…Increasingly, literature recommends offering breast screening equivalent to cis women for TGD patients with breast tissue; including transmasculine patients who have not had chest surgery, and transfeminine patients who have breast tissue growth following GAHT [22][23][24]. Coad et al [19] suggest offering TGD patients with breast tissue the same breast screening as cis women with an equivalent family history of relevant cancers. This group agreed that TGD patients assigned female at birth who have not had gender-affirming chest surgery should be offered the same breast screening as cis women with equivalent risk, as risk remains in the breast tissue.…”