Invasive Breast Cancer in a Trans Man After Bilateral Mastectomy: Case Report and Literature Review

Kopetti, Camille; Schaffer, Clara; Zaman, Khalil; Liapi, Aikaterini; Summa, Pietro G. di; Bauquis, Olivier

doi:10.1016/j.clbc.2020.10.005

Cited by 19 publications

(29 citation statements)

References 14 publications

(36 reference statements)

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“…Taking all the cases into account, there were only 24 cases of breast cancer in transgender men by 2020. [3][4][5][6][7][8][9][10][11] It is important to emphasize that these papers show a substantial heterogeneity regarding histological diagnosis (DCIS, IDC and grade), biological profile (ER, PR, HER2 neu, AR), stage and sequence between the appearance of breast cancer and mastectomy. These is an important bias for an incidence analysis (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the peripheral androgen-to-estrogen conversion, some authors recommend aromatase inhibitors and others lowering the androgen dose or switching to dihydrotestosterone, which is nonaromatizable. 11,12,17 Taking this into consideration, the detection of AR should become a standard for this population, although the effects of stimulating or blocking the AR are unknown, and even less frequently observed, in an androgen therapy context.…”

Section: Discussionmentioning

confidence: 99%

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Oncological Mastectomy in the Context of Reaffirmation of Sex in a Male Transgender Patient: Case Report and Literature Review

Sciuto¹,

Romero²,

Cristiani³

et al. 2022

Arch Breast Cancer

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Background: Breast cancer in the male transgender patient is a great challenge for the medical team, because it is completely different from the usual clinical scenario and there is a lack of scientific knowledge and protocols for managing this special medical situation. Case presentation: We present a 32-year-old transmasculine patient, who developed a palpable nodule on the left breast during the androgen hormonal treatment. Imaging showed a BIRADS5 nodule and core biopsy detected a luminal B breast invasive carcinoma (IDC) with androgen receptor expression. He underwent a gender reaffirmation oncological mastectomy, chemotherapy and hormonal therapy. Conclusion: In the transgender male scenario, the surgical technique should take into consideration the patient’s aesthetical desire and the oncological result. In this context, it is controversial if the hormonal and oncological therapies should also be changed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Oncological Mastectomy in the Context of Reaffirmation of Sex in a Male Transgender Patient: Case Report and Literature Review

Sciuto¹,

Romero²,

Cristiani³

et al. 2022

Arch Breast Cancer

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“…10,13,15,17,18,23,26,27,30,31,33 Eight cases reported a negative BRCA status, and the rest did not report a BRCA status. 10,15,21,24,26,29,30 Body mass index and race were not reported in these studies despite being known risk factors for BCa incidence. Brown and Jones, 11 Katayama et al, 23 and Fundytus et al 18 each describe one case of BCa in patients who had undergone a prior hysterectomy and bilateral oophorectomy.…”

Section: Predisposing Bca Risk Factors Were Infrequently Reportedmentioning

confidence: 93%

The Impact of Exogenous Testosterone on Breast Cancer Risk in Transmasculine Individuals

et al. 2023

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Background Exogenous testosterone is vital to gender-affirming therapy for transmasculine individuals. Testosterone may be implicated in breast cancer (BCa) because it can activate androgen and estrogen receptors. To further explore this risk, we performed a systematic review to investigate the impact of exogenous testosterone on BCa risk in transmasculine individuals. Methods We searched PubMed/MEDLINE and Ovid/Embase for clinical and preclinical studies assessing BCa and testosterone therapy and screened 6125 articles independently. We ascertained level of evidence using a modified tool from Cook et al (Chest. 1992;102:305S–311S) and risk of bias using a modified Joanna Briggs Institute's Critical Appraisal Tool. Results Seventy-six studies were included. Epidemiological data suggested that BCa incidence was higher in transmasculine individuals compared with cisgender men but lower compared with cisgender women. Histological studies of transmasculine breast tissue samples also demonstrated a low incidence of precancerous lesions. Interestingly, cases demonstrated that BCa occurred at a younger average age in transmasculine individuals and was predominantly hormone receptor positive. The mechanism for BCa in transmasculine individuals may be related to androgen receptor stimulation or conversion to estradiol. Serum studies reported varied estradiol levels associated with exogenous testosterone. Animal and in vitro studies demonstrated that testosterone was growth inhibitory but may induce proliferation at higher doses or with low estradiol levels. Conclusions Plastic surgeons play a critical role in providing gender-affirming care for transmasculine patients. The limited studies available suggest that this patient population has decreased risk for BCa when compared with cisgender women; however, any BCa that does occur may have different clinical presentations and underlying mechanisms compared with cisgender women and men. Overall, the limitations for clinical studies and discrepancies among preclinical studies warrant further investigation.

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“…50,61 Among transgender men who have undergone reduction mammoplasty, screening may also be limited by patient or clinician impression that they are no longer at risk of breast cancer, although top surgery does not fully remove all breast tissue as in oncologic mastectomy. 62,63 Surgeons must also be aware of and sensitive to the psychosocial implications of breast cancer treatment in patients taking exogenous hormones. It is standard of care to prescribe hormone-blocking medications for estrogen-responsive breast cancers, but discontinuation of feminizing hormones may be psychologically untenable for some patients.…”

Section: While Factors That Contribute To Oncologic Disparities Inmentioning

confidence: 99%

Surgical Implications of LGBTQ+ Health Disparities: A Review

Awe

2022

The American Surgeon

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Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) patients face challenging health care disparities. However, due to restrictions in reporting and collection of sexual orientation and gender identity (SOGI) demographic data, comprehensive studies of surgical disparities in the LGBTQ+ population are limited. This review aims to summarize the existing literature describing surgical disparities in LGBTQ+ patients and to identify areas of surgical care in which further studies are warranted. This review addresses the literature in infectious diseases, substance use disorders, bariatrics, cardiovascular medicine, oncology, and laryngology as relevant to surgical practice. Understanding the current landscape of knowledge in LGBTQ+ surgical disparities and the areas where gaps in research exist will help the surgeon to create a framework of practice to provide more equitable care to LGBTQ+ patients.

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Invasive Breast Cancer in a Trans Man After Bilateral Mastectomy: Case Report and Literature Review

Cited by 19 publications

References 14 publications

Oncological Mastectomy in the Context of Reaffirmation of Sex in a Male Transgender Patient: Case Report and Literature Review

Oncological Mastectomy in the Context of Reaffirmation of Sex in a Male Transgender Patient: Case Report and Literature Review

The Impact of Exogenous Testosterone on Breast Cancer Risk in Transmasculine Individuals

Surgical Implications of LGBTQ+ Health Disparities: A Review

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