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Breast Cancer In Transgender Patients: A Call To Action
Harsh Patel1, Daniel Delgadillo, MD1, Randy Sherman, MD1, Esther Kim, MD2, Dhivya Srinivasa, MD1.
1Cedars-Sinai Medical Center, Los Angeles, CA, USA, 2UCSF, San Francisco, CA, USA.

Breast Cancer in Transgender Patients: A Call to Action
Harsh Patel, Dan Delgadillo MD, Randy Sherman MD, Esther Kim MD, Dhivya Srinivasa MD
Purpose:
Both hormonal and surgical modifications are necessary to complete transitioning to the target gender for transgender patients. These alterations create complex anatomy. Accordingly, the literature is in agreement that the hormonal milieu and barriers to access to care puts these patients at nontraditional risks of developing hormone-sensitive cancers. Additionally, lack of consensus on management and screening for gender specific tumors becomes glaringly dangerous in the context of altered anatomy. Herein we present both WPATH provider survey results on transgender cancer screening as well as a metanalysis of breast cancer incidence in transmen and transwomen.
Methods:
For the meta-analysis, 3 large volume reviews with distinct study populations of level 3 evidence were analyzed using STATA (StataCorp). This meta-analysis captured 11,736 patients with. Additionally, all case reports were included for incidence and prevalence analysis. For the provider survey, WPATH providers were contacted with an online thirteen question survey regarding their practice type, screening practices, and recommendations.
Results:
Table 1 summarizes our demographic, hormone effects, and cancer incidence data. Most notably, transmales carry 7.5x risk of developing breast cancer compared to cismales. For transfemales, hormone therapy had temporal effects on cancer incidence. With respect to provider practices, we had 46 respondents. Nearly all providers (98%) agree that standardized screening protocols are necessary for breast and prostate cancer in transgender patients. Of those who perform masculinizing chest surgery, all explained that some breast tissue is retained, but 10% of respondents do not provide information on self-exams or future screening.
Conclusions:
Our results underscore two issues: the transgender patient population has unique demands with respect to cancer screening due to anatomic variations and hormone therapy. Our provider survey demonstrates that providers need a consensus regarding screening guidelines for transgender patients. Our meta-analysis results further demand attention as population specific data shows increased risk in the transmale population compared to cismales. Provider guidelines for long-term management of these patients is of
paramount importance. Central databases to improve catchment should also be established to best delineate incidence and prevalence as well as the role of hormone therapy on tumor biology.
Table 1:

AuthorsYearM-t-FAge at Cancer DxTotal Positive CasesIncidenceMedian Duration of Hormone TxF-t-MAge at Cancer DxTotal Positive CasesIncidenceMedian Duration of Hormone TxCombined Incidence (per 100000)
Blok120192260511546.71812293940.31543
Gooren22013230751.524.121.47952715.920.14.5
Brown32014356661.520.41-157956.970.95-20
Averages271154.76.317.0719.7120140.942.417.622.5

1 de Blok CJ, Wiepjes CM, Nota NM, van Engelen K, Adank MA, Dreijerink KM, Barbé E, Konings IR, den Heijer M. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ 2019. BMJ. 2019;365:l1652.
2 Gooren, L.J., van Trotsenburg, M.A., Giltay, E.J., & van Diest, P.J. (2013). Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. Journal of Sexual Medicine, 10, 3129–3134. 
3 Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat. 2015;149(1):191–19.


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