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Transgender and breast cancer risk: recent studies demonstrate a possibility

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An increasing number of individuals in the world define itself as transgender (or nonbinary).

Transgender persons are subjects whose sex identity does not comply with the sex recognized at birth, and nonbinary refers to people who do not identify as a man or a woman but instead identify elsewhere along the sex spectrum.

Cisgender refers to someone whose sex at birth is the same as their sex identity. Transgender individuals may undergo sex-affirming surgical procedures and/or sex-affirming hormone therapy, which is usually either estrogen- or androgen-based, to reach their physical appearance in accord with their sex identity.

Male-to-female (MtF) people are assigned male at birth but wish to present as female on either a temporary or permanent basis, depending upon the degree of their dysphoria. Conversely, female-to-male (FtM) are assigned female at birth, but they wish to present as male.

Transgender people use hormone treatments to reduce the sex dysphoria.

However, the potential long-term effects of these therapies, in particular sex-affirming hormone therapy, and the risk of hormonally sensitive tumors [e.g. breast cancer (BC)] are not currently well estimated or understood.

Because transgender individuals experience incongruence between the sex assigned to them at birth and their sex identity, they are excluded from conventional clinical studies (or standard screening) that require persons to identify within the typical sex dichotomy criteria (male or female).

There are no studies that have evaluated routine screening mammography for transgender women (MtF) upon treatment with hormonal therapy; however, recent cohort studies have reported multiple cases of BC in these populations.

A recent study, conducted as “meta-analysis”, demonstrated that there is a possible risk for BC in transgender individuals.

This study reported that in literature are described 78 BC diagnoses in transgender individuals.

Breast tumors were identified in 34 FtM and 44 MtF individuals: 12 BCs in 6582 screened MtF (0.2%) and 25 BCs in 6146 FtM (0.4%). However, the overall prevalence of BC remains low in this population but higher in MtF subjects.

Statistical analysis demonstrated that BC is highest in FtM and in MtF in comparison to cisgender men, but lower in cisgender women.

Since the risk for BC development is appreciable in transgender patients, these individuals should be subjected to breast/ chest examinations.