Risk of breast cancer in transgender persons studied in veterans

A study of breast cancer in transgender veterans has identified 10 new cases, increasing the total number of published cases in both female-to-male and male-to-female transgender persons. Patient outcomes, use of cross-sex hormones, and recommendations for screening were presented in an article in the peer-reviewed journal LGBT Health (2015;2(1):77-80).

Veterans Health Administration records from 1998 to 2013 were reviewed by George R. Brown, MD, of Quillen College of Medicine and Mountain Home Veterans Administration Medical Center in Johnson City, Tennessee. He identified breast cancer cases affecting seven natal females (sex at birth) and three natal males. Whereas the natal males had late-stage disease at diagnosis that proved fatal, earlier stage disease with a better prognosis was detected in the natal females.

Known cases of breast cancer in transgender persons, including this study, are now 12 in female-to-male persons and 13 in male-to-female persons.

The author wrote, “patients who seek CSH [cross-sex hormones] treatment from medical sources may also obtain CSH from nonmedical sources in unknown quantities.” He went on to explain that these unknown quantities make it difficult to conduct studies of dose-response and CSH dose/exposure to breast cancer outcomes.

"Breast cancer in transgender patients is rarely reported, and when it is, it is often in association with hormonal therapy and mentioned as a potential side effect of that therapy, particularly with estrogens," said LGBT Health Editor-in-Chief William Byne, MD, PhD, James J. Peters VA Medical Center, Bronx, New York, and Icahn School of Medicine at Mount Sinai, also in New York.

"Cohorts of transgender and transsexual patients followed prospectively, however, have not led to the detection of an increased incidence relative to the general population. Brown concludes that screening methods in place for nontransgender persons should be sensitively discussed with transgender persons, whether or not they have utilized hormonal therapy, and routinely provided by their clinicians," said Byne.

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