Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands
Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands
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DOI：
10.1136/bmj.l1652
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发表时间：
2019-05-14
影响因子：
105.7
通讯作者：
den Heijer, Martin
中科院分区：
文献类型：
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作者：
de Blok, Christel J. M.;Wiepjes, Chantal M.;den Heijer, Martin
目的：研究荷兰跨性别人群与荷兰普通人群相比乳腺癌的发病率和特征。研究背景：荷兰阿姆斯特丹一家专门的三级性别诊所。参与者：2260名成年跨性别女性。（男性性别在出生时分配，女性性别认同）和1229名成年跨性别男性（出生时性别分配为女性，男性性别认同）接受性别确认激素治疗的患者。（例如，组织学，激素受体状态）在跨性别人群中的乳腺癌的发生率。在队列中的2260名跨性别女性中，确定了15例浸润性乳腺癌（激素治疗的中位持续时间为18年，范围为7-37年）。这比顺性别男性高46倍（标准化发病率比46.7，95%置信区间27.2至75.4），但低于顺性别女性（0.3，0.2至0.4）。大多数肿瘤是导管起源和雌激素和孕激素受体阳性，8.3%的人表皮生长因子2（HER 2）阳性。在1229名跨性别男性中，确定了4例浸润性乳腺癌（激素治疗的中位持续时间为15年，范围为2-17年）。这是低于预期相比，cisgender妇女（标准化发病率比0.2，95%置信区间0.1至0.5）。CONCLUSIONSSThis研究表明，增加的风险，乳腺癌的跨女性相比，cisgender男性和风险较低的跨男性相比，cisgender女性。在跨性别女性中，在相对较短的激素治疗期间，乳腺癌的风险增加，乳腺癌的特征更像女性模式。这些结果表明，对于使用激素治疗的变性人来说，针对顺性别者的乳腺癌筛查指南是足够的。
OBJECTIVETo investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population.DESIGNRetrospective, nationwide cohort study.SETTINGSpecialised tertiary gender clinic in Amsterdam, the Netherlands.PARTICIPANTS2260 adult trans women (male sex assigned at birth, female gender identity) and 1229 adult trans men (female sex assigned at birth, male gender identity) who received gender affirming hormone treatment.MAIN OUTCOME MEASURESIncidence and characteristics (eg, histology, hormone receptor status) of breast cancer in transgender people.RESULTSThe total person time in this cohort was 33 991 years for trans women and 14 883 years for trans men. In the 2260 trans women in the cohort, 15 cases of invasive breast cancer were identified (median duration of hormone treatment 18 years, range 7-37 years). This was 46-fold higher than in cisgender men (standardised incidence ratio 46.7, 95% confidence interval 27.2 to 75.4) but lower than in cisgender women (0.3, 0.2 to 0.4). Most tumours were of ductal origin and oestrogen and progesterone receptor positive, and 8.3% were human epidermal growth factor 2 (HER2) positive. In 1229 trans men, four cases of invasive breast cancer were identified (median duration of hormone treatment 15 years, range 2-17 years). This was lower than expected compared with cisgender women (standardised incidence ratio 0.2, 95% confidence interval 0.1 to 0.5).CONCLUSIONSThis study showed an increased risk of breast cancer in trans women compared with cisgender men and a lower risk in trans men compared with cisgender women. In trans women, the risk of breast cancer increased during a relatively short duration of hormone treatment and the characteristics of the breast cancer resembled a more female pattern. These results suggest that breast cancer screening guidelines for cisgender people are sufficient for transgender people using hormone treatment.