Dados do Resumo

Título

Hormone therapy in transgender women and breast cancer risk.

Introdução

Breast cancer is a widely studied disease in cisgender women, although there are limited studies on trans women undergoing hormone therapy (HT), and given the risk exogenous hormones represent for cis women, it means a relevant gap in this subject. This understanding can help clarify the risks related to HT, due to guiding clinical decisions and improving prevention strategies for transgender individuals. This also helps to identify the factors limiting proper screening in the current situation.

Objetivo

To analyze whether Gender Affirming Hormone Therapy (GAHT) in trans women is related to an increased risk of breast cancer, compared with that of cis women undergoing menopause hormone therapy (MHT) and trans men on GAHT.

Métodos

The literature review was conducted by searching in electronic databases MEDLINE and LILACS. We selected 17 articles, being 4 systematic reviews, 9 other reviews, 1 case series, 2 cohort studies, 1 cross-sectional study. The oldest article was published in 2018, the most in the last two years.

Resultados

Obstacles in diagnosing breast cancer in trans patients include lack of specific guidelines, a shortage of trained professionals, and limited health care access. There are guidelines recommending screening trans women similarly to cis women, while others suggest no screening, one suggests screening based on risk factors: Family history, type of HT and duration, and mastectomy. Studies indicate breast cancer incidence rates decrease in the following order: cis women, trans women, trans men, cis men. For all groups, hormone therapy duration is a significant factor and it is advised to discontinue if this type of cancer is diagnosed. Factors influencing clinical decision are: In menopause, progestin and estrogen are used for a limited time, while in GAHT, estrogen is used throughout life. Most transgenders begin GAHT before gonad removal, being exposed to higher hormone levels compared to cisgender patients. The role of testosterone in breast cancer remains unclear.

Conclusões

It is possible to understand that trans women on GAHT have higher breast cancer risk than cis men and lower risk than cis women on MHT. Establishing reliable guidelines is fundamental for breast cancer secondary prevention in trans individuals, which requires proper care from trained professionals. To achieve this, we need better epidemiological data, and better identification of transgender individuals in health services reports, leading to improved representation in future studies.

Financiador do resumo

The authors declare to be provided by their own means.

Palavras Chave

Transgender; Menopause; Breast cancer