22 mei 2019: Bron: BMJ 2019;365:l1652

Omdat transgendervrouwen (van man naar vrouw) hormonen nodig hebben om vrouw te worden blijken zij een verhoogde kans te hebben op borstkanker. Dat blijkt uit een Nederlandse studie uit de periode 1072 tot 2016. 

Uit het studieverslag van : 

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands dat volledig gratis is in te zien.

The researchers identified 18 cases of breast cancer (15 invasive and three noninvasive) in 17 of the 2,260 transgender women after an average of 18 years of hormone treatment. The average age at diagnosis was 50 years. Compared with cisgender men, transgender women had a 46-fold higher risk for breast cancer (standardized incidence ratio , 46.7); however, this risk was lower than that seen in cisgender women (SIR, 0.3). The majority of these cases were found to be ductal in origin and estrogen and progesterone receptor-positive; 8.3 percent were human epidermal growth factor receptor 2-positive. Invasive breast cancer was diagnosed in four of the 1,229 transgender men (no noninvasive cases were reported), with diagnosis occurring at an average age of 47 years after a median of 15 years of hormone treatment. Compared with cisgender women, this number was lower than expected (SIR, 0.2).

This research "suggests that hormone treatment alters the risk of breast cancer in transgender people compared with initial risk based on their birth assigned sex," the authors write.

Het abstract:

Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1652 (Published 14 May 2019) Cite this as: BMJ 2019;365:l1652

  1. Christel J M de Blok, PhD candidate1 2,  
  2. Chantal M Wiepjes, PhD candidate1 2,  
  3. Nienke M Nota, PhD candidate1 2,  
  4. Klaartje van Engelen, clinical geneticist3,  
  5. Muriel A Adank, clinical geneticist4,  
  6. Koen M A Dreijerink, endocrinologist1 2,  
  7. Ellis Barbé, pathologist5,  
  8. Inge R H M Konings, medical oncologist6,  
  9. Martin den Heijer, professor in endocrinology and head of division1 2
Author affiliations
  1. Correspondence to: M den Heijer, Department of Internal Medicine, Section Endocrinology, Amsterdam UMC, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, Netherlands m.denheijer@vumc.nl
  • Accepted 27 March 2019

Abstract

Objective To investigate the incidence and characteristics of breast cancer in transgender people in the Netherlands compared with the general Dutch population.

Design Retrospective, nationwide cohort study.

Setting Specialised tertiary gender clinic in Amsterdam, the Netherlands.

Participants 2260 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 measures Incidence and characteristics (eg, histology, hormone receptor status) of breast cancer in transgender people.

Results The 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).

Conclusions This 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.

 


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