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호르몬을 쓰는 트랜스 여성의 유방암 위험은 남성의 46배 - 그래도 여성보다는 낮음, 네덜란드 코호트

호르몬 치료를 받는 트랜스젠더 사람들의 유방암 위험: 네덜란드 전국 코호트 연구

코호트 및 등록 연구교차성호르몬
Authors
Christel J.M. de Blok, Chantal M. Wiepjes, Nienke M. Nota, Klaartje van Engelen, Muriel A. Adank, Koen M.A. Dreijerink, Ellis Barbé, Inge R.H.M. Konings, Martin den Heijer
Journal
BMJ
Year
2019
Source
https://doi.org/10.1136/bmj.l1652

Summary

Researchers used records from the Amsterdam gender clinic, which treats over 95% of Dutch transgender patients, linked to the national record of cancer diagnoses. They counted breast cancers in about 3,500 people on cross-sex hormones. Trans women got breast cancer far more often than men normally do (about 46 times), but still less often than women. Their tumours looked like the typical hormone-sensitive breast cancers seen in women. This suggests estrogen, and possibly the testosterone-blocking drug cyproterone acetate, shifts risk toward the female pattern. Trans men had a lower risk than women, likely helped by having had their breasts removed. The authors concluded the overall risk is low and normal screening is enough. With only 15 and 4 cases, missing data on major risk factors, and comparisons with the general population, the numbers are rough.

Key findings

  • 연구는 호르몬 치료를 받은 트랜스 여성 2,260명과 트랜스 남성 1,229명을 추적했고, 추적 기간은 합쳐서 각각 약 34,000년과 15,000년이었습니다.
  • 트랜스 여성은 호르몬을 통상 18년(7~37년) 쓴 뒤 통상 50세에 유방암 15건이 나타났습니다.
  • 유방암은 트랜스 여성에서 남성보다 약 46배 흔했지만(아마 27배에서 75배 사이), 여성보다는 약 3분의 1만큼만 흔했습니다.
  • 트랜스 여성의 종양 대부분은 보통 여성에서 보이는 것과 같은 호르몬 민감성 종류였습니다(83%가 에스트로겐, 67%가 프로게스테론의 영향을 받음).
  • 트랜스 남성은 유방암이 4건으로 여성의 비율의 약 5분의 1이지만 남성의 비율의 59배였으며, 3건은 유방 제거 몇 년 후에 일어났습니다.
  • 치료법이 자주 바뀌었고 대부분의 트랜스 여성이 사이프로테론 아세테이트를 썼기 때문에, 연구자들은 서로 다른 호르몬 약을 비교할 수 없었습니다.
  • 저자들은 호르몬을 쓰는 트랜스젠더 사람에게도 일반적인 유방 검진 규칙으로 충분하다고 결론지었습니다.

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.

Conclusion

This large nationwide cohort study in the Netherlands showed an increased risk of breast cancer in trans women compared with cisgender men. The risk in trans women is still lower than in Dutch cisgender women and resembles a more female type of breast cancer and hormone receptor status. In trans men, a lower risk compared with Dutch cisgender women was observed. Based on this study, we conclude that the absolute overall risk of breast cancer in transgender people remains low and therefore it seems sufficient for transgender people using hormone treatment to follow screening guidelines as for cisgender people. As the risk of breast cancer in trans women increased during a relatively short duration of hormone treatment, it would be worthwhile for future studies to investigate in more detail the cause of breast cancer in transgender people receiving hormone treatment.