Breast Cancer in a Male to Female Transsexual Patient with a BRCA2 Mutation

Breast cancer is rare in male patients. Certain predisposing factors, be they genetic (e.g. BRCA2 gene mutations) or hormonal (imbalance between estrogen and androgen levels) have been implicated in male breast cancer pathophysiology. 

Male to female (MtF) transsexualism is a condition that generally involves cross-sex hormone therapy. Anti-androgens and estrogens are used to mimic the female hormonal environment and induce the cross-sex secondary characteristics. In certain situations, the change of the hormonal milieu can be disadvantageous and favor the development of hormone-dependent pathologies, such as cancer. 

We report a case of a MtF transgender (TG) patient who developed breast cancer after seven years of cross-sex hormonal therapy. The patient was found to be BRCA2 positive, and suffered recurrent disease. The patient was unaware of being a member of an established BRCA2 mutation positive kindred. 

This represents the first case of a BRCA2 mutation predisposing to breast cancer in a MtF transgender patient.

Purchase full article at:   http://goo.gl/4SsOEP

By:  Corman V1, Potorac I2, Manto F3, Dassy S4, Segers K5, Thiry A6, Bours V7, Daly AF8, Beckers A9.

• 1V Corman, Department of Endocrinology, CHU de Liege, Liege, Belgium.
• 2I Potorac, Department of Endocrinology, CHU de Liege, Liege, 4000, Belgium.
• 3F Manto, Faculty of Medicine, University of Liege, Liege, Belgium.
• 4S Dassy, Department of Oncology, St. Nikolaus-Hospital, Eupen, Belgium.
• 5K Segers, Department of Human Genetics, CHU de Liege, University of Liege, Liege, Belgium.
• 6A Thiry, Department of Anatomo-pathology, CHU de Liege, Liege, Belgium.
• 7V Bours, Department of Human Genetics, CHU de Liege, University of Liege, Liege, Belgium.
• 8A Daly, Department of Endocrinology, University of Liège, Liège, Belgium.
• 9A Beckers, Department of Endocrinology, Domaine Universitaire du Sart-Tilman, CHU de Liege, Liege, Belgium albert.beckers@chu.ulg.ac.be.
• Endocr Relat Cancer. 2016 Mar 21. pii: ERC-16-0057

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Cancer Incidences for Women, per 100,000 Population (2012/15)

Via:  https://atlas.qz.com/charts/Ekrf305tg

Breast Cancer and Sexual Function

As the most common malignancy affecting women within the United States, breast cancer can bring about multiple physical and psychological challenges. Among the greatest challenges are those associated with female sexual function. 

Chemotherapy, endocrine therapy, surgeries and radiation can all have a large effect in altering a woman's sexual health and function. Sexual concerns result in significant emotional distress, including sadness/depression, issues related to personal appearance, stigma, and negative impacts on personal relationships. 

In this article, we discuss some of the specific challenges that present with each type of treatment and the socio-physical impact they have on survivorship. Among the most detrimental to sexual function, are the use of chemotherapy and endocrine therapy. Additionally, anatomical changes that transpire in patients who have undergone surgery or radiation therapy (RT), disrupt perceptions of body image. Here we will discuss and also review the contemporary literature to determine effective management and treatment of sexual dysfunction.

Below:  Sexual health in women

Clinical trials of interventions in breast cancer survivors

Intervention	N	Trial	Results
Topical testosterone (25)	21	Phase I/II	Significant improvement in dyspareunia and dryness
Transdermal testosterone (26)	150	RCT	Compared to placebo, no difference in sexual function scores at 4 or 8 weeks of intervention
Vaginal dehydroepiandrosterone (33)	441*	RCT	Compared to placebo, improvement in sexual satisfaction scores
Aqueous 4% lidocaine (30,31)	49	RCT	Compared to normal saline, significant improvement in pain; resumption of sexual intercourse in 17 of 20 women who had previously abstained
Vaginal pH-balanced gel (28)	86	RCT	Compared to placebo, nonsignificant improvement in vaginal dryness and dyspareunia
Polycarbophil-based vaginal moisturizer (29)	45	RCT	Compared to placebo, trend towards improved dyspareunia scores. Both groups had improvement in average vaginal dryness

RCT, randomized controlled trial. *, breast and gynecologic cancer survivors included in this study.

Full article at:   http://goo.gl/MMyGHu

By:  Boswell EN1, Dizon DS1.

• 1 Dana-Farber Cancer Institute, 2 The Oncology Sexual Health Program, The Massachusetts General Hospital Cancer Center, Boston, MA 06114, USA.
• Transl Androl Urol. 2015 Apr;4(2):160-8. doi: 10.3978/j.issn.2223-4683.2014.12.04. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Adherence to Mammography Screening Guidelines Among Transgender Persons and Sexual Minority Women

We used retrospective (2012-2013) chart review to examine breast cancer screening among transgender persons and sexual minority women (n = 1263) attending an urban community health center in Massachusetts. 

Transgender were less likely than cisgender patients and bisexuals were less likely than heterosexuals and lesbians to adhere to mammography screening guidelines (respectively, adjusted odds ratios = 0.53 and 0.56; 95% confidence intervals = 0.31, 0.91 and 0.34, 0.92) after adjustment for sociodemographics. 

Enhanced cancer prevention outreach is needed among gender and sexual minorities.

Via: http://ht.ly/Ssnxx  Purchase full article at: http://goo.gl/wdTZ5k

By: Bazzi AR1, Whorms DS1, King DS1, Potter J1.

• 1Angela Robertson Bazzi is with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Debra S. Whorms, Dana S. King, and Jennifer Potter are with Fenway Health, Boston. Jennifer Potter is also with the Harvard Medical School, Boston.
• 
  More at:  https://twitter.com/hiv_insight