title: Breast cancer development in transsexual subjects receiving cross-sex hormone treatment.
abstract: BACKGROUND
  Transsexual people receive cross-sex hormones as part of their treatment, potentially inducing hormone-sensitive malignancies.
  
  
  OBJECTIVE
  To examine the occurrence of breast cancer in a large cohort of Dutch male and female transsexual persons, also evaluating whether the epidemiology accords with the natal sex or the new sex.
  
  
  METHODS
  Number of people with breast cancer between 1975 and 2011.
  
  
  METHODS
  We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure), and 795 female-to-male (FtM) subjects receiving testosterone (15,974 total years of exposure).
  
  
  RESULTS
  Among MtF individuals one case was encountered, as well as a probable but not proven second case. The estimated rate of 4.1 per 100,000 person-years (95% confidence interval [CI]: 0.8-13.0) was lower than expected if these two cases are regarded as female breast cancer, but within expectations if viewed as male breast cancer. In FtM subjects, who were younger and had shorter exposure to cross-sex hormones compared with the MtF group, one breast cancer case occurred. This translated into a rate of 5.9 per 100,000 person-years (95% CI: 0.5-27.4), again lower than expected for female breast cancer but within expected norms for male breast cancer.
  
  
  CONCLUSIONS
  The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development.
authors.affiliation: Emeritus VU University Medical Center, Amsterdam, The Netherlands; Androconsult, Chiang Mai, Thailand.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Gooren
authors.forename: Michael A A
authors.initials: MA
authors.lastname: van Trotsenburg
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Giltay
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Diest
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D018567:Breast Neoplasms, Male / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D005783:Gender Identity; D012739:Gonadal Steroid Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects; D063106:Transgender Persons; D014189:Transsexualism / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D012739:Gonadal Steroid Hormones; D013739:Testosterone
keywords: Breast Cancer Risk; Estrogen; Female-to-Male Transsexual Subject; Male-to-Female Transsexual Subject; Testosterone