title: Hormonal and surgical treatment in trans-women with BRCA1 mutations: a controversial topic.
abstract: BACKGROUND
  Male-to-female transgender persons (trans-women) receive livelong cross-sex hormonal treatment in order to induce and maintain secondary female characteristics. One of the concerns of long-term estrogen treatment is the induction of carcinomas of estrogen-sensitive tissues such as the breast. BRCA1 mutations have been shown to account for a large proportion of inherited predispositions to breast cancer.
  
  
  OBJECTIVE
  The aim of this case report is to discuss the hormonal and surgical options in the treatment of trans-women with a genetic predisposition for breast cancer.
  
  
  METHODS
  We describe a case of a trans-woman who was found to be a carrier of a BRCA1 mutation.
  
  
  RESULTS
  The patient underwent a breast augmentation. She refused a prophylactic mastectomy followed by a primary breast reconstruction. She also underwent a vaginoplasty and a bilateral castration. Androgen blocking treatment was stopped after surgery; estradiol treatment however was continued.
  
  
  CONCLUSIONS
  This case points to the importance of routine investigation of family history in trans-women. Trans-women with BRCA mutations should be carefully monitored and if cancers develop, this should be reported. Follow-up should be according to the guidelines for breast cancer screening in biological women, and the guidelines for prostate cancer and colon cancer screening in men.
authors.affiliation: Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium.
authors.forename: Britt
authors.initials: B
authors.lastname: Colebunders
authors.forename: Guy
authors.initials: G
authors.lastname: T'Sjoen
authors.forename: Steven
authors.initials: S
authors.lastname: Weyers
authors.forename: Stan
authors.initials: S
authors.lastname: Monstrey
mesh_terms: D000328:Adult; D019313:BRCA1 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods; D009154:Mutation; D063106:Transgender Persons
chemical_list: D019313:BRCA1 Protein
keywords: BRCA1; Hormonal Treatment; Trans-Woman