Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia.
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
Clin Endocrinol (Oxf). 2018 Dec;89(6):700-711. doi: 10.1111/cen.13835. Epub 2018 Sep 18.
Cancers are a leading cause of death worldwide, and transgender individuals are no exception. The effects of gender-affirming hormone therapy (GAHT) on sex hormone-dependent tumours are unclear. Therefore, this review seeks to determine whether tumour risk in transgender individuals differs from the general population, to guide clinical screening recommendations.
We performed a systematic review based on the PRISMA guidelines. MEDLINE, Embase and PsycINFO databases were searched for studies examining tumour incidence, prevalence or cancer-related mortality in transgender individuals. All English peer-reviewed publications were included if histological type and temporal relation to GAHT were reported. Case reports were included if there were ≥2 cases of the same histological type.
The search strategy identified 307 studies. Excluding those that did not meet inclusion criteria, 43 studies (7 cohort studies, 2 cross-sectional studies and 34 case reports) were reviewed. Retrospective cohort studies suggest no increase in risk of tumour development in transgender individuals receiving GAHT compared to the general population. Notably, the mean ages of cohorts were young and were treated with GAHT for insufficient durations to assess tumour risk. Case reports raise potential associations between high-dose oestradiol and anti-androgen therapy with prolactinoma and meningioma, respectively.
Further longitudinal studies are required to assess the risk of GAHT and hormone-dependent tumour development. Until further evidence is available, tumour screening should be based on guidelines for the general population and the presence of organs in transgender individuals rather than gender identity or hormonal therapy status.
癌症是全球主要死因之一，跨性别者也不例外。目前尚不清楚性别肯定激素疗法（GAHT）对性激素依赖性肿瘤的影响。因此，本综述旨在确定跨性别者的肿瘤风险是否与普通人群不同，以指导临床筛查建议。
我们按照 PRISMA 指南进行了系统综述。检索了 MEDLINE、Embase 和 PsycINFO 数据库，以查找检查跨性别者肿瘤发病率、患病率或癌症相关死亡率的研究。如果报告了组织学类型和与 GAHT 的时间关系，则纳入所有英语同行评审出版物。如果有≥2 例相同组织学类型的病例报告，则纳入病例报告。
搜索策略确定了 307 项研究。排除不符合纳入标准的研究后，共审查了 43 项研究（7 项队列研究、2 项横断面研究和 34 项病例报告）。回顾性队列研究表明，接受 GAHT 的跨性别者与普通人群相比，肿瘤发展风险没有增加。值得注意的是，队列的平均年龄较小，且接受 GAHT 的时间不足以评估肿瘤风险。病例报告提出了高剂量雌二醇和抗雄激素治疗分别与泌乳素瘤和脑膜瘤之间的潜在关联。
需要进一步的纵向研究来评估 GAHT 和激素依赖性肿瘤发展的风险。在进一步的证据出现之前，肿瘤筛查应基于普通人群的指南以及跨性别者器官的存在，而不是性别认同或激素治疗状况。
