Department of Gynecology, Hospital Municipal Dr. Bernardo Houssay, Buenos Aires, Argentina
Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Int J Gynecol Cancer. 2020 Dec;30(12):1990-1996. doi: 10.1136/ijgc-2020-001860. Epub 2020 Oct 27.
In the last several years, demand for transgender care from gynecologists has increased significantly. Transgender people comprise a diverse group who do not identify with the sex they were assigned at birth. Worldwide, it is estimated that 25 million people identify as transgender. Some undergo hormonal and/or surgical treatment aiming to feminize or masculinize their bodies. Cross-sex hormone treatment for transgender women-individuals assigned as male at birth who identify themselves as women-includes exogenous estrogen and/or progestin administration in combination with anti-androgens, whereas testosterone is used for transgender men-individuals whose natal sex is women but identify themselves as men. Although it is usually rare, hormone-sensitive malignancies may arise, and long-term effects remain unknown. In addition, reconstructive surgeries may include breast augmentation and vaginoplasty (creation of a vagina) for transgender women, and chest masculinization surgery (bilateral mastectomy) and metoidioplasty (lengthening of the clitoris to create a microphallus) or phalloplasty (creation of a phallus) for transgender men. Evidence relating to breast and reproductive tract cancers in the trans population is limited and insufficient to estimate cancer prevalence, and recommendations for screening and preventive care depend on the patients' hormonal and surgical status. Even less information exists regarding the sub-set of individuals with genetic predisposition for these malignancies. In this review, we aimed to summarize current recommendations for gynecologists and gynecologic oncologists regarding cancer screening and personalized cancer-risk assessment in transgender people.
在过去的几年中，妇科医生对跨性别护理的需求显著增加。跨性别者是一群与出生时被指定的性别不认同的人。据估计，全世界有 2500 万人认同自己的跨性别身份。有些人会接受激素和/或手术治疗，以使其身体女性化或男性化。跨性别女性（出生时被指定为男性但自我认同为女性的个体）的跨性别激素治疗包括外源性雌激素和/或孕激素与抗雄激素联合使用，而睾酮则用于跨性别男性（出生时的性别为女性但自我认同为男性的个体）。尽管这种情况通常很少见，但可能会出现激素敏感型恶性肿瘤，并且长期影响仍不清楚。此外，重建手术可能包括跨性别女性的乳房增大和阴道成形术（创建阴道），以及跨性别男性的胸部男性化手术（双侧乳房切除术）和阴蒂成形术（阴蒂延长以创建小阴茎）或阴茎成形术（创建阴茎）。关于跨性别人群中的乳腺癌和生殖道癌症的证据有限且不足以为癌症发病率提供估计，并且筛查和预防保健的建议取决于患者的激素和手术状态。对于这些恶性肿瘤具有遗传易感性的个体亚组，信息就更少了。在这篇综述中，我们旨在总结妇科医生和妇科肿瘤医生关于跨性别者癌症筛查和个性化癌症风险评估的当前建议。
