Chowdhry Divya N, O'Connell Avice M
University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY.
J Breast Imaging. 2020 Mar 25;2(2):161-167. doi: 10.1093/jbi/wbz092.
In the United States, at least 1.4 million adults identify as transgender. Despite growing national awareness, the transgender population experiences disparities in breast care access and breast health outcomes. One of the challenges of breast care delivery to transgender patients is the lack of evidence-based screening guidelines, which is likely partly due to the infrequency of transgender breast cancer cases. Several gender-affirming hormonal and surgical interventions are available that impact the imaging appearance of the breasts and the risk of breast cancer. Breast imaging radiologists should be familiar with the imaging appearance of expected findings and potential complications following gender-affirming interventions. It has been shown that the incidence of breast cancer in transgender women is higher than in natal males but still lower than in natal females, implying that estrogen supplementation confers an increased breast cancer risk. It is proposed that transgender women follow the screening guidelines for natal females if they have risk factors for breast cancer and received hormone therapy for > 5 years. However, further research is necessary, especially in transgender women who have no risk factors or received hormone therapy for ≤ 5 years. The breast cancer risk of presurgical transgender men is considered equivalent to that of natal females, but the risk markedly decreases following bilateral mastectomy. It is proposed that transgender men follow the screening guidelines for natal females if they have any preserved breast tissue, or that they undergo annual chest wall and axillary physical exam if they are status post bilateral mastectomy.
在美国，至少有140万成年人认定自己为跨性别者。尽管全国范围内的认知度不断提高，但跨性别群体在获得乳房护理和乳房健康结果方面仍存在差异。为跨性别患者提供乳房护理的挑战之一是缺乏基于证据的筛查指南，这可能部分归因于跨性别乳腺癌病例的罕见性。有几种性别肯定性的激素和手术干预措施，会影响乳房的影像学表现和患乳腺癌的风险。乳房影像放射科医生应熟悉性别肯定性干预后预期发现的影像学表现和潜在并发症。研究表明，跨性别女性患乳腺癌的发病率高于出生时认定为男性的人，但仍低于出生时认定为女性的人，这意味着补充雌激素会增加患乳腺癌的风险。有人建议，如果有乳腺癌风险因素且接受激素治疗超过5年，跨性别女性应遵循出生时认定为女性的人的筛查指南。然而，有必要进行进一步研究，特别是针对没有风险因素或接受激素治疗时间≤5年的跨性别女性。术前跨性别男性患乳腺癌的风险被认为与出生时认定为女性的人相当，但双侧乳房切除术后风险会显著降低。有人建议，如果跨性别男性有任何保留的乳房组织，应遵循出生时认定为女性的人的筛查指南；如果他们已经接受了双侧乳房切除术，则应每年进行胸壁和腋窝体格检查。
