Di Lisa Francesca Sofia, Villa Alice, Filomeno Lorena, Arcuri Teresa, Chiofalo Benito, Sanguineti Giuseppe, Pizzuti Laura, Krasniqi Eriseld, Barba Maddalena, Sergi Domenico, Lombardo Francesco, Romanelli Francesco, Botti Claudio, Zoccali Giovanni, Ciliberto Gennaro, Vici Patrizia
Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Ther Adv Med Oncol. 2024 Aug 10;16:17588359241259466. doi: 10.1177/17588359241259466. eCollection 2024.
Transgender individuals exhibit a higher prevalence of cancer-related risk factors, such as substance abuse and sexually transmitted infections. These factors, coupled with suboptimal adherence to cancer screening recommendations, may lead to a higher incidence of cancers, such as breast and cervical cancer, and contribute to delayed diagnoses in transgender patients. Herein, we report a unique case of a transgender man with a history of alcohol and drug abuse, undergoing gender-affirming exogenous testosterone therapy, who developed synchronous locally advanced breast cancer and human papilloma virus (HPV)-related cervical cancer. He underwent concurrent chemoradiation for cervical cancer and surgery followed by endocrine therapy for breast cancer. The treatments were suboptimals due to patient's comorbidities, among them liver cirrhosis leading to an early death. Additionally, we have conducted a review of existing literature, including case reports, clinical studies, and review articles investigating the role of potential risk factors specifically related to breast and cervical tumors in transgender men. Gender-affirming testosterone therapy is common among transgender men to induce gender affirmation, but its link to breast cancer risk remains ambiguous, with studies being limited and sometimes contradictory. Conversely, HPV is a well-established cause of up to 99% of cervical cancers. Despite persistent risk for cervical cancer in transgender men who retain their cervix, several studies indicate notable disparities in screening adherence, due to personal and structural barriers. Moreover, alcohol and drug use disorders, commonly encountered in transgender population, may negatively influence the adherence to screening programs. Current cancer screening guidelines for this population are somewhat unclear, and specific programs based on more robust data are urgently required along with further tailored studies.
跨性别者患癌症相关风险因素的患病率较高，如药物滥用和性传播感染。这些因素，再加上对癌症筛查建议的依从性欠佳，可能导致乳腺癌和宫颈癌等癌症的发病率更高，并导致跨性别患者的诊断延迟。在此，我们报告一例独特病例，一名有酒精和药物滥用史的跨性别男性，正在接受性别确认的外源性睾酮治疗，他同时患上了局部晚期乳腺癌和人乳头瘤病毒（HPV）相关的宫颈癌。他接受了宫颈癌同步放化疗和乳腺癌手术后的内分泌治疗。由于患者的合并症，治疗效果欠佳，其中肝硬化导致其过早死亡。此外，我们还对现有文献进行了综述，包括病例报告、临床研究以及调查跨性别男性中与乳腺和宫颈肿瘤具体相关的潜在风险因素作用的综述文章。性别确认的睾酮治疗在跨性别男性中很常见，用于实现性别确认，但其与乳腺癌风险的联系仍不明确，相关研究有限且有时相互矛盾。相反，HPV是高达99%宫颈癌的明确病因。尽管保留宫颈的跨性别男性仍有患宫颈癌的持续风险，但多项研究表明，由于个人和结构障碍，他们在筛查依从性方面存在显著差异。此外，跨性别群体中常见的酒精和药物使用障碍可能会对筛查项目的依从性产生负面影响。目前针对该人群的癌症筛查指南有些不明确，迫切需要基于更有力数据的具体项目以及进一步的针对性研究。
