Ramadan Retaj, Tan Sophia, Lowik A J, Isaac Kathryn V
Faculty of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Int J Transgend Health. 2024 Jun 21;26(3):528-543. doi: 10.1080/26895269.2024.2351448. eCollection 2025.
Breast cancer is a global health burden. Although screening and treatment programs have improved breast cancer survival for Canadians, it is unclear if there is a disparity in cancer burden and care received by transgender and Two-Spirit patients due to the general paucity of research concerning breast cancer care of these individuals. A systematic review was conducted to examine the burden of breast cancer in transgender and Two-Spirit populations, identify how gender modality/identity may impact the delivery of breast cancer care, and develop actionable recommendations for the provision of more inclusive, high-quality cancer care. A comprehensive search of PubMed/MEDLINE (OVID), Embase (OVID), and Web of Science databases was conducted using keywords and based on the PRISMA framework. Two independent reviewers performed selection and data extraction of studies that met inclusion criteria related to breast cancer in adult transgender and/or Two-Spirit patients. Of 7,402 articles screened, 61 studies were included, the majority of which focused on binary-identified trans people, with none addressing Two-Spirit people's experiences of cancer care. Findings determined no clear association between gender affirming hormone therapy and risk of breast cancer in transgender populations. Additionally, the burden of breast cancer could be identified for transgender and/or Two-Spirit patients. Patient-provider and system barriers in the delivery of breast cancer care were identified, including lack of trust and knowledge, discrimination, and insufficient population-wide data collection and research. Significant gaps in literature regarding the experiences, barriers and needs of transgender and/or Two-Spirit patients with breast cancer exist. Developing effective guidelines and clinical practices that encompass all gender identities and expanding the depth and scope of research is crucial toward fostering diverse, inclusive, and equitable healthcare.
乳腺癌是一项全球性的健康负担。尽管筛查和治疗项目提高了加拿大乳腺癌患者的生存率，但由于针对这些个体乳腺癌护理的研究普遍匮乏，尚不清楚跨性别者和双性人在癌症负担和接受的护理方面是否存在差异。本研究进行了一项系统综述，以检查跨性别者和双性人群体中的乳腺癌负担，确定性别模式/身份如何影响乳腺癌护理的提供，并为提供更具包容性、高质量的癌症护理制定可行的建议。使用关键词并基于PRISMA框架，对PubMed/MEDLINE（OVID）、Embase（OVID）和Web of Science数据库进行了全面检索。两名独立评审员对符合纳入标准的成年跨性别者和/或双性人乳腺癌相关研究进行了筛选和数据提取。在筛选的7402篇文章中，纳入了61项研究，其中大多数聚焦于二元性别认定的跨性别者，没有一项涉及双性人的癌症护理经历。研究结果表明，在跨性别群体中，性别确认激素治疗与乳腺癌风险之间没有明确关联。此外，可以确定跨性别者和/或双性人患者的乳腺癌负担。研究还确定了乳腺癌护理提供过程中的患者-提供者和系统障碍，包括缺乏信任和知识、歧视以及全人群数据收集和研究不足。关于跨性别者和/或双性人乳腺癌患者的经历、障碍和需求的文献存在重大空白。制定涵盖所有性别身份的有效指南和临床实践，并扩大研究的深度和范围，对于促进多样化、包容性和公平的医疗保健至关重要。
