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变性的患者

跨性别者 identifies with the female side of the gender spectrum but was assigned male at birth.
这些人可能包括跨性别妇女, historically referred to as male-to-female transsexuals.

跨性别者 identifies with the male side of the gender spectrum but was assigned female at birth.
这些人可能包括变性男性, historically referred to as female-to-male transsexuals.

为 跨性别者和性别不一致者, breast cancer screening recommendations are based on
the sex assigned at birth, 风险 factors, and use of exogenous hormones.

顺性别者 has a gender identity that matches the sex assigned at birth.

跨性别患者乳腺癌的发病率:

由于流行病学信息不足和缺乏长期研究，跨性别群体的乳腺癌发病率在很大程度上是未知的. 患乳腺癌的年龄更小
在跨性别者中有诊断报告.

Risk of Breast Cancer in the Transgender Population:

Gender-affirming therapy can influence an individual’s 风险 of developing certain cancers, 包括乳腺癌. A transgender person may undergo either gender-affirming hormone treatment, 外科处置, or a combination thereof as part of their transition.
跨性别者 is usually treated with antiandrogen and estrogen hormones, whereas a transmasculine person is treated with the hormone testosterone. 性别确认乳房手术包括对跨性别男性的缩胸或乳房切除术——被称为“顶级手术”, 还有隆胸, 脂肪移植, 或者在变性女性中两者都有.

在接受性别确认激素治疗的变性女性中，也可以发现发生在顺性女性身上的相同乳房病理. 像这样, 变性女性的乳房也可能是良性的, 如纤维腺瘤, 囊肿, 和脂肪瘤(脂肪团), as well as breast cancers that include ductal and lobular carcinomas.

A transgender person can present with the same breast symptoms as a cisgender person, 包括可触及的乳房肿块(肿块)和乳房疼痛以及正常或异常的乳头溢液.

跨性别乳腺癌的体征和症状
可以包括:

  • 乳房组织中的无痛肿块或增厚
  • Changes to the skin covering your breast, such as dimpling, puckering, redness or scaling
  • Changes to your nipple, such as redness or scaling, or a nipple that begins to turn inward
  • 乳头分泌物

乳癌筛检指引
跨性别患者:

There is no consensus on screening guidelines in transgender patients. The guidelines presented here are a summary from the American College of Radiology, using available studies and recommendations primarily from UCLA, 芬威健康, 和内分泌学会, 以及荷兰的一项研究，其中包括3,489名变性患者.

 

跨性别女性影像指南:

Recommendations for breast cancer screening in a transfeminine person is typically based on:
•出生时指定的男性性别
• The number of years of feminizing hormone exposure
•乳房发育
•任何显著的乳腺癌风险因素.

Below are common scenarios for transgender women with corresponding breast cancer
基于上述因素的筛查指南:

 

Transfeminine (male-to-female) Age 40+, Hormone use 5+ years, Avg. 风险. . .

跨性别者(男变女); 40岁或以上，过去或现在使用激素等于或大于5年的人处于平均风险.

  • No long-term data exists for screening transgender women for breast cancer with imaging.
  • 一项荷兰队列研究的3,489名变性患者显示，接受性别确认激素治疗的变性女性患乳腺癌的风险比顺性男性高，但与顺性女性相比没有增加.
  • Large prospective cisgender studies have shown that taking hormones, 尤其是雌激素和黄体酮, increase breast cancer 风险 in cisgender postmenopausal females, which could support a role for screening in this clinical setting. 另外, 在顺性男性中, high estrogen levels associated with certain conditions, 比如克氏综合症, 肝脏疾病, 睾丸功能障碍, 和肥胖, are recognized 风险 factors for developing breast cancer.
  • Current breast cancer screening recommendations in transgender women, 40 year or older with past or current hormone use equivalent or greater than five years, 有两种选择:
    -Annual or biennial mammograms starting at age 50 (per UCSF and 芬威健康 recommendations).-Screening transgender woman with the same frequency as cisgender women (annually) beginning at
    40岁(根据内分泌学会).
Transfeminine (male-to-female) Age 25-30+, Hormone use 5+ years, Higher than avg. 风险. . .

跨性别者(男变女); 年龄在25到30岁之间，过去或现在使用激素等于或大于5年的人的风险高于平均水平 (这包括在10到30岁之间有乳腺癌或胸部放疗史的人, those with a genetic predisposition to breast cancer, those with a family history of breast or ovarian cancer, 以及未经测试的具有乳腺癌遗传易感性的一级亲属的个体).

  • 关于变性人的数据有限, 以及从顺性别研究中推断出的数据, 数字乳房x光检查或DBT有助于筛查风险高于平均水平的变性女性的乳腺癌.
  • 一些跨性别健康专家和专业协会建议，在患乳腺癌风险高于平均水平的跨性别女性中，采用数字化乳房x光摄影或断层合成技术筛查乳腺癌  http://transcare.ucsf.edu/guidelines/breast-cancer-women .
  • There is no consensus on the age at which to initiate screening in this clinical setting.
    • 内分泌学会建议对变性女性进行与顺性女性相同频率的筛查(从40岁开始每年一次)。.
    • ACR推荐高风险筛查 cisgender 女性每年进行乳房x光检查的时间要比患病亲属确诊时早10年(但不能早于30岁)或早于放疗后8年(但不能早于25岁).
  •  
Transfeminine (male-to-female) Any age, Hormone use 0-5 years, Avg. 风险. . .

变性人(男变女)的人 no hormone use (or hormone use less than 5 years) at any age who is at average 风险.

    • 没有文献支持在这种临床环境中使用数字乳房x光检查进行乳腺癌筛查.
    • In the absence of identifiable 风险 factors for breast cancer, general screening has no role because of an overall low prevalence of disease. 未使用激素且无显著风险因素的跨性别者一生中患乳腺癌的风险被认为与顺性男性的平均风险相当, 也就是0.1%(相比之下，12%).平均风险为4%的顺性别女性).
Transfeminine (male-to-female) Age 25-30+, Hormone use 0-5 years, Higher than avg. 风险. . .

跨性别者(男变女); 年龄在25 - 30岁或以上，没有使用激素(或使用激素少于5年)，风险高于平均水平 (personal history of breast cancer or chest irradiation at 10 to 30 years of age, 有乳腺癌遗传易感性的人, 有乳腺癌或卵巢癌家族史, and having a first-degree relative with genetic predisposition to breast cancer, 但是你自己没有经过测试).

    • 来自风险可比的顺性别男性的有限数据表明，筛查乳房x线摄影或断层合成可能在这种临床环境中有益.

 

跨性别男性影像指南:

Recommendations for breast cancer screening in a transfeminine person is typically based on:
•出生时指定的男性性别
• The number of years of feminizing hormone exposure
•乳房发育
•任何显著的乳腺癌风险因素.

Below are common scenarios for transgender women with corresponding breast cancer
基于上述因素的筛查指南:

Transmasculine Person (female-to-male, any age, any 风险) - Bilateral Mastectomies. . .

变性男性(从女性变成男性)的人 with bilateral mastectomies (“top surgery”) at any age and any 风险.

  • 单纯乳房切除术后变性患者乳腺癌风险降低的估计来自高风险的顺性女性. A <2% 风险 of breast cancer is observed in cisgender women who undergo prophylactic mastectomy due to inherited cancer predisposition. 因此, 据推测，变性男性在接受顶级手术后患乳腺癌的风险相对较低.
  • 没有相关文献支持在这种临床环境中使用数字乳房x线摄影断层合成进行乳腺癌筛查.
跨性别者(女变男，40岁以上，平均年龄. 风险)-缩胸. . .

变性男性(从女性变成男性)的人 做过缩胸手术或没有做过胸部手术，40岁及以上的人有平均风险.

  • 没有做过胸部手术(有乳房组织)的变性人患乳腺癌的风险与顺性女性相当，无论激素治疗如何.
  • 在这个临床环境中，建议每年使用数字乳房x线照相术或断层合成技术筛查乳腺癌，从40岁开始筛查，并在预期寿命超过5至7岁时继续筛查 因为未做过手术的跨性别患者患乳腺癌的风险与顺性别女性相似.
Transmasculine Person (female-to-male, age 30+, medium 风险)-缩胸. . .

跨性别者(女变男) 做过缩胸手术或没有做过胸部手术的人, 30 years of age or older who are at intermediate 风险 她有乳腺癌的个人病史, 小叶肿瘤, 非典型导管增生, 或15%到20%的终生乳腺癌风险).

    • 没有做过胸部手术(有乳房组织)的变性人患乳腺癌的风险与顺性女性相当，无论激素治疗如何.
    • 具有中等乳腺癌风险的跨男性个体可以从40岁之前开始筛查乳房x光检查中获益，也可以从补充筛查中获益.
    • Annual screening with digital mammography or DBT is recommended in this clinical setting as it is for 风险 comparable cisgender women with high-风险 lesions, such as 小叶肿瘤 or 非典型导管增生, beginning at diagnosis but not before 30 years of age.
    • 有乳腺癌病史的变性人建议每12个月做一次乳房x光检查，因为他们患乳腺癌的风险与顺性女性相似.
    • 在这一人群中，乳房MRI或双侧全超声筛查可作为乳房x光检查的补充.
Transmasculine Person (female-to-male, age 25-30, high 风险) - Breast Reduction. . .

跨性别者(女变男) 做过缩胸手术或没有做过胸部手术的人, 30 years of age or older who are at intermediate 风险 她有乳腺癌的个人病史, 小叶肿瘤, 非典型导管增生, 或15%到20%的终生乳腺癌风险).

    • In addition to beginning screening earlier than average-风险 cisgender women, people in this high-风险 group benefit from supplemental screening.
    • Annual screening with digital mammography or tomosynthesis is recommended in this clinical setting
      • 从放射治疗后8年开始，而不是在25岁之前在10到30岁之间接受幔层放射治疗的患者.
      • In transmasculine individuals with familial breast cancer 风险, 建议每年进行一次乳房x光筛查，比确诊时患病亲属的年龄早10年，但不能早于30岁, as their breast cancer 风险 is similar to cisgender women.
      • Supplemental screening with breast MRI is appropriate in this population, 除了每年的乳房x光检查.
      • Supplemental screening with breast ultrasound may be appropriate in this population.