Risque sénologique chez les patients transgenres : à propos des recommandations américaines sur le dépistage des néoplasies mammaires

Abstract

Transgender patients have a poorly understood breast cancer risk despite their growing number and social acceptance. Epidemiological data are generally extrapolated from cisgender and postmenopausal women. A transgender woman is the result of the transition from male to female. These patients will benefit from hormone therapy based on estradiol in order to acquire female secondary sex characteristics. The incidence of breast neoplasia is similar to that of cisgender men. Nevertheless, it has later onset than for cisgender women and is often discovered at a more advanced stage. After the age of 50 years-old and after 5 years of hormone therapy, transgender women can benefit from a screening mammogram without a clearly defined rhythm. A transgender man is the result of the transition from female to male. These patients will benefit from hormone therapy based on testosterone in order to acquire male secondary sex characteristics. These patients can benefit from a total and bilateral mastectomy with nipple transplant called “top surgery”. Depending on family risk factors, the surgeon can prescribe a preoperative assessment, remaining at his discretion. Without breast surgery, only conventional biennial screening is admitted. Some guidelines recommend an annual clinical examination of the chest wall if “top surgery” has been done. Radiologists must know the specifics related to management of transgender patients for better care.