The transgender population face inequalities throughout the cancer pathway. Much of this stems from a lack of access to specialist knowledge of gender-affirming care and how it intersects with cancer. Breast cancer care in particular presents challenges for both patients and clinicians given the interaction with sex hormones , potential to exacerbate dysphoria and differing management in cisgender men vs. cisgender women. Breast cancer risk remains of concern in trans people. The best estimate of breast cancer incidence is trans men and non-binary people assigned female at birth (TMNB) is only 5 times less than in cisgender women. In trans women and non-binary people assigned male at birth (TFNB) the incidence is only 3 times less than in cisgender women. However cancer registries in most countries fail to accurately record gender identity and trans status.
In response to this need, we established the UK Cancer and Transition Service (UCATS), a national multidisciplinary team meeting and clinic where any transgender patient with active or historical cancer can access specialist advice and support. This was coproduced with patient and public involvement and input from a specialist cancer charity.
We discuss 6 cases of breast cancer in TMNB where cancer and gender-affirming care were mutually impacted by each other. Two of these lead to the establishment of UCATS and a further 4 were managed by the service. Challenges experienced by patients and clinicians included access to satisfactory reconstructive options, access to and management of gender-affirming hormones, and choice of anti-oestrogenic therapy.
We recommend introduction similar services internationally and inclusion of gender identity and trans status in cancer registries to improve data collection on cancer risk. Further research is required on the use of gender-affirming hormones in hormone receptor-positive breast cancer in adjuvant and metastatic settings.
Chelsea and Westminster Hospitals NHS Trust.
Has not received any funding.
All authors have declared no conflicts of interest.