Breast cancer in a transgender man

Abstract

A 52-year-old transgender man presented for evaluation of a new diagnosis of breast cancer. The patient was designated female at birth. Three months after initiation of gender-affirming hormone therapy (GAHT) with testosterone gel, he underwent bilateral mas-tectomy for gender affirmation. Final pathology revealed a left-sided, pathologic T1 tumor (pT1) that was identified as grade 2 invasive ductal carcinoma and as estrogen receptor (ER)-positive, proges-terone receptor-negative, and human epidermal growth factor receptor 2 (HER2)-negative by immunohistochemistry (score, 1þ). The patient reported no preoperative symptoms of breast lumps or any changes to the skin of the breast or the nipples. He had a past medical history of Barrett esophagus, depression, and orthopedic surgeries. He had no history of chest irradiation. Family history was negative for breast or ovarian cancer. Of note, he had a negative screening mammogram performed 5 years earlier; repeat screening had not been obtained.