Breast Cancer, Risk Reduction
Conditions
Keywords
Transgender, Gender Diverse, Nonbinary, Risk Assessment, Mastectomy, Top Surgery
Brief summary
The population of transgender and gender-diverse (TGD) persons in Wisconsin and the U.S. is steadily increasing. As this population grows, the number of individuals seeking gender-affirming therapies, including gender-affirming operations and gender-affirming hormone therapy, is also growing. An example of gender-affirming surgery is chest masculinization surgery, in which most breast tissue is removed in a person assigned female or intersex at birth to allow the chest to appear masculine. Gender-affirming chest masculinization surgery is not generally considered equivalent to an oncologic mastectomy, which aims to removal all breast tissue for future breast cancer reduction or current breast cancer treatment. The goals of this investigation are to 1) determine the percent of TGD persons considering chest masculinization surgery who have an elevated lifetime risk of breast cancer development and/or a pathogenic genetic mutation; 2) measure the percent who are at risk and choose to undergo risk-reducing mastectomies as part of chest masculinization surgery; and 3) assess and compare self-perceived breast cancer risk with calculated risk. The results of this study will substantially inform TGD patients and surgeons on the utility of personalized breast cancer risk assessment prior to chest masculinization surgery and the accuracy of self-perceived breast cancer risk in TGD persons.
Interventions
DIAGNOSTIC_TESTBreast Cancer Risk Assessment
Gail and IBIS Tools will be utilized to calculate mean lifetime breast cancer risk
Sponsors
Medical College of Wisconsin
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. ≥18 years old. 2. Assigned female or intersex at birth and identify as non-cisgender. 3. Any individual considering undergoing gender-affirming chest masculinization surgery 4. Ability to communicate in English. 5. Ability to understand a written informed consent document, and the willingness to sign it.
Exclusion criteria
1. \<18 years old. 2. Assigned male sex at birth. 3. Previously underwent chest masculinization surgery or any form of oncological mastectomy for the purposes of risk-reduction or cancer treatment. 4. Any previous or current history of breast cancer, including ductal carcina in situ (DCIS). 5. Inability to communicate in English.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Estimated prevalence of TGD persons seeking chest masculinization surgery who at an elevated breast cancer risk. | 1 year | Validated breast cancer risk calculators (IBIS and Gail) will be used to determine lifetime breast cancer risk of participants enrolled into the study. Ranges and 95% CI will be made to estimate the percent of TGD persons at risk. |
| Rate of uptake of oncologic risk reducing mastectomies as part of chest masculinization surgery in TGD persons at risk of breast cancer based on validated models. | 1 year | To determine whether those TGD persons at elevated risk of breast cancer development choose to undergo risk-reducing mastectomies as part of their chest masculinization surgery. |
| Self-perceived breast cancer risk vs calculated breast cancer risk | 1 year | A visual analog scale from 0-100% will be used to compare and assess the self-perceived estimated breast cancer risk with calculated breast cancer risk. 13% is marked as the average cisgender women's risk of breast cancer and participants report their self-perceived risk as single whole integer (ex. 8%, 15%, 25%, etc.) on the scale from 0-100% where 0-12% represents below average risk person and 13-100% represent above average risk. |
Countries
United States
Outcome results
None listed