背景:性别确认睾酮治疗(TT)对乳腺癌风险的影响尚不清楚。这项研究调查了跨男性个体(TMI)中TT与乳腺组织组成和乳腺组织密度之间的关联。
方法:在2013年至2019年期间接受胸部轮廓手术的444个TMI中,病理学家在425个TMI中评估了乳腺组织组成(小叶萎缩和基质组成的类别),并使用我们的自动化深度学习算法(百分比上皮,%纤维基质,和%脂肪)。444个TMI中有42个在手术前进行了乳房X线照相术,放射科医生读取了它们的乳腺组织密度。乳房X线摄影数字文件,适用于25/42TMI,使用LIBRA软件进行分析以获得百分比密度,绝对密集区域,和绝对非密集区域。线性回归用于描述TT使用持续时间与乳腺组织组成或乳腺组织密度测量值之间的关联。同时调整潜在的混杂因素。还进行了按体重指数分层的分析。
结果:长期使用TT与小叶萎缩程度增加有关(p<0.001),但与纤维含量无关(p=0.82)。每6个月的TT与上皮(exp(β)=0.97,95%CI0.95,0.98,调整p=0.005)和纤维基质(exp(β)=0.99,95%CI0.98,1.00,调整p=0.05)的数量减少有关,但不是脂肪(exp(β)=1.01,95CI0.98,1.05,adjp=0.39)。在超重/肥胖TMI中,TT对乳腺上皮的影响减弱(exp(β)=0.98,95%CI0.95,1.01,adjp=0.14)。比较TT用户和非用户时,TT使用者的上皮减少了28%(exp(β)=0.72,95%CI0.58,0.90,adjp=0.003)。TT与放射科医师的乳腺密度评估(p=0.58)或LIBRA测量值(p>0.05)无相关性。
结论:TT减少乳腺上皮,但这种效应在超重/肥胖TMI中减弱。TT有可能影响TMI的乳腺癌风险。需要进一步的研究来阐明TT对乳腺密度和乳腺癌风险的影响。
BACKGROUND: The effect of gender-affirming
testosterone therapy (TT) on breast cancer risk is unclear. This study investigated the association between TT and breast tissue composition and breast tissue density in trans masculine individuals (TMIs).
METHODS: Of the 444 TMIs who underwent chest-contouring surgeries between 2013 and 2019, breast tissue composition was assessed in 425 TMIs by the pathologists (categories of lobular atrophy and stromal composition) and using our automated deep-learning algorithm (% epithelium, % fibrous stroma, and % fat). Forty-two out of 444 TMIs had mammography prior to surgery and their breast tissue density was read by a radiologist. Mammography digital files, available for 25/42 TMIs, were analyzed using the LIBRA software to obtain percent density, absolute dense area, and absolute non-dense area. Linear regression was used to describe the associations between duration of TT use and breast tissue composition or breast tissue density measures, while adjusting for potential confounders. Analyses stratified by body mass index were also conducted.
RESULTS: Longer duration of TT use was associated with increasing degrees of lobular atrophy (p < 0.001) but not fibrous content (p = 0.82). Every 6 months of TT was associated with decreasing amounts of epithelium (exp(β) = 0.97, 95% CI 0.95,0.98, adj p = 0.005) and fibrous stroma (exp(β) = 0.99, 95% CI 0.98,1.00, adj p = 0.05), but not fat (exp(β) = 1.01, 95%CI 0.98,1.05, adj p = 0.39). The effect of TT on breast epithelium was attenuated in overweight/obese TMIs (exp(β) = 0.98, 95% CI 0.95,1.01, adj p = 0.14). When comparing TT users versus non-users, TT users had 28% less epithelium (exp(β) = 0.72, 95% CI 0.58,0.90, adj p = 0.003). There was no association between TT and radiologist\'s breast density assessment (p = 0.58) or LIBRA measurements (p > 0.05).
CONCLUSIONS: TT decreases breast epithelium, but this effect is attenuated in overweight/obese TMIs. TT has the potential to affect the breast cancer risk of TMIs. Further studies are warranted to elucidate the effect of TT on breast density and breast cancer risk.