CA: A Cancer Journal for Clinicians最新文献

{"title":"Treating EGFR-mutant nonsmall cell lung cancer is no longer a one-size-fits-all approach","authors":"Lauren J. Antrim MD, Jyoti Malhotra MD, MPH","doi":"10.3322/caac.70027","DOIUrl":"10.3322/caac.70027","url":null,"abstract":"<p>Just over 2 decades ago, Lynch et al. published a landmark article in which they elucidated that activating mutations in the epidermal growth factor receptor (<i>EGFR</i>) positively correlated with clinical responses to the first-generation tyrosine kinase inhibitor (TKI), gefitinib, in patients with nonsmall cell lung cancer (NSCLC).<span><sup>1</sup></span> Although estimates vary, it is believed that up to one third of cases of NSCLC may harbor these mutations.<span><sup>2</sup></span> Over the last 20 years, great strides have been made to improve both the efficacy and the tolerability of therapies targeting EGFR, with fourth-generation EGFR TKIs in development. In this edition of <i>CA: A Cancer Journal for Clinicians</i>, Borgeaud et al. provide an exceptionally detailed review of <i>EGFR</i>-mutant NSCLC that describes the molecular underpinnings of this oncogenic driver, discusses modern treatment approaches, and explores the gamut of clinical situations that can be encountered while treating a patient with <i>EGFR</i>-mutant NSCLC.<span><sup>3</sup></span></p><p>Although Borgeaud and colleagues explicitly do not cover the management of <i>EGFR</i> exon 20 insertions, they do provide some brief insights into P-loop and αC-helix compressing (PACC or <i>uncommon</i>) mutations and present a comprehensive review that can be a useful tool for clinicians treating patients with <i>common</i> <i>EGFR</i> mutations (L858R, exon 19 deletions) across all stages of presentation. Studies investigating the effectiveness of immunotherapy and vascular endothelial growth factor (VEGF) inhibitors to early phase trials targeting potential acquired mutations on EGFR TKIs are detailed. For clinicians treating patients with early stage or locally advanced NSCLC, their article analyzes pivotal studies, such as ADAURA and LAURA (ClinicalTrials.gov identifiers NCT02511106 and NCT03521154, respectively), which led to osimertinib (third-generation TKI) becoming the standard of care in the adjuvant and postchemoradiation setting, respectively.<span><sup>4, 5</sup></span> Furthermore, crucial ongoing studies are highlighted, such as NeoADAURA (ClinicalTrials.gov identifier NCT04351555), which is investigating the incorporation of osimertinib in the neoadjuvant setting.<span><sup>6</sup></span> Potential considerations for less straight-forward situations, such as metastatic recurrence while on or after adjuvant osimertinib, are also discussed.</p><p>In recent years, treatment of <i>EGFR</i>-mutant NSCLC in the metastatic setting has grown increasingly complex, with multiple treatment regimens now approved. Borgeaud et al. provide a detailed overview of available first-line regimens and important treatment considerations. With the initial publication of the FLAURA trial (ClinicalTrials.gov identifier NCT02296125) in 2017 and subsequent study updates, osimertinib became the clear choice for first-line systemic therapy in the metastatic setting, with an improvement","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 5","pages":"373-375"},"PeriodicalIF":232.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary assessment of patients with extensive stage small cell lung cancer: A geriatric tumor board.","authors":"Humera Khurshid,Sakeena Raza,Robert Brunault,Brittany Duffy,Michael Kavanaugh","doi":"10.3322/caac.70026","DOIUrl":"https://doi.org/10.3322/caac.70026","url":null,"abstract":"","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"721 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr Harmon Eyre, MD (1941–2025)","authors":"John R. Seffrin PhD, Otis W. Brawley MD","doi":"10.3322/caac.70025","DOIUrl":"10.3322/caac.70025","url":null,"abstract":"<p>Dr Harmon Eyre, a much-respected figure of the American Cancer Society (ACS), passed away on May 31, 2025, in Salt Lake City. He was 84 years old.</p><p>Dr Eyre started with the ACS as a volunteer in 1971 and joined the ACS national board in 1978. He became its national volunteer president in 1988 and, from 1993 to 2008, served as the Chief Medical Officer and the Editor-in-Chief of <i>CA: A Cancer Journal for Clinicians.</i></p><p>During his tenure, he increased the effectiveness of the ACS by elevating an emphasis on cancer control and the recruitment of world-class scientists into this ACS research program. In time, it would become one of the leading cancer epidemiology and surveillance groups worldwide. These nascent efforts would bring about one of the most influential and effective cancer surveillance and epidemiology programs in the world.</p><p>Under Dr Eyre's stewardship, the Cancer Prevention Study 3 (CPS-3) launched in 2006. The CPS-3 cohort was designed to help the ACS understand the differences between people who get cancer and people who don’t get cancer by utilizing participant recruitment strategy to achieve greater racial and ethnic diversity and collecting biospecimens for molecular epidemiology research. It continues to provide insights into the causes of cancer today and is likely to continue to bear fruit well into the 2030s.</p><p>Dr Eyre was instrumental in ensuring continuous support in the pursuit of cancer-related research. For example, in response to federal reductions in funding of grants available to early career investigators in the 1990s, he effectively convinced the ACS board to shift the ACS research program's emphasis with greater support for such researchers. In addition, he led the ACS’s efforts to sponsor tobacco-control grants at a time when federal sponsorship was waning.</p><p>Dr Eyre also contributed to several ACS guidelines on cancer screening and prevention. For example, he led the ground-breaking prostate cancer screening process, which followed the ACS's organization of a review of the scientific literature and a gathering of external experts in the areas of both screening and treatment for prostate cancer. The ultimate recommendation called for informed decision making between the patient and the physician. It acknowledged the legitimate concerns about over-screening and overtreatment of the disease but also the hope that prostate cancer screening might save lives. Although released in 1997, it remains highly relevant today and serves as the basis for contemporary prostate cancer screening guidelines and statements from numerous organizations in the United States, Canada, and Europe.</p><p>Other ACS guidelines implemented under Dr Eyre include the colorectal screening guideline, which added screening colonoscopy, and the 2002 cervical cancer screening guideline, which added human papillomavirus DNA testing. Dr Eyre went on to write a book entitled <i>Informed Decisions</i>. Together with his work ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 5","pages":"371-372"},"PeriodicalIF":232.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized care for patients with EGFR-mutant nonsmall cell lung cancer: Navigating early to advanced disease management","authors":"Maxime Borgeaud MD,&nbsp;Timothée Olivier MD,&nbsp;Jair Bar MD, PhD,&nbsp;Stephanie Pei Li Saw MD, PhD,&nbsp;Kaushal Parikh MD,&nbsp;Giuseppe Luigi Banna MD,&nbsp;Claudio De Vito MD, PhD,&nbsp;Jill Feldman,&nbsp;Xiuning Le MD, PhD,&nbsp;Alfredo Addeo MD","doi":"10.3322/caac.70024","DOIUrl":"10.3322/caac.70024","url":null,"abstract":"<p>The discovery of activating mutations in the epidermal growth factor receptor (<i>EGFR</i>) gene has revolutionized the management of lung cancer, enabling the development of targeted tyrosine kinase inhibitors (TKIs). These therapies offer improved survival and reduced side effects compared with conventional treatments. Recent advancements have significantly reshaped the treatment paradigm for <i>EGFR</i>-mutant non-small cell lung cancer. TKIs are now incorporated into the management of early stage and locally advanced disease, and phase 3 trials have explored combination strategies in metastatic settings. Although these intensified approaches improve progression-free survival, they come with increased toxicity and higher costs, underscoring the need for precise patient selection to maximize benefit. Emerging data on biomarkers, such as co-mutations and circulating tumor DNA, show promise for refining treatment decisions. In addition, significant progress in understanding resistance mechanisms to EGFR TKIs has broadened therapeutic options. This review provides a comprehensive overview of the current landscape of <i>EGFR</i>-mutant nonsmall cell lung cancer, highlighting recent breakthroughs and discussing strategies to optimize treatment based on the latest evidence.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 5","pages":"387-409"},"PeriodicalIF":232.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is active surveillance an alternative to surgery for some patients with esophageal cancer?","authors":"Carrie Printz","doi":"10.3322/caac.70023","DOIUrl":"10.3322/caac.70023","url":null,"abstract":"&lt;p&gt;Overall survival with active surveillance was noninferior to overall survival with surgery after 2 years for some patients with esophageal cancer who achieved a clinical complete response after neoadjuvant chemoradiotherapy, according to researchers.&lt;/p&gt;&lt;p&gt;Results from the phase 3, randomized study showed that the overall survival rate was 74% for patients undergoing active surveillance and 71% for patients having surgery.&lt;/p&gt;&lt;p&gt;The authors caution that their research will require extended follow-up to determine the long-term efficacy of active surveillance. Some esophageal surgeons have concerns about the trial’s design and findings.&lt;/p&gt;&lt;p&gt;Results of the Neoadjuvant Chemoradiotherapy Followed by Active Surveillance Versus Standard Surgery for Esophageal Cancer (SANO) trial appear in &lt;i&gt;The Lancet&lt;/i&gt; (doi:10.1016/S1470-2045(25)00027-0).&lt;/p&gt;&lt;p&gt;Kimberly Wilson, a survivor of stage IV esophageal cancer and patient advocate who underwent surgery in 2022, supports the study’s efforts to assess all potential treatment options for the disease.&lt;/p&gt;&lt;p&gt;“I believe very strongly in research supporting a wide variety of patients’ needs and perspectives to draw in the medical community’s ability to provide patients with multiple options,” says Wilson, a program specialist for the Esophageal Cancer Action Network, who had a total esophagectomy in 2022 after undergoing chemotherapy, radiation, and immunotherapy.&lt;/p&gt;&lt;p&gt;Unable to avoid surgery because of her advanced disease, Wilson says that she fits into the rare category of stage IV esophageal cancer “thrivers” who continue to live fairly regular lives—albeit at a slower pace.&lt;/p&gt;&lt;p&gt;“My stomach was pulled up to make what now functions as my esophagus,” she says. “Despite how challenging the surgery was, I would do it again.”&lt;/p&gt;&lt;p&gt;The phase 3, randomized SANO trial is a multicenter study of patients in 12 Dutch hospitals. The research was conducted between November 2017 and January 2021. Participants had locally advanced esophageal cancer and a clinical complete response after chemoradiotherapy. After screening 1115 patients, researchers included 309 individuals: 198 participants went on active surveillance, whereas 111 had the standard surgery. The standard surgery was esophagectomy within the 2 weeks after a clinical complete response was achieved.&lt;/p&gt;&lt;p&gt;Seventy-eight percent of the participants were male, and 22% were female. The primary end point was overall survival, which was analyzed according to a modified intention-to-treat principle allowing crossover at the time of clinical complete response and an intention-to-treat principle. The median follow-up was 38 months. Secondary end points included progression-free survival, health-related quality of life, and treatment-related morbidity and mortality.&lt;/p&gt;&lt;p&gt;The 2-year overall survival rate with active surveillance (74%) was noninferior to the rate with standard surgery (71%) after the modified intention-to-treat analysis. In the intention-to-treat ana","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 4","pages":"274-276"},"PeriodicalIF":232.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy-induced taste changes affect nutrition, quality of life","authors":"Carrie Printz","doi":"10.3322/caac.70022","DOIUrl":"10.3322/caac.70022","url":null,"abstract":"&lt;p&gt;Although chemotherapy helps to prevent cancer growth in many patients, it also can destroy healthy cells that may cause taste changes and appetite loss. Many patients experience taste alteration as a common symptom but do not report it, and health care professionals may overlook the condition because it is not life-threatening.&lt;/p&gt;&lt;p&gt;A Turkish study reported that 67.7% of participants treated with chemotherapy experienced a change in taste. Researchers also found that 21.8% of patients were at moderate risk for malnutrition. Quality of life was also diminished in correlation with the intensity of taste changes.&lt;/p&gt;&lt;p&gt;Researchers found that patients with oral mucositis, dry mouth, gingival sensitivity, and gingival pain had a significantly higher severity of taste alteration and poorer quality of life. The study appears in &lt;i&gt;Supportive Care in Cancer&lt;/i&gt; (doi:10.1007/s00520-025-09431-8).&lt;/p&gt;&lt;p&gt;The descriptive and cross-sectional study analyzed 330 patients, aged 18 years or older, who were receiving at least two outpatient chemotherapy treatments for cancer at a Turkish university hospital between March and June 2023. Participants were interviewed in person with the Descriptive Characteristics Form, the Chemotherapy-Induced Taste Alteration Scale, the Malnutrition Universal Screening Tool, and the World Health Organization Quality of Life Questionnaire.&lt;/p&gt;&lt;p&gt;More than half (57.6%) of the participants were 60 years old or older and female (51.8%). Thirty-seven percent of the participants were obese, 47.6% were smokers, and 27.6% had breast cancer; 39.7% were undergoing chemotherapy for five cycles or fewer, 40% were undergoing chemotherapy every 2 weeks, and 52% were not receiving any additional therapy.&lt;/p&gt;&lt;p&gt;Findings showed that 67.7% of the patients reported taste alterations of moderate severity, 77.9% had mouth sores, 88.5% had dry mouth, 83.9% had gingival sensitivity, and 17.9% had gingival pain. In the group, 21.8% were at moderate risk for malnutrition. More than half the patients (54.8%) lost weight after chemotherapy, and this correlated with significantly greater taste changes. Researchers identified a statistically significant correlation among taste alteration, malnutrition, and quality-of-life scores, with taste alteration being highly predictive of both conditions.&lt;/p&gt;&lt;p&gt;Taste alteration was higher in women than men and higher in patients with breast cancer than those with gastrointestinal, lung, urinary, or hematologic cancers. Taste alteration was lower in patients with a good or very good appetite in comparison with those with a poor or moderate appetite.&lt;/p&gt;&lt;p&gt;No statistically significant differences were found in taste alteration with age or the number of chemotherapy treatments between patients with a good or very good appetite and patients with a poor or moderate appetite.&lt;/p&gt;&lt;p&gt;Findings showed a statistically significant association between taste alteration and oral mucositis, dry mouth, gingival sensitivity and pain, r","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 4","pages":"271-273"},"PeriodicalIF":232.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contemporary management of prostate cancer.","authors":"Deep Chakrabarti, Peter Albertsen, Aidan Adkins, Amar Kishan, Vedang Murthy, Chris Parker, Angela Pathmanathan, Alison Reid, Oliver Sartor, Nicholas Van As, Jochen Walz, Alison Tree","doi":"10.3322/caac.70020","DOIUrl":"https://doi.org/10.3322/caac.70020","url":null,"abstract":"<p><p>Prostate cancer is the most common cancer in two thirds of the world, with an expected doubling in both incidence and mortality in the next two decades. No strong environmental associations exist for the development of prostate cancer; therefore, lifestyle measures are unlikely to mitigate this increasing burden. The last three decades have seen rapid developments in the diagnostic and therapeutic landscape of prostate cancer, including multiparametric magnetic resonance imaging, positron emission tomography, robotic surgery, image-guided hypofractionated and stereotactic radiotherapy, novel anti-androgens and radioligand therapies. Prostate cancer is unique in that not everyone with a diagnosis needs treatment, and active surveillance is the preferred option for some. This review discusses the contemporary management of all stages of prostate cancer in the light of these modern developments, enabling holistic individualization of treatment, and describes the promise of future research to further improve outcomes.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":" ","pages":""},"PeriodicalIF":503.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contemporary management of prostate cancer.","authors":"Deep Chakrabarti,Peter Albertsen,Aidan Adkins,Amar Kishan,Vedang Murthy,Chris Parker,Angela Pathmanathan,Alison Reid,Oliver Sartor,Nicholas Van As,Jochen Walz,Alison Tree","doi":"10.3322/caac.70020","DOIUrl":"https://doi.org/10.3322/caac.70020","url":null,"abstract":"Prostate cancer is the most common cancer in two thirds of the world, with an expected doubling in both incidence and mortality in the next two decades. No strong environmental associations exist for the development of prostate cancer; therefore, lifestyle measures are unlikely to mitigate this increasing burden. The last three decades have seen rapid developments in the diagnostic and therapeutic landscape of prostate cancer, including multiparametric magnetic resonance imaging, positron emission tomography, robotic surgery, image-guided hypofractionated and stereotactic radiotherapy, novel anti-androgens and radioligand therapies. Prostate cancer is unique in that not everyone with a diagnosis needs treatment, and active surveillance is the preferred option for some. This review discusses the contemporary management of all stages of prostate cancer in the light of these modern developments, enabling holistic individualization of treatment, and describes the promise of future research to further improve outcomes.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"27 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urothelial carcinoma: Perioperative considerations from top to bottom","authors":"Wesley Yip, Salvador Jaime-Casas, Anjaney Kothari, Mary Sullivan, Leslie K. Ballas, Domenique Escobar, Anne K. Schuckman, Jonathan E. Rosenberg, Jonathan A. Coleman","doi":"10.3322/caac.70019","DOIUrl":"https://doi.org/10.3322/caac.70019","url":null,"abstract":"Urothelial carcinoma is an aggressive entity that is associated with significant morbidity, but there have been major advances in both our understanding of and treatment options for patients with this disease. In this review, the authors focus on novel therapeutic and diagnostic approaches in the perioperative setting, with an emphasis on patient-centered and individualized care. For urothelial carcinoma of the bladder (UCB), advances in nonplatinum-based therapies, specifically immunotherapy and antibody–drug conjugates, have expanded the therapeutic arsenal for patients with muscle-invasive UCB in both the neoadjuvant and adjuvant settings to improve survival outcomes. Given the significant morbidity of extirpative surgery (radical cystectomy and urinary diversion), there have also been greater efforts to evaluate bladder-sparing protocols and improve the selection of patients for surgery and their postoperative recovery. The authors review special considerations for organ-sparing surgery in females, geriatric co-management, and enhanced recovery after surgery protocols. For upper tract urothelial carcinoma, there has been increasing recognition of its unique diagnostic and therapeutic challenges, including risks of renal functional loss. There have been advances in molecular profiling that have demonstrated various genomic differences between upper tract urothelial carcinoma and UCB, with treatment implications. This article reviews studies evaluating perioperative care that focused on optimizing therapeutic approaches, including neoadjuvant/adjuvant chemotherapy and immunotherapy, as well as nephron-sparing strategies in carefully selected cases.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"10 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer in a transgender man","authors":"Alison May Berner BA(Hons), MBBS, MSc, PhD, MRCP,&nbsp;Tristan Michael MacKenzie MTH, MHR,&nbsp;Shirish Kulkarni MBBS, MRCP,&nbsp;Chin Chong BSc(Hons), MBBS, MRCGP,&nbsp;Loren Schechter MD,&nbsp;Caroline Michie MBChB, FRCPE,&nbsp;Ole-Petter Riksfjord Hamnvik MB, BCh, BAO, MMSc, MRCPI","doi":"10.3322/caac.70021","DOIUrl":"10.3322/caac.70021","url":null,"abstract":"&lt;p&gt;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 mastectomy 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, progesterone receptor-negative, and human epidermal growth factor receptor 2 (HER2)-negative by immunohistochemistry (score, 1+). 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.&lt;/p&gt;&lt;p&gt;This patient's presentation as a transgender man with incidentally found breast cancer raises several considerations regarding his gender-related health needs. An overview of frequently used terms in gender health and recommendations on how best to deliver quality cancer care to transgender and gender-diverse (TGD) individuals is provided in a 2025 review by Cathcart-Rake et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For many TGD individuals, gender-affirming medical interventions are an important component of addressing gender incongruence and alleviating gender dysphoria.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; For trans men, a key intervention is GAHT with testosterone gel or injections.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Testosterone treatment leads to suppression of the hypothalamic–pituitary–ovarian axis, which reduces estrogen and progesterone production and leads to cessation of menses. In addition, numerous physical changes are seen after 1–2 years of testosterone treatment, including voice deepening, increased facial and body hair growth, clitoromegaly, fat redistribution, and increased muscle mass (Figure 1). Such treatment has been associated with lower rates of depression, gender dysphoria, and suicidality.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; For example, in one study&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; of 64 TGD patients seeking GAHT with testosterone, early treatment with testosterone was found to significantly relieve gender incongruence, depression, and suicidal ideation within 3 months of treatment (Figure 2).&lt;/p&gt;&lt;p&gt;Several studies have attempted to elucidate the risk of breast cancer in transgender populations, and the results generally indicate that transgender men have a lower breast cancer risk than cisgender women, but it is higher than the risk for cisgender men.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; The reduced risk compared with cisgender women has largely been attributed to the effect of gender-affirming mastectomy leading to a lower volume of tissue susceptible to developing breast cancer, ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 5","pages":"376-386"},"PeriodicalIF":232.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}