Angelina Jolie, Breast Cancer and the Transgender Community

Like me, I'm sure most of you have recently heard or read about Angelina Jolie's NYT article. Jolie has revealed that due to an 87% chance risk of developing breast cancer, she opted to have her breast removed, plummeting her chances of breast cancer to about 5%. Jolie is a carrier of the BRCA1 gene heavily linked to breast cancer, this gene put Jolie at the 87% risk of breast cancer development.

Some breast cancer gene info:

About 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.

Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two).

Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases.

You are substantially more likely to have an abnormal breast cancer gene if:
  • You have blood relatives (grandmothers, mother, sisters, aunts) on either your mother's or father's side of the family who had breast cancer diagnosed before age 50.
  • There is both breast and ovarian cancer in your family, particularly in a single individual.
  • There are other gland-related cancers in your family such as pancreatic, colon, and thyroid cancers.
  • Women in your family have had cancer in both breasts.
  • You are of Ashkenazi Jewish (Eastern European) heritage.
  • You are African American and have been diagnosed with breast cancer at age 35 or younger.
  • A man in your family has had breast cancer.

The average woman in the United States has about a 1 in 8, or a 12-13%, risk of developing breast cancer in her lifetime. Women who have an abnormal BRCA1 or BRCA2 gene (or both) can have up to an 80% risk of being diagnosed with breast cancer during their lifetimes. Breast cancers associated with an abnormal BRCA1 or BRCA2 gene tend to develop in younger women and occur more often in both breasts than cancers in women without these abnormal genes.

Women with an abnormal BRCA1 or BRCA2 gene also have an increased risk of developing ovarian, colon, pancreatic, and thyroid cancers, as well as melanoma.

  • ATM: The ATM gene helps repair damaged DNA. DNA carries genetic information in cells. Inheriting two abnormal copies of this gene causes the disease ataxia-telangiectasia, a rare disease that affects brain development. Inheriting one abnormal ATM gene has been linked to an increased rate of breast cancer in some families because the abnormal gene stops the cells from repairing damaged DNA.

  • p53 (also called the TP53 gene): The p53 gene provides instructions to the body for making a protein that stops tumor growth. Inheriting an abnormal p53 gene causes Li-Fraumeni syndrome, a disorder that causes people to develop soft tissue cancers at a young age. People with this rare syndrome have a higher-than-average-risk of breast cancer and several other cancers, including leukemia, brain tumors, and sarcomas (cancer of the bones or connective tissue).

  • CHEK2: The CHEK2 gene also provides instructions for making a protein that stops tumor growth. Li-Fraumeni syndrome also can be caused by an inherited abnormal CHEK2 gene. Even when an abnormal CHEK2 gene doesn't cause Li-Fraumeni syndrome, it can double breast cancer risk.

  • PTEN: The PTEN gene helps regulate cell growth. An abnormal PTEN gene causes Cowden syndrome, a rare disorder in which people have a higher risk of both benign (not cancer) and cancerous breast tumors, as well as growths in the digestive tract, thyroid, uterus, and ovaries.

  • CDH1: The CDH1 gene makes a protein that helps cells bind together to form tissue. An abnormal CDH1 gene causes a rare type of stomach cancer at an early age. Women with an abnormal CDH1 gene also have an increased risk of invasive lobular breast cancer.

  • Genetic testing

    There are genetic tests available to determine if someone has an abnormal BRCA1 or BRCA2 gene. A genetic counselor also may order testing for an abnormal ATM, p53, CHEK2, PTEN, or CDH1 gene if it's determined from your personal or family history that these tests are needed.

    Despite a drop in breast cancer in very recent years, due to long term studies that proved hormones raised breast cancer/cancer rates in pre menopausal women using birth control and post menopausal women using HRT (hormone replacement therapy), breast cancer still remains the second leading cause of death in women.

    Given all the facts above, I have yet to see where genetic testing is part of the medical process on females seeking transition BEFORE they are given high doses of cancer cause hormones. Testosterone is the quick, cheap and easy first step in transition. There are countless trans females with breasts intact on testosterone for YEARS because they cannot afford to have the surgery to remove them. How many of these women has the medical community tested for cancer genes??? The answer is NONE. The ONLY exception would be IF a female seeking transition insisted that that be part of her medical care. How many women seeking transition have asked to be tested for cancer genes? NONE! Females seeking transition would be too afraid to request cancer gene testing because they might not get their precious "T script." But it shouldnt be up to them, it should be up to the medical community (FIRST DO NO HARM) claiming care for their well being! Rather than collude with hetero patriarchy in normalizing lesbians (primarily) via transition!

    Even in trans females who have had their breast removed pre testosterone (rare), once they begin using high doses of testosterone, cancer gene or no cancer gene, they still run the risk of breast cancer in the remaining breast tissue left. AND if they do have breast cancer genes, the drop in possible breast cancer risk to 5% from breast removal, immediately goes up with every injection from testosterone therapy, which is ongoing for the rest of the patient's life.

    I have a sickening feeling the female Trans Trender community in 20 years time (or less) will resemble gay male communities in the 80's during the AIDS crisis. And the medical community responsible for the crisis will conveniently exempt itself by saying these women chose to transition.



    1. Am I missing something? I haven't heard of a single transitioner developing breast cancer. Statistically it's likely *someone* will, but post-mastectomy there's very little breast tissue for cancer to develop in. And a lump may be even easier to detect early when the chest is flat. I mean, this is one of your weirder posts. Haven't you ever heard of choosing your battles?

    2. You might want to bone up on your lack of info. And fighting misogyny IS my battle.


    3. From the NYT "About 75% of breast cancers are estrogen receptor-positive (ER-positive, or ER+). About 65% of ER-positive breast cancers are also progesterone receptor-positive (PR-positive, or PR+)."

      So not sure where the links to FTM HRT fit in with your "analysis".

      It would seem that the primary risk a transman might experience for breast cancer is if his testosterone levels were consistently too high and were aromatizing into estrogen. However, post mastectomy it would seem that transmen's risk of breast cancer would be no greater than cisgender mens risk who also experience aromatization and increased estradiol.

      It would seem that the post-mastectomy the healthcare focus should be placed on encouraging transmen to consider the risks/benefits of retaining/removing their uterus, cervix, and ovaries.

      Additionally, trans healthcare providers need to be monitoring hormone levels, lipid panels, metabolic panels, and CBC profiles of their patients to ensure the full picture of a patient's health and healthcare needs. These tests are routine for many non-trans patients too.

      Yet again, the facts are obscured in your tirades.



    5. I know this is not statistical, but both the people I know who have transitioned (from M to F) have died of cancer. Both were relatively young and diagnosed past the point where the cancers, in multiple sites, were operable. Supposedly both were being regularly monitored medically: nevertheless in both cases the cancers were either missed or developed so rapidly they did not show up until well entrenched.

      It's anecdotal, obviously, but it sends a shiver down my spine.

    6. I've personally known one lesbian, one bisexual women, one gay man, one straight man and two straight women who had cancer. I don't know any transpeople with cancer, but I'm sure it'll come up. Again, a statistical probability. All told, the drinking and smoking and obesity in the LGBT community will probably kill more people by far than hormones will kill transpeople. But it's not like you'd see Dirt go on some campaign about that. She actually cares less about lesbian women than she does about hating and trying to cut down transmen. What a pathetic waste of energy.

    7. It seems to me that we simply do not know what all the risks of long term use of an exogenous source of hormones in females. I AM NOT A PHYSICIAN AND THE PERSON KNOWN AS DIRT IS NOT A PHYSCIAN EITHER. Having said this, I'm not convinced that years of synthetically produced hormones is good for anyone in the long run.

      From the NYT "About 75% of breast cancers are estrogen receptor-positive (ER-positive, or ER+). About 65% of ER-positive breast cancers are also progesterone receptor-positive (PR-positive, or PR+)."

      Apparently, this person doesn't understand basic science because the female body tends to convert excess testosterone into estrogen. This is not new science. Females naturally produce very small amounts of testosterone. It's a delicate balancing act that is constantly going on in the human body. I am not assuming that all FTMs get their testosterone levels properly monitored all the time.

      Susan G. Komen....excellent source of information on breast cancer

      "Introduction: Androgens (such as testosterone) are natural hormones. They are important in sexual development in both men and women. In women, androgens are produced in small amounts by the ovaries and the adrenal glands. Similar to higher blood estrogen levels, higher amounts of androgens in the blood may be linked to an increased risk of breast cancer in women.


      Of the androgens that have been studied in relation to breast cancer risk, the most data are available for testosterone. Studies show higher blood levels of testosterone may increase the risk of breast cancer in postmenopausal women. And, although findings are limited, there is some evidence that higher blood levels of testosterone may also increase breast cancer risk in premenopausal women. "

      This is a good link on androgens and breast cancer.

    8. "Am I missing something? I haven't heard of a single transitioner developing breast cancer. Statistically it's likely *someone* will, but post-mastectomy there's very little breast tissue for cancer to develop in. And a lump may be even easier to detect early when the chest is flat. I mean, this is one of your weirder posts. Haven't you ever heard of choosing your battles?"

      "Top surgery" might lessen the odds of developing breast cancer, but it does NOT prevent all breast cancer. Even with prophylactic mastectomy, not all breast tissue cells are removed.

      Question: If we know that prophylactic mastectomy isn't a 100% guarantee that a person won't get breast cancer, how can people say the "top surgery" is? Men can get breast cancer. Aren't the goals and procedures of "top surgery" and "prophylactic mastectomy" different in that one is to cosmetically produce a "masculine chest" whereas the other is to remove breast tissue as a preventative measure. SURGEONS AREN'T GOING TO PERFORM PROPHYLACTIC MASTECTOMY WITHOUT THE BRACA GENE AND A VERY STRONG FAMILY HISTORY.


    9. "Am I missing something? I haven't heard of a single transitioner developing breast cancer. Statistically it's likely *someone* will, but post-mastectomy there's very little breast tissue for cancer to develop in. And a lump may be even easier to detect early when the chest is flat. I mean, this is one of your weirder posts. Haven't you ever heard of choosing your battles?"

      If people got their heads cut off, they wouldn't get brain cancer either. Or, if people got their healthy legs cut off, I'm sure they wouldn't get bone cancer. At least, not in one of their legs. If everyone got 'preventative appendectomies', no one would ever get appendicitis. Indeed, we could apply this logic to any part of the human anatomy. That is, if we remove such and such, our risk of cancer surely goes down.

      Of course, people have to factor in the reality that surgery itself always comes with certain risks. There are also issues of hospital acquired infections. A patient sure as heck doesn't want a drug resistance HAI (healthcare associated infection).

      Approximately 1 out of every 20 hospitalized patients will contract an HAI. (CDC)



      Harvard Health....

      "Jolie underwent what’s called a prophylactic double mastectomy. That means she had both of her breasts removed even though she hadn’t been diagnosed with breast cancer. She said she did this because she carries a gene, called BRCA1, that significantly increases the odds of developing breast or ovarian cancer.

      A related gene, BRCA2, also greatly boosts the chances of developing breast cancer. (Men with these mutations also have an increased risk of breast cancer.) You can learn more about BRCA1 and BRAC2 at the National Cancer Institute’s website.

      In the general population, about 12 out of 100 women (12%) will develop breast cancer at some point during their lives. Among women who have inherited a harmful mutation in BRCA1 or BRCA2, 60 out of 100 (60%) will develop breast cancer. Women who have at least two close relatives—a mother, sister, or daughter—who have had breast or ovarian cancer are also at much higher risk. (Jolie’s mother died of ovarian cancer at age 56.) These women are good candidates for prophylactic mastectomy.

      A University of Michigan study showed that nearly three-quarters of women who opted to have prophylactic mastectomy were actually at very low risk of developing cancer in the healthy breast. According to the researchers, those women didn’t have a good medical reason for doing it and were “not expected to benefit in terms of disease-free survival.”

    11. "Cancer experts also cautioned that there is no need for women without family histories to undergo routine genetic testing for BRCA genes (Wall Street Journal, 5/14). They stressed that Jolie's condition is atypical; BRCA-related mutations are estimated to cause only 5% to 10% of breast cancers in the U.S.

      "It's important to make it clear that a BRCA mutation is a special, high-risk situation," said Monica Morrow, chief of the breast service at Memorial Sloan-Kettering. For women at very high risk, preventive surgery is advised, but few women fall into that category, she said (New York Times, 5/14).

      Otis Brawley, chief medical officer of the American Cancer Society, in a statement said, "While only a small number of breast cancers are linked to known genetic risk factors, women facing such a high risk need to know that, and need to be able to discuss their options with genetic specialists and knowledgeable health professionals so they can have all the information and expertise at their fingertips to do what's right for them." However, "[t]his does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer," Brawley added (Sun, Washington Post, 5/14).


      (1.) Jolie carries the BRCA1 gene. It's been diagnosed and the science is clear. There is overwhelming scientific research that says that she has a high risk of developing breast cancer and a moderate risk of ovarian cancer (See graph). Jolie’s mother died of ovarian cancer at age 56.

      (2.) FTMs essentially get their healthy breasts removed because of a psychiatric diagnosis.

      There is NO lab test for (2.).

      It really isn't something that can be precisely quantified. It's not something that we can pick up and examine. It all goes by how people say they feel.

    13. Sorry, BRCA1 Mutation Carrier...

      High Risk of Breast Cancer and a High Risk of Ovarian Cancer...

      Strength of Evidence

      +++ Multiple studies demonstrated association and are relatively consistent.

      Magnitude of Absolute Risk
      Breast (female) High
      Ovary, fallopian tube, peritoneum High

    14. "All told, the drinking and smoking and obesity in the LGBT community will probably kill more people by far than hormones will kill transpeople."

      This could be true for all I know. It took the medical community decades before they came to the conclusion that the old standard practice of giving HRT to all post menopausal women wasn't too wise after all.

      As to people who smoke or eat too much, I'm sure that there are quite a few trans identified people who smoke, drink, or are overweight. If there are NO trans people who smoke, drink, or are overweight, then they really must be special people.


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