Grading of Recommendations Assessment, Development and Evaluation (GRADE) summary of findings table for the effect of exposure to cross-sex hormones on breast cancer risk, prognosis and mortality in trans people (review 1)
| Population: trans people aged 16–83 yr Intervention: cross-sex hormone therapy | |||
|---|---|---|---|
| Outcome; population | Effect | No. of exposed participants (no. of studies) | Certainty of evidence (GRADE) |
| Trans men exposed to testosterone | |||
| Breast cancer risk* | Differences in incidence rate or cumulative incidence between exposed cohorts and nonexposed cohorts or general population samples were not statistically significant or were not reported† | 1069 (3)20–22 | ⊕○○○ Very low‡§ |
| Stage at diagnosis | No primary research evidence identified | ||
| Survival | |||
| Breast cancer mortality | |||
| Trans women exposed to estrogen only, androgen deprivation or antiandrogens only, or estrogen with androgen deprivation or antiandrogens | |||
| Breast cancer risk* | Differences in incidence rate or cumulative incidence between exposed cohorts and general population samples were not statistically significant or were not reported† | 3419 (2)20,21 | ⊕○○○ Very low‡§ |
| Stage at diagnosis | No primary research evidence identified | ||
| Survival | |||
| Breast cancer mortality | |||
↵* Assessed with the use of administrative database or medical records, with follow-up not reported or at a minimum of 6 years after cross-sex hormone therapy started.
↵† We did not calculate a single pooled effect estimate. Additional information and detailed results for each study are provided in
Supplementary Table S4, Appendix 4.
↵‡ Very low certainty rating = we have very little confidence in the effect estimate, and the true effect is likely to be substantially different from the effect estimate.
↵§ The evidence was downgraded owing to the observational nature of the study designs and serious concerns regarding risk of bias, indirectness and imprecision.
Detailed Grading of Recommendations Assessment, Development and Evaluation assessments are provided in Supplementary Table S5, Appendix 4.