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Parpex G, Ottaviani M, Lorphelin H, Mezzadri M, Marchand E, Cahen-Doidy L, Benifla JL, Huchon C, Mimoun C. Accuracy of sentinel lymph node biopsy in male breast cancer: Systematic review and meta-analysis. Breast 2024; 75:103703. [PMID: 38461570 PMCID: PMC10940173 DOI: 10.1016/j.breast.2024.103703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is commonly used in the surgical management of male breast cancer. Contrary to female breast cancer, limited data exist about its performance in male breast cancer. The objective of this systematic review and meta-analysis was to evaluate the SLNB accuracy in male breast cancer. METHODS MEDLINE, EMBASE, Web of Science and The Cochrane Library were searched from January 1995 to April 2023 for studies evaluating the SLNB identification rate and false-negative rate in male breast cancer with negative preoperative axillary evaluation and primary surgery. For SLNB false-negative rate, the gold standard was the histology of axillary lymph node dissection (ALDN). Methodological quality was assessed by using the QUADAS-2 tool. Pooled estimates of the SLNB identification rate and false-negative rate were calculated. Heterogeneity of the pooled studies was evaluated using I2 index. RESULTS A total of 12 retrospective studies were included. The 12 studies that reported the SLNB identification rate gathered a total of 164 patients; the 5 studies that reported the SLNB false-negative rate gathered a total of 50 patients with a systematic ALND. The pooled estimate of the SLNB identification rate was 99.0%. The SLNB false-negative rates were 0% in the 5 included studies and consequently so as the pooled estimate of the false-negative rate with no heterogeneity. CONCLUSION SLNB for male breast cancer, following negative preoperative axillary assessment and primary surgery, appears feasible, consistent, and effective. Our research supports conducting immediate SLNB histological evaluation to facilitate prompt ALND in case of positive results.
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Affiliation(s)
- Guillaume Parpex
- Paris Cité University, Paris, France; Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France.
| | - Marie Ottaviani
- Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Henri Lorphelin
- Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Matthieu Mezzadri
- Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Eva Marchand
- Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Laurence Cahen-Doidy
- Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Jean Louis Benifla
- Paris Cité University, Paris, France; Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Cyrille Huchon
- Paris Cité University, Paris, France; Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
| | - Camille Mimoun
- Paris Cité University, Paris, France; Department of Gynecology and Obstetrics, Breast Surgery Department, APHP, Lariboisière Hospital, Saint Louis Hospital, Paris, France
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2
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Vasconcelos de Matos L, Volovat S, Debiasi M, Cardoso F. Unfolding the role of the PI3K/AKT/MTOR pathway in male breast cancer: A pragmatic appraisal. Breast 2023; 72:103576. [PMID: 37696110 PMCID: PMC10507227 DOI: 10.1016/j.breast.2023.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
Breast cancer in men is rare, but a relevant public health issue, yielding a 25% higher risk of mortality comparing to female counterparts. The representation of males in clinical trials has been scarce and treatment decisions are based mainly on extrapolations from data in females. In the setting of estrogen-dependent metastatic disease, the use of everolimus has been seldom reported, although the PI3K/AKT/mTOR pathway seems to be a critical oncogenic driver. This paper dissects hallmark biological features of ER+/HER2-advanced male breast cancer, setting a comprehensive basis to promote personalized care, focusing on the potential of targeting the PI3K/AKT/mTOR pathway.
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Affiliation(s)
| | - Simona Volovat
- Department of Medical Oncology-Radiotherapy, Grigore T Popa University of Medicine and Pharmacy, Iași, Romania
| | - Marcio Debiasi
- Breast Unit, Champalimaud Clinical Centre / Champalimaud Foundation, Lisbon, Portugal
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre / Champalimaud Foundation, Lisbon, Portugal
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Clinicopathological features, genetic alterations, and BRCA1 promoter methylation in Japanese male patients with breast cancer. Breast Cancer Res Treat 2023; 197:593-602. [PMID: 36494460 PMCID: PMC9883318 DOI: 10.1007/s10549-022-06822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Male breast cancer (MBC) is a rare cancer accounting for only 1% of all male cancers and is, therefore, poorly studied. We aimed to characterize the subtypes of MBC in Japanese patients based on genetic profiling, the presence of tumor-infiltrating cells, and the expression of immunohistochemical markers. METHODS This retrospective study included 103 patients with MBC diagnosed between January 2009 and December 2019 at various hospitals in Japan. Clinicopathological patient characteristics were obtained from medical records, and formalin-fixed paraffin-embedded tissue specimens were analyzed for histological markers, mutations of 126 genes, BRCA1 methylation, and stromal tumor-infiltrating lymphocytes. RESULTS The median patient age was 71 (range 31-92) years. T1-stage tumors were the most frequent (47.6%), and most were node negative (77.7%). The majority of tumors were positive for estrogen receptor (98.1%), progesterone receptor (95.1%), and androgen receptor (96.1%), and BRCA2 was the most frequently mutated gene (12.6%). The most common treatment was surgery (99.0%), either total mastectomy (91.1%) or partial mastectomy (7.0%). Survival analysis showed a 5-year recurrence-free survival rate of 64.4% (95% confidence interval [CI] 46.7-88.8) and a 5-year overall survival rate of 54.3% (95% CI 24.1-100.0). CONCLUSION Japanese MBC is characterized by a high rate of hormonal receptor positivity and BRCA2 somatic mutation. Due to the observed clinicopathological differences in MBC between the Western countries and Japan, further prospective studies are needed to evaluate the most suitable treatment strategies.
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Appiah D, Mai M, Parmar K. A Prospective Population-Based Study of Cardiovascular Disease Mortality following Treatment for Breast Cancer among Men in the United States, 2000-2019. Curr Oncol 2022; 30:284-297. [PMID: 36661672 PMCID: PMC9857851 DOI: 10.3390/curroncol30010023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Male breast cancer is rare but its incidence and mortality are increasing in the United States, with racial/ethnic disparities in survival reported. There is limited evidence for cardiotoxicity of cancer treatment among men with breast cancer. We evaluated the relation between breast cancer treatment and cardiovascular disease (CVD) mortality among men and investigated the salient roles that race/ethnicity play on this relation. Data were from 5216 men with breast cancer aged ≥ 40 years from the Surveillance, Epidemiology, and End Results program who were diagnosed from 2000 to 2019 and underwent surgery. Competing risk models were used to estimate hazards ratios (HR) and 95% confidence intervals (CI). During a median follow-up of 5.6 years, 1914 deaths occurred with 25% attributable to CVD. In multivariable-adjusted models, men who received chemotherapy had elevated risk for CVD (HR: 1.55, 95%CI: 1.18-2.04). This risk was higher among Hispanic men (HR: 3.96, 95%CI: 1.31-12.02) than non-Hispanic Black and non-Hispanic White men. There was no significant association between radiotherapy and CVD deaths. In this population-based study, treatment with chemotherapy was associated with elevated risk of CVD mortality in men with breast cancer. Racial/ethnic disparities in the association of chemotherapy and CVD mortality were observed.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Megan Mai
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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5
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Male Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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The role of postoperative radiation therapy in stage I–III male breast cancer: A population-based study from the surveillance, epidemiology, and End Results database. Breast 2022; 65:41-48. [PMID: 35810531 PMCID: PMC9272391 DOI: 10.1016/j.breast.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to investigate the role of postoperative radiation therapy in a large population-based cohort of patients with stage I–III male breast cancer (MaBC). Methods Patients with stage I–III breast cancer treated with surgery were selected from the Surveillance, Epidemiology, and End Results cancer database from 2010 to 2015. Multivariate logistic regression identified the predictors of radiation therapy administration. Multivariate Cox regression model was used to evaluate the predictors of survival. Results We identified 1321 patients. Age, stage, positive regional nodes, surgical procedure, and HER2 status were strong predictors of radiation therapy administration. There was no difference between patients who received radiation therapy and those who did not (P = 0.46); however, after propensity score matching, it was associated with improved OS (P = 0.04). In the multivariate analysis of the unmatched cohort, the factors associated with better OS were administration of radiation therapy and chemotherapy. In the subset analysis of the unmatched cohort, postoperative radiation therapy was associated with improved OS in men undergoing breast-conserving surgery (BCS), with four or more node-positive or larger primary tumours (T3/T4). Furthermore, we found no benefit of radiation therapy, regardless of the type of axillary surgery in mastectomy (MS). In older MaBC patients with T1-2N1 who underwent MS, radiation therapy showed no significant effects, regardless of chemotherapy. Conclusion Postoperative radiation therapy could improve the survival of MaBC patients undergoing BCS, with four or more node-positive or larger primary tumours. Moreover, it should be carefully considered in patients undergoing MS and older T1-2N1 patients. Postoperative radiation therapy may improve survival of some male breast cancer patients. Patients undergoing breast-conserving surgery or with large tumours may benefit. Radiation therapy had no benefits in mastectomy regardless of axillary surgery type. Radiation therapy was not effective in older T1-2N1 patients with receiving mastectomy.
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7
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Rutherford CL, Goodman D, Lannigan A. A systematic literature review of the management, oncological outcomes and psychosocial implications of male breast cancer. Eur J Surg Oncol 2022; 48:2104-2111. [PMID: 35725681 DOI: 10.1016/j.ejso.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancers, it has significant oncological, survival and psychosocial implications for patients. The aim of this study is to assess the latest literature in the diagnosis, management, oncological outcomes, and psychosocial impact of MBC. METHODS A systematic literature review was conducted using the PRISMA guidelines (Moher et al., 2009) [1] to explore the management of MBC, with particular focus on investigative imaging, surgical management, oncological outcomes, survival, genetic screening and psychosocial effects. Electronic databases were searched for randomised control trials, cohort studies and case series involving more than 10 patients. Imaging and surgical techniques, local and distant disease recurrence, survival, genetic screening and psychosocial implications in the setting of MBC were assessed. RESULTS The search criteria identified 199 articles, of which 59 met the inclusion criteria. This included 39,529 patients, with a mean age of 64.5 years (55-71), and a mean follow-up of 66.3 months (26.2-115). Mastectomy remains the most frequently used surgical technique, with an average of 89.6%. Loco-regional and distant recurrence rate was 10.1% and 21.4% respectively. Disease-free survival (DFS) at 5 and 10 years was 66.8% and 54.5% respectively. Disease-specific survival (DSS) at 5 and 10 years was 87.1% and 67.1% respectively. Overall survival (OS) at 5 and 10 years was 72.7% and 50.7% respectively. Genetic screening was conducted in 38.6% of patients of which 4.8% and 15.8% were found to be BRCA1 and BRCA2 carriers respectively. Psychosocial studies were conducted mainly using questionnaire and interview-based methodology focusing primarily on awareness of breast cancer in men, support available and impact on gender identity. CONCLUSIONS This review demonstrates that men present with later stage disease with subsequent impact on survival outcomes. There remains a paucity of high-level evidence and prospective studies are required. There is a need for increasing awareness amongst the public and health care professionals in order to improve outcomes and reduce stigma associated with MBC.
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Affiliation(s)
| | - D Goodman
- National University of Ireland Galway, Ireland
| | - A Lannigan
- University Hospital Wishaw, United Kingdom
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8
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Clinicopathologic characteristics and prognosis for male breast cancer compared to female breast cancer. Sci Rep 2022; 12:220. [PMID: 34997151 PMCID: PMC8741943 DOI: 10.1038/s41598-021-04342-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022] Open
Abstract
Male breast cancer (MBC) is rare. Due to limited information, MBC has always been understudied. We conducted a retrospective population-based cohort study using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. The clinical and biological features of female breast cancer (FBC) patients were compared with MBC patients. Cox regression models and competing risks analyses were used to identify risk factors associated with cancer-related survival in MBC and FBC groups. Results showed that MBC patients suffered from higher TNM stages, tumor grades, and a higher percentage of hormone receptor-positive tumors, compared with FBC patients (all p < 0.05). In addition, the breast tumor locations varied a lot between males and females (p < 0.05). FBC patients were associated with superior overall survival than MBC patients. Results from multivariate cox regression and competing risks analyses showed age, race, T, N, M-stages, tumor grades, estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2) overexpression were independent prognosis factors in FBC patients (all p < 0.05). MBC patients had similar risk factors to FBC patients, but PR and HER-2 status did not independently influence survival (all p > 0.05). Tumor location was an independent prognostic factor for both gender groups.
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9
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ESMER AC, DAĞ A, BERKEŞOĞLU M, TAZEOĞLU D. Male Breast Cancer: A Single-Center Experience. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.927704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Adjuvant Radiation Therapy for Male Breast Cancer-A Rare Indication? Cancers (Basel) 2020; 12:cancers12123645. [PMID: 33291697 PMCID: PMC7761961 DOI: 10.3390/cancers12123645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
Due to its rarity, there are no randomized trials investigating the outcome of adjuvant radiotherapy in MBC. This study reports on patient and tumor characteristics of 41 consecutive MBC patients treated between 1990 and 2018 and on clinical outcomes after surgical resection of tumors and adjuvant radiotherapy of the chest wall or breast. Local control (LC), locoregional control (LRC), overall survival (OS), disease-free survival (DFS), and toxicity were evaluated. After a median follow-up of 80 months (95% CI: 14.6-213.8 months) there was only one recurrence, in a patient's locoregional lymph nodes 17 months after start of radiotherapy, resulting in an LC rate of 100% at 5 years and a 5-year LRC rate of 97.4% (standard deviation (SD): 0.025). Five-year DFS and OS rates were 64.6% (SD: 0.085) and 57.2% (SD: 0.082), respectively. Adjuvant radiotherapy was tolerated well without high-grade (CTCAE grade > II) adverse events. After tumor resection and adjuvant radiotherapy, LC and LRC rates in MBC patients are excellent and comparable to results found for female breast cancer (FBC) patients. However, as patients are often diagnosed with locally advanced, higher-risk tumors, distant recurrences remain the major failure pattern.
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11
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Triple Negative Breast Cancer in a Male to Female Transgender Patient: A Case Report and Literature Review. Adv Radiat Oncol 2020; 5:1083-1089. [PMID: 33083671 PMCID: PMC7557203 DOI: 10.1016/j.adro.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/22/2022] Open
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Ishii T, Nakano E, Watanabe T, Higashi T. Epidemiology and practice patterns for male breast cancer compared with female breast cancer in Japan. Cancer Med 2020; 9:6069-6075. [PMID: 32613775 PMCID: PMC7433825 DOI: 10.1002/cam4.3267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/12/2020] [Accepted: 06/11/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The incidence of male breast cancer (MBC), although rare, has shown an increase. However, the current epidemiology of and practice patterns for MBC remain unclear. This study evaluated the characteristics and care patterns for MBC compared with female breast cancer (FBC) in Japan. METHODS Using the National Database of Hospital-Based Cancer Registries (HBCR) linked to the Diagnosis Procedure Combination data, we analyzed newly diagnosed breast cancer cases between January 2012 and December 2015 at participating hospitals in a large quality-of-care monitoring project. We employed logistic regression models to assess cancer treatment differences between MBC and FBC in patients who were indicated for adjuvant radiation therapy and neo-adjuvant/adjuvant chemotherapy. RESULTS Of 142,636 breast cancer patients, 870 (0.61%) were MBC patients. At diagnosis, the mean age of MBC patients was 10 years older than FBC patients (70 vs 60 years; P < .001). Advanced-stage cancer was more frequently observed in MBC than in FBC (stage III/IV 18.9%/6.1% vs 10.6%/5.2%). Despite this, MBC patients were less likely to receive adjuvant radiation therapy and neo-adjuvant/adjuvant chemotherapy. Gender was an independent treatment determinant factor for chemotherapy decisions. CONCLUSION MBC patients were older and had higher stages of cancer than FBC patients at diagnosis, but received suboptimal treatment.
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Affiliation(s)
- Taisuke Ishii
- Division of Health Services ResearchNational Cancer CenterTokyoJapan
| | - Eriko Nakano
- Department of Medical OncologySt. Luke’s International HospitalTokyoJapan
| | - Tomone Watanabe
- Division of Health Services ResearchNational Cancer CenterTokyoJapan
| | - Takahiro Higashi
- Division of Health Services ResearchNational Cancer CenterTokyoJapan
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Halbach SM, Midding E, Ernstmann N, Würstlein R, Weber R, Christmann S, Kowalski C. Male Breast Cancer Patients' Perspectives on Their Health Care Situation: A Mixed-Methods Study. Breast Care (Basel) 2020; 15:22-29. [PMID: 32231494 PMCID: PMC7098323 DOI: 10.1159/000501956] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Male breast cancer is rare. No information was available on how male breast cancer patients (MBCPs) experience the health care they receive in Germany in a setting that is tailored to women. The aim of this study was to explore the health care situation of MBCPs from their perspectives. METHODS The study follows a mixed-methods design, combining quantitative data from a standardized written questionnaire with qualitative data from personal interviews. Descriptive statistics (quantitative data) and qualitative content analysis (qualitative data) were used for data analysis. RESULTS Questionnaires completed by 100 and personal interviews of 27 MBCPs were analyzed. Several men reported mainly positive experiences while others experienced shortcomings. These included delays in diagnosis, health care provider uncertainty about treatment (tamoxifen, radiation therapy), experiences of stigmatization, and issues of continuity of care including unclear responsibilities for aftercare and access challenges to breast-cancer-specific care in gynecology settings. CONCLUSIONS The awareness of male breast cancer needs to be increased among the public, health care providers and researchers in order to avoid delays in diagnosis and reduce stigmatization and uncertainty about treatment. Health care structures ensuring access to gynecology care and clear responsibilities for aftercare need to be established.
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Affiliation(s)
- Sarah Maria Halbach
- Center for Health Communication and Health Service Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology, Bonn, Germany
| | - Evamarie Midding
- Center for Health Communication and Health Service Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Service Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology, Bonn, Germany
| | - Rachel Würstlein
- Department of Gynecology and Obstetrics, Breast Center and CCCLMU, University of Munich (LMU), Munich, Germany
| | - Rainer Weber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Sherin Christmann
- Center for Health Communication and Health Service Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology, Bonn, Germany
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Lomma C, Chan A, Chih H, Reid C, Peter W. Male Breast Cancer in Australia. Asia Pac J Clin Oncol 2020; 17:e57-e62. [PMID: 31957255 DOI: 10.1111/ajco.13299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Abstract
AIMS Male breast cancer is rare and treatment recommendations are based on female breast cancer guidelines. We analyzed an Australian dataset of patients with early breast cancer (including ductal carcinoma in situ, DCIS) for demographic, pathological and treatment information. The primary objective was to compare treatment delivery for males versus females. METHODS Australian data from the BreastSurgANZ Quality Audit (BQA) from 1 October 2006 and 30 September 2016 were analyzed. Demographic and pathological information was obtained and compared between males and females. Treatment recommendations were compared to BreastSurgANZ Key Performance Indicators (KPIs) and National Comprehensive Cancer Network (NCCN) guidelines to assess for adherence to national and international guidelines, respectively. RESULTS A total of 99,768 breast cancer episodes were analyzed, comprising 585 males (544 invasive; 41 DCIS) and 99 183 (99.4%) females (85 596 invasive; 13 525 DCIS; 62 unknown). Compared with females, males were older at diagnosis, more likely to be hormone receptor-positive and lymph node-positive disease, and more likely to have mastectomy. The proportion of males undergoing breast conserving surgery receiving radiotherapy was the only BreastSurgANZ KPI that was not met. Males were less likely to receive adjuvant chemotherapy than females using NCCN guidelines. CONCLUSION Australian males with breast cancer account for 0.6% of breast cancer incidence and have similar clinico-pathological features as reported internationally. Overall, there is good compliance with the surgical KPIs, and adherence to NCCN guidelines for adjuvant systemic treatment is similar to previous international studies.
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Affiliation(s)
- Chris Lomma
- Breast Cancer Research Centre-WA, Western Australia, Australia
| | - Arlene Chan
- Breast Cancer Research Centre-WA, Western Australia, Australia.,School of Medicine, Curtin University, Perth, Western Australia, Australia
| | - HuiJun Chih
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christopher Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Willsher Peter
- Breast Cancer Research Centre-WA, Western Australia, Australia
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Wang F, Reid S, Zheng W, Pal T, Meszoely I, Mayer IA, Bailey CE, Park BH, Shu XO. Sex Disparity Observed for Oncotype DX Breast Recurrence Score in Predicting Mortality Among Patients with Early Stage ER-Positive Breast Cancer. Clin Cancer Res 2020; 26:101-109. [PMID: 31748278 PMCID: PMC7380510 DOI: 10.1158/1078-0432.ccr-19-2424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/25/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Prognostic value of Oncotype DX Breast Recurrence Score (RS) in male patients with breast cancer is understudied. We evaluated associations of RS with overall mortality in male patients with breast cancer and compared it with female counterparts. EXPERIMENTAL DESIGN With a cohort of 848 male and 110,898 female patients with breast cancer identified from the National Cancer Database (2010-2014), we estimated HRs and 95% confidence intervals (CI) for overall mortality associated with RS using Cox regression models. RS was evaluated continuously, as well as by categorization following respective traditional (≤17, 18-30, and ≥31) and TAILORx (≤10, 11-25, and ≥26) cutoffs. RESULTS RS was positively associated with mortality in male patients (HR = 1.13; 95% CI, 1.02-1.26 per unit RS increment) up to RS > 21, after which the risk plateaued. Among female patients, mortality began to increase with RS only when RS > 23 (HR = 1.02; 95% CI, 1.01-1.02 per unit of RS increment). The intermediate- (HR = 5.37; 95% CI, 1.79-16.11) and high-risk diseases (HR = 4.28; 95% CI, 1.22-14.97) defined by TAILORx, but not traditional cutoffs established for female patients, were associated with elevated mortality risk in men even after adjustment for demographic, clinical characteristics, and treatments, except chemotherapy. CONCLUSIONS RS is associated with mortality in male patients with breast cancer at a much lower threshold than that for female patients. Studies are needed to establish specific guidelines for RS thresholds for male patients with breast cancer.
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Affiliation(s)
- Fei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Breast Surgery, the Second Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Sonya Reid
- Division of Hematology/Oncology, Department of Medicine, Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tuya Pal
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ingrid Meszoely
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ingrid A Mayer
- Division of Hematology/Oncology, Department of Medicine, Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina E. Bailey
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ben Ho Park
- Division of Hematology/Oncology, Department of Medicine, Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
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16
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Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease for which no randomised controlled trials (RCT) have been conducted to determine optimal surgical management. The available data have been reviewed to identify reasonable options and reveal areas in need of investigation. METHODS All published series on the surgical management of MBC have been reviewed to determine approaches to treatment of the primary, the breast and the axilla together with the psychological sequelae of surgery. FINDINGS Mastectomy is still the major surgical offer but a convincing case can be made for the use of neoadjuvant endocrine treatment in order to facilitate breast conserving surgery. Sentinel node biopsy has been successfully used for staging MBC although nomograms for prediction of nodal status are inadequately calibrated. There are psychological sequelae of mastectomy in males and as yet no evidence that the needs of those with MBC are being met. CONCLUSIONS Collaborative studies are required so that men can participate in meaningful RCTs to provide an evidence-based rational foundation for the surgery of MBC.
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Affiliation(s)
- Ian S Fentiman
- Research Oncology, Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.
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17
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Male breast cancer: a disease distinct from female breast cancer. Breast Cancer Res Treat 2018; 173:37-48. [PMID: 30267249 DOI: 10.1007/s10549-018-4921-9] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Male breast cancer (BC) is rare, representing approximately 1% of cancers that occur in men and approximately 1% of all BCs worldwide. Because male BC is rare, not much is known about the disease, and treatment recommendations are typically extrapolated from data available from clinical trials enrolling female BC patients. METHODS We review the epidemiology, risk factors, prognosis, and the varied molecular and clinicopathologic features that characterize male BC. In addition, we summarize the available data for the use of systemic therapy in the treatment of male BC and explore the ongoing development of targeted therapeutic agents for the treatment of this subgroup of BCs. RESULTS There are important biological differences between male and female BC. Male BC is almost exclusively hormone receptor positive (+), including the androgen receptor (AR), and is associated with an increased prevalence of BRCA2 germline mutations, especially in men with increased risk for developing high-risk BC. Additional research is warranted to better characterize male BC. To accomplish this, a multi-national consortium approach, such as the International Male Breast Cancer Program, is needed in response to the scarcity of patients. This approach allows the pooling of information from a large number of men with BC and the creation of registries for future therapeutic-focused clinical trials. CONCLUSIONS Given the unique biology of BC in men, promising new therapeutic targets are currently under investigation, including the use of poly-ADP-ribose polymerase inhibitors or AR-targeted agents either as monotherapy or in combination with other agents.
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18
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Pattern of care of adjuvant radiotherapy in male breast cancer patients in clinical practice: an observational study. Strahlenther Onkol 2018; 195:289-296. [PMID: 30046931 DOI: 10.1007/s00066-018-1337-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/04/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Due to the rarity of male breast cancer (male BC), no consensus has been reached regarding the most appropriate curative treatment strategy. The objective of the present observational study was to identify patient and tumor characteristics and assess the role of radiotherapy (RT) in clinical practice. METHODS Between 1998 and 2014, data of male BC patients treated at two breast centers were consecutively collected and retrospectively analyzed. Patients were stratified based on the addition of adjuvant RT. Data on overall survival (OS) and local recurrence-free survival (LRFS) were estimated with the Kaplan-Meier method and compared by the log-rank test. RESULTS A consecutive cohort of 58 male BC patients was evaluated. Median follow-up was 56 months. Twenty-one patients (36.2%) received adjuvant RT. Overall, patients undergoing postoperative RT were characterized by more high-risk features. Patients receiving postoperative RT had significantly more frequently a high UICC stage (50 vs. 9.7% UICC III, p = 0.018) and positive lymph nodes as compared to patients undergoing surgery alone (65 vs. 34.4% pN+, p = 0.046). Accordingly, there was a higher proportion of patients receiving axillary lymph node dissection in the RT group (71.4 vs. 35.6%). Mastectomy was performed in 31/37 (86.1%) in the surgery group as compared to 14/21 (66.7%) in patients receiving postoperative RT. In addition, RT patients were more likely to receive endocrine therapy (78.9 vs. 39.3%, p = 0.016). Outcome was not significantly different between the groups (5-year LRFS: 89.8 vs. 80.0%, p = 0.471 and 5‑year OS 88.4 vs. 88.9%, p = 0.819). CONCLUSION The present observational study evaluated the pattern of care in male BC patients treated in clinical practice. Due to its rarity, randomized clinical trials are unlikely and male BC remains an entity with a poor evidence base. Nevertheless, RT remains a crucial component of the multidisciplinary treatment strategy in male BC.
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19
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Altman AM, Kizy S, Yuan J, Denbo JW, Jensen EH, Hui JYC, Tuttle TM, Marmor S. Distribution of 21-Gene Recurrence Scores in Male Breast Cancer in the United States. Ann Surg Oncol 2018; 25:2296-2302. [PMID: 29907942 DOI: 10.1245/s10434-018-6566-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The 21-gene recurrence score (RS) is a RT-PCR assay estimating risk of distant recurrence in estrogen receptor positive (ER+), human epidermal growth factor receptor 2 negative (HER2) breast cancer (BC). Studies validating RS are limited to women. Our objective was to assess RS distribution and factors associated with high-risk RS in male BC. METHODS Using the Surveillance, Epidemiology, and End Results database, we identified men and women with ER+/HER2- BC from 2010 to 2013. Patients were categorized into risk groups using the traditional and the Trial Assigning Individualized Options for Treatment (TAILORx) cutoffs. Multivariable logistic regression determined factors associated with testing and high-risk TAILORx RS. RESULTS We identified 1388 men and 154,196 women with ER+/HER2- BC. Twenty-five percent of men and 30% of women had RS testing. Mean age of tested men was 63; most were white (81%), had grade I or II tumors (67%), and had stage I or II (95%) BC. Factors associated with increased RS testing were younger age, recent year of diagnosis, lymph node negativity, and lower-stage tumors (p ≤ 0.05). By TAILORx, 21% of men had high-risk RS compared with 14% of tested women. Men with grade III and PR negative tumors were more likely to have a high-risk RS (p ≤ 0.05). Chemotherapy utilization was correlated with RS. CONCLUSIONS Using a large population-based dataset, we found that compared with women, men were significantly more likely to have high-risk RS. Grade III and PR-negative BC were significantly associated with high-risk RS. Higher RS in men correlated with increased chemotherapy utilization.
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Affiliation(s)
- Ariella M Altman
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Scott Kizy
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jianling Yuan
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Jason W Denbo
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Eric H Jensen
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jane Y C Hui
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
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20
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The biology of male breast cancer. Breast 2018; 38:132-135. [PMID: 29316513 DOI: 10.1016/j.breast.2018.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/15/2017] [Accepted: 01/04/2018] [Indexed: 12/16/2022] Open
Abstract
Important differences have begun to emerge concerning the molecular profile of female and male breast cancer which may prove to be of therapeutic value. This review examined all the available data on the genomics of MBC. Most male cancers are ER+ve but without a corresponding increase in PR positivity and only a weaker association with estrogen-controlled markers such as PS2, HSP27 and Cathepsin-D. HER2 +ve cancers are rare in males and the role of androgen receptor is controversial. Although the Luminal A phenotype was the most frequent in both MBC and FBC, no Luminal B or HER2 phenotypes were found in males and the basal phenotype was very rare. Using hierarchical clustering in FBC, ERα clustered with PR, whereas in MBC, ERα associated with ERβ and AR. Based on limited data it appears that Oncotype DX is effective in determining recurrence risk in selected MBC. In future, tailored therapies based on genomics will probably yield the most promising approach for both MBC and FBC.
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21
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Severson TM, Zwart W. A review of estrogen receptor/androgen receptor genomics in male breast cancer. Endocr Relat Cancer 2017; 24:R27-R34. [PMID: 28062545 DOI: 10.1530/erc-16-0225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/06/2017] [Indexed: 01/17/2023]
Abstract
Male breast cancer is a rare disease, of which little is known. In contrast to female breast cancer, the very vast majority of all cases are positive for estrogen receptor alpha (ERα), implicating the function of this steroid hormone receptor in tumor development and progression. Consequently, adjuvant treatment of male breast cancer revolves around inhibition of ERα. In addition, the androgen receptor (AR) gradually receives more attention as a relevant novel target in breast cancer treatment. Importantly, the rationale of treatment decision making is strongly based on parallels with female breast cancer. Yet, prognostic indicators are not necessarily the same in breast cancer between both genders, complicating translatability of knowledge developed in female breast cancer toward male patients. Even though ERα and AR are expressed both in female and male disease, are the genomic functions of both steroid hormone receptors conserved between genders? Recent studies have reported on mutational and epigenetic similarities and differences between male and female breast cancer, further suggesting that some features are strongly conserved between the two diseases, whereas others are not. This review critically discusses the recent developments in the study of male breast cancer in relation to ERα and AR action and highlights the potential future studies to further elucidate the genomic regulation of this rare disease.
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Affiliation(s)
- Tesa M Severson
- Division of Molecular Pathologythe Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesisthe Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wilbert Zwart
- Division of Molecular Pathologythe Netherlands Cancer Institute, Amsterdam, the Netherlands
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22
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Follow-Up of Patients with Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Giunta G, Rossi M, Toia F, Rinaldi G, Cordova A. Male breast cancer: Modified radical mastectomy or breast conservation surgery? A case report and review of the literature. Int J Surg Case Rep 2016; 30:89-92. [PMID: 28006719 PMCID: PMC5192241 DOI: 10.1016/j.ijscr.2016.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Male breast cancer (MBC) is a rare disease that accounts for <1% of breast cancer cases. The most common treatment is modified radical mastectomy (MRM). Recently, breast conservative surgery (BCS) is getting popular for MBC treatment. We report a case and reviewed the literature to investigate whether emerging BCS can be considered as an alternative of a more radical surgery. PRESENTATION OF CASE A 46 y.o. patient, presented with a painless left breast lump over a period of six months. The patient underwent a quadrantectomy at another institution. Pathology revealed an intraductal carcinoma in close proximity to the margins of excision. Adjuvant hormonal therapy was proposed to the patient, who refused and was referred to our Institution. We performed a MRM and a sentinel lymph node biopsy (SLNB). A contralateral breast liposuction and an adenectomy were also performed. The patient underwent also a nipple-areolar complex reconstruction. The patient didn't receive adjuvant therapy. DISCUSSION Both oncological safety and satisfactory cosmetic outcomes are the goals of MBC treatment. No specific guidelines for MBC treatment have been proposed. MRM is currently the surgical gold standard of MBC (approximately 70% of all cases). Some authors reported that male BCS associated with radiation therapy is a feasible alternative MRM. Taking into account data from the literature and considering the previous surgery, in the case we report, we offered a MRM, SLNB and a contralateral breast symmetrization. CONCLUSION MRM with SLNB and reconstruction of male breast asymmetry should be still considered as the treatment of choice of MBC.
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Affiliation(s)
- Gabriele Giunta
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy.
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
| | - Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
| | - Gaetana Rinaldi
- Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy
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24
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Adekolujo OS, Tadisina S, Koduru U, Gernand J, Smith SJ, Kakarala RR. Impact of Marital Status on Tumor Stage at Diagnosis and on Survival in Male Breast Cancer. Am J Mens Health 2016; 11:1190-1199. [PMID: 27694551 PMCID: PMC5675311 DOI: 10.1177/1557988316669044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effect of marital status (MS) on survival varies according to cancer type and gender. There has been no report on the impact of MS on survival in male breast cancer (MBC). This study aims to determine the influence of MS on tumor stage at diagnosis and survival in MBC. Men with MBC ≥18 years of age in the SEER database from 1990 to 2011 were included in the study. MS was classified as married and unmarried (including single, divorced, separated, widowed). Kaplan–Meier method was used to estimate the 5-year cancer-specific survival. Multivariate regression analyses were done to determine the effect of MS on presence of Stage IV disease at diagnosis and on cancer-specific mortality. The study included 3,761 men; 2,647 (70.4%) were married. Unmarried men were more often diagnosed with Stage IV MBC compared with married (10.7% vs. 5.5%, p < .001). Unmarried men (compared with married) were significantly less likely to undergo surgery (92.4% vs. 96.7%, p < .001). Overall unmarried males with Stages II, III, and IV MBC have significantly worse 5-year cancer-specific survival compared with married. On multivariate analysis, being unmarried was associated with increased hazard of death (HR = 1.43, p < .001) and increased likelihood of Stage IV disease at diagnosis (OR = 1.96, p < .001). Unmarried males with breast cancer are at greater risk for Stage IV disease at diagnosis and poorer outcomes compared with married males.
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Affiliation(s)
| | - Shourya Tadisina
- 1 McLaren Flint, Flint, MI, USA.,2 Michigan State University, East Lasing, MI, USA
| | - Ujwala Koduru
- 1 McLaren Flint, Flint, MI, USA.,2 Michigan State University, East Lasing, MI, USA
| | | | - Susan Jane Smith
- 1 McLaren Flint, Flint, MI, USA.,2 Michigan State University, East Lasing, MI, USA
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25
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Affiliation(s)
- Iraj Khalkhali
- LA BioMed at Harbor-UCLA Medical Center, Torrance, California
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26
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Choi MY, Lee SK, Lee JE, Park HS, Lim ST, Jung Y, Ko BK, Nam SJ. Characterization of Korean Male Breast Cancer Using an Online Nationwide Breast-Cancer Database: Matched-Pair Analysis of Patients With Female Breast Cancer. Medicine (Baltimore) 2016; 95:e3299. [PMID: 27100414 PMCID: PMC4845818 DOI: 10.1097/md.0000000000003299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to review the characteristics and the survival rate in male breast cancer (MBC) patients in Korea over a 31-year period. Additionally, we analyzed the overall survival (OS) rate of a group of MBC matched to females with breast cancer. We retrospectively analyzed the data from 400 Korean patients who were treated for MBC from 1978 to 2009. Patient demographics and clinical information were routinely documented throughout the study period. Survival and prognostic factors were evaluated. Each MBC patient was matched with 5 female breast cancer (FBC) patients based on 7 characteristics and we compared the OS rates between the 2 groups. For MBC cases, the median follow-up was 72 months and the 5-year OS rate was 85.9%. In univariate analyses, the prognostic factors influencing OS were age (more than 60 years, P <0.001), tumor size (>2 cm, P = 0.007), and having a negative progesterone receptor (PR) status (P = 0.042). Only the age (P = 0.028) and tumor size (P = 0.024) were significant prognostic factors for OS in multivariate analysis. After matching, we had 260 male patients matched to 1300 female patients for analysis. Compared with cases among females, the rate of mastectomy was higher among MBC cases and tumors, which were almost invasive ductal carcinomas (IDCs), were more likely to be located in the central part of the breast. For MBC cases, the percentage of adjuvant radiation therapy was low compared with female cases. The primary hormone therapy agent used was tamoxifen. The 5-year OS rates were similar in MBC compared with FBC (91.0% vs. 92.6%, P = 0.300). We found that only the age (more than 60 years) and tumor size were independent prognostic factors of survival in MBC. The prognosis for MBC is similar to that for FBC given similar stage and hormone-receptor status.
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Affiliation(s)
- Min-Young Choi
- From the Division of Breast and Endocrine Surgery (M-YC), Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine; Division of Breast and Endocrine Surgery (SKL, JEL, SJN), Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Surgery (HSP), Yonsei University College of Medicine, Seoul; Department of Surgery (STL), St. Vincent's Hospital, The Catholic University of Korea; Department of Surgery (YJ), Ajou University School of Medicine, Suwon; and Department of Surgery (BKK), Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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27
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Ferzoco RM, Ruddy KJ. Optimal delivery of male breast cancer follow-up care: improving outcomes. BREAST CANCER-TARGETS AND THERAPY 2015; 7:371-9. [PMID: 26648754 PMCID: PMC4664432 DOI: 10.2147/bctt.s75630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Male breast cancer is a rare disease. There are limited data to inform optimal treatment and follow-up strategies in this population. Currently, most follow-up guidelines are drawn from the vast literature on female breast cancer, despite the fact that male breast cancer has unique biological characteristics. In this review, we discuss clinical characteristics of male breast cancer as well as current best practices for long-term care with a focus on surveillance, screening, and treatment-related symptom management in male breast cancer survivors.
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28
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Dietz JR, Partridge AH, Gemignani ML, Javid SH, Kuerer HM. Breast Cancer Management Updates: Young and Older, Pregnant, or Male. Ann Surg Oncol 2015; 22:3219-24. [PMID: 26265366 DOI: 10.1245/s10434-015-4755-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Indexed: 12/24/2022]
Abstract
Every year, more and more patients fall into rare or extreme categories of breast cancer-young, elderly, pregnant, or male. Contributing factors may be improved risk assessment and screening techniques (especially of dense breast tissue), delayed childbearing, and the aging population. These patients can challenge usual medical decision making because of their unique situation. There might be a concern for the fetus, worry about future fertility, a question of local control in a man, or concern for overdiagnosis or overtreatment in an older patient. Because these populations are seldom included in the large breast cancer trials from which standard treatment recommendations are made, an update on management for young, elderly, pregnant, and male breast cancer patients may be helpful.
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Affiliation(s)
- Jill R Dietz
- Case Western Reserve School of Medicine, Cleveland, USA,
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29
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Mitri ZI, Jackson M, Garby C, Song J, Giordano SH, Hortobágyi GN, Singletary CN, Hashmi SS, Arun BK, Litton JK. BRCAPRO 6.0 Model Validation in Male Patients Presenting for BRCA Testing. Oncologist 2015; 20:593-7. [PMID: 25948675 DOI: 10.1634/theoncologist.2014-0425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 02/05/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND BRCAPRO is a risk assessment model to estimate the risk of carrying a BRCA mutation. BRCA mutation carriers are at higher risk of developing breast, ovarian, pancreatic, and prostate cancer. BRCAPRO was developed for women and found to be superior to other risk assessment models. The present study evaluated the validity of BRCAPRO at predicting the risk of male patients carrying a BRCA mutation. PATIENTS AND METHODS A total of 146 men who presented for genetic counseling and testing from February1997 to September 2011, and their test results were included in the present study. BRCAPRO risk assessment for all patients was calculated using the BRCAPRO clinical CancerGene assessment software. RESULTS The mean age at presentation was 57 years. Of the 146 patients, 48 had breast cancer, 18 had pancreatic cancer, 39 had prostate cancer, 27 had other primary cancers, and 37 had no cancer. Fifty patients (34%) tested positive for a BRCA mutation (22 BRCA1, 27 BRCA2, and 1 BRCA1 and BRCA2). The mean BRCAPRO score for all patients was 24.96%. The BRCAPRO score was significantly higher for patients who tested positive for a BRCA mutation (46.19% vs. 13.9%, p < .01). The area under the receiver operating characteristics curve was 0.83 for all patients for the BRCAPRO score to predict the risk of carrying a BRCA mutation. At a cutoff point of 30.02%, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.74, 0.81, 0.67, and 0.86, respectively. CONCLUSION BRCAPRO appears to be a valid risk assessment tool for determining the risk of carrying a BRCA mutation in men. IMPLICATIONS FOR PRACTICE Men carrying genetic mutations in the BRCA gene have a greater risk than the general population of developing certain types of cancer, including breast, pancreatic, and prostate cancer. BRCAPRO is a risk assessment model that predicts the risk of carrying a BRCA mutation. The present study aimed at validating BRCAPRO for use with men seen for genetic counseling, whether affected by cancer or not. The data available for 146 patients revealed that BRCAPRO was effective at identifying patients at risk of BRCA mutation. These findings could help in identifying a subset of high-risk patients who should proceed to genetic testing.
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Affiliation(s)
- Zahi I Mitri
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Michelle Jackson
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Carolyn Garby
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Juhee Song
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Sharon H Giordano
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Gabriel N Hortobágyi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Claire N Singletary
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - S Shahrukh Hashmi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Banu K Arun
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Jennifer K Litton
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
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Díaz García N, Cuadrado Rouco C, Vich P, Alvarez-Hernandez C, Brusint B, Redondo Margüello E. [Breast cancer update in primary care: (V/V)]. Semergen 2014; 41:76-88. [PMID: 25002350 DOI: 10.1016/j.semerg.2014.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians ought to know thoroughly this pathology to optimize the health care services for these patients making the best use of available resources. A series of five articles on breast cancer is presented below. It is based on a review of the scientific literature over the last ten years. In this final section, the social, psychological, occupational and family issues related to the disease will be reviewed, as well as presenting some special situations of breast cancer, including breast cancer in men, during pregnancy and last stages of life. This summary report aims to provide a current and practical review about this disease, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness.
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Affiliation(s)
| | | | - Pilar Vich
- Centro de Salud Los Alpes, Madrid, España
| | | | | | - Esther Redondo Margüello
- Centro de Salud Internacional, Madrid Salud, Grupo de Actividades Preventivas de SEMERGEN, España
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31
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Kipling M, Ralph JEM, Callanan K. Psychological impact of male breast disorders: literature review and survey results. ACTA ACUST UNITED AC 2014; 9:29-33. [PMID: 24803884 DOI: 10.1159/000358751] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Referrals of men to breast assessment clinics are increasing. While most of the men will have benign disease, some of them will have breast cancer. Whichever pathology they have, men should be offered a service tailored to their needs, rather than being 'shoehorned' into a service designed to care for women. This paper explores the psychological impact on men of their condition and of attending a breast assessment clinic. METHODS The literature regarding male experience of breast problems is reviewed, and screening for psychological morbidity is discussed. Results of a survey regarding an all-male breast assessment clinic are reported, with a plan for future research. RESULTS Many of the 78 men surveyed described negative feelings relating to their condition although they did not want to be seen in an all-male breast assessment clinic if that meant a longer wait. Men reported feelings of anxiety, embarrassment, emasculation and even depression regarding their condition. CONCLUSIONS Men are distressed by gynaecomastia and need psychological support for any breast-related presentation. More formalised research into this area is needed, although the men's distress does not translate into the desire to attend an all-male assessment clinic if this means a longer wait before being seen.
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Affiliation(s)
- Mike Kipling
- Breast Unit, University Hospital of North Durham (UHND), Durham, UK
| | - Jane E M Ralph
- Breast Unit, University Hospital of North Durham (UHND), Durham, UK
| | - Keith Callanan
- Breast Unit, University Hospital of North Durham (UHND), Durham, UK
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Maráz R, Boross G, Pap-Szekeres J, Markó L, Rajtár M, Ambrózay É, Bori R, Cserni G. The role of sentinel node biopsy in male breast cancer. Breast Cancer 2014; 23:85-91. [DOI: 10.1007/s12282-014-0535-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Kwong A, Chau WW, Mang OWK, Wong CHN, Suen DTK, Leung R, Wong K, Lee A, Shea C, Morse E, Law SCK. Male Breast Cancer: A Population-Based Comparison with Female Breast Cancer in Hong Kong, Southern China: 1997–2006. Ann Surg Oncol 2013; 21:1246-53. [DOI: 10.1245/s10434-013-3377-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Indexed: 12/22/2022]
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La Verde N, Collovà E, Lonardi S, Generali D, Moretti A, Atzori F, Cazzaniga M, Saggia C, Tondulli L, Marcon I, Gentile AL, Rossello R, Martelli O, Aglione S, Farina G, Cinquini M, Garassino M. Male Breast Cancer: Clinical Features and Multimodal Treatment in a Retrospective Survey Analysis at Italian Centers. TUMORI JOURNAL 2013; 99:596-600. [DOI: 10.1177/030089161309900506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background We report a collection of data about early breast cancer in male patients from 13 Italian institutions. Methods and study design We obtained data from patient charts and performed statistical analysis. The primary end points were overall survival and disease-free survival. Results A total of 205 men with invasive breast cancer was identified, with a median age of 66 years. Pathological characteristics were heterogeneous for T stage, N stage and HER2 status. Histological subtype was predominantly ductal infiltrating carcinoma. Most of them were hormone receptor positive. Mastectomy was the most common strategy. Postsurgical treatment was not standardized. Patients with large tumors were more likely to be treated with chemotherapy. Disease recurrence was associated with an ER+ and PR+ status. Conclusions We identified a correlation between relapse and hormone receptor expression, as is the case in female breast cancer.
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Affiliation(s)
- Nicla La Verde
- AO Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | - Elena Collovà
- Hospital of Legnano, Division of Medical Oncology, Legnano
| | - Sara Lonardi
- Veneto Oncology Institute IRCCS, Medical Oncology Unit 1, Padua
| | - Daniele Generali
- Azienda Istituti Ospitalieri di Cremona, UO Multidisciplinare di Patologia Mammaria, Cremona
| | - Anna Moretti
- AO Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | | | | | | | - Luca Tondulli
- AO Universitaria Integrata di Verona Borgo Trento Hospital, Department of Oncology, Verona
| | - Ilaria Marcon
- Ospedale di Circolo e Fondazione Macchi, Department of Oncology, Varese
| | | | - Rosalba Rossello
- Policlinico Universitario “G Martino”, Department of Human Pathology, Medical Oncology and Integrated Therapies Unit, Messina
| | - Olga Martelli
- AO S Giovanni-Addolorata, Medical Oncology Unit, Rome
| | | | | | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research, Department of Oncology, Milan
| | - Marina Garassino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Oncology Unit 1, Milan, Italy
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Clinicopathologic characteristics and survival of male breast cancer. Int J Clin Oncol 2013; 19:280-7. [DOI: 10.1007/s10147-013-0555-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
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Deb S, Jene N, Fox SB. Genotypic and phenotypic analysis of familial male breast cancer shows under representation of the HER2 and basal subtypes in BRCA-associated carcinomas. BMC Cancer 2012; 12:510. [PMID: 23146383 PMCID: PMC3561656 DOI: 10.1186/1471-2407-12-510] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 10/05/2012] [Indexed: 01/07/2023] Open
Abstract
Background Male breast cancer (MBC) is an uncommon and relatively uncharacterised disease accounting for <1% of all breast cancers. A significant proportion occurs in families with a history of breast cancer and in particular those carrying BRCA2 mutations. Here we describe clinicopathological features and genomic BRCA1 and BRCA2 mutation status in a large cohort of familial MBCs. Methods Cases (n=60) included 3 BRCA1 and 25 BRCA2 mutation carries, and 32 non-BRCA1/2 (BRCAX) carriers with strong family histories of breast cancer. The cohort was examined with respect to mutation status, clinicopathological parameters including TNM staging, grade, histological subtype and intrinsic phenotype. Results Compared to the general population, MBC incidence was higher in all subgroups. In contrast to female breast cancer (FBC) there was greater representation of BRCA2 tumours (41.7% vs 8.3%, p=0.0008) and underrepresentation of BRCA1 tumours (5.0% vs 14.4%, p=0.0001). There was no correlation between mutation status and age of onset, disease specific survival (DSS) or other clincopathological factors. Comparison with sporadic MBC studies showed similar clinicopathological features. Prognostic variables affecting DSS included primary tumour size (p=0.003, HR:4.26 95%CI 1.63-11.11), age (p=0.002, HR:4.09 95%CI 1.65-10.12), lymphovascular (p=0.019, HR:3.25 95%CI 1.21-8.74) and perineural invasion (p=0.027, HR:2.82 95%CI 1.13-7.06). Unlike familial FBC, the histological subtypes seen in familial MBC were more similar to those seen in sporadic MBC with 46 (76.7%) pure invasive ductal carcinoma of no special type (IDC-NST), 2 (3.3%) invasive lobular carcinomas and 4 (6.7%) invasive papillary carcinoma. A further 8 (13.3%) IDC-NST had foci of micropapillary differentiation, with a strong trend for co-occurrence in BRCA2 carriers (p=0.058). Most tumours were of the luminal phenotype (89.7%), with infrequent HER2 (8.6%) and basal (1.7%) phenotype tumours seen. Conclusion MBC in BRCA1/2 carriers and BRCAX families is different to females. Unlike FBC, a clear BRCA1 phenotype is not seen but a possible BRCA2 phenotype of micropapillary histological subtype is suggested. Comparison with sporadic MBCs shows this to be a high-risk population making further recruitment and investigation of this cohort of value in further understanding these uncommon tumours.
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Affiliation(s)
- Siddhartha Deb
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, 3002, Australia.
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Sandhu NP, Bride MBM, Dilaveri CA, Neal L, Farley DR, Loprinzi CL, Wahner-Roedler DL, Ghosh K. Male breast cancer. JOURNAL OF MEN'S HEALTH 2012. [DOI: 10.1016/j.jomh.2012.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sroufe RL, Schwartz D, Rineer J, Choi K, Rotman M, Schreiber D. A population-based study of the impact of post-mastectomy radiation on survival for male breast cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0062-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Greif JM, Pezzi CM, Klimberg VS, Bailey L, Zuraek M. Gender differences in breast cancer: analysis of 13,000 breast cancers in men from the National Cancer Data Base. Ann Surg Oncol 2012; 19:3199-204. [PMID: 22766989 DOI: 10.1245/s10434-012-2479-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine gender-specific differences in breast cancer utilizing the National Cancer Data Base (NCDB). METHODS Breast cancer patients entered in the NCDB from 1998 through 2007 were compared by gender for demographics, tumor characteristics, treatment, and outcomes. RESULTS A total of 13,457 men were compared to 1,439,866 women. Men were older, more often African American, less often Hispanic, had larger tumors, less often had low-grade disease, less often had stage 0 or I disease, and were more likely to have metastases to lymph nodes and/or distantly. Cancers in men were less likely lobular and more likely estrogen receptor and/or progesterone receptor positive. Men were more likely to have total mastectomy and less likely to receive radiotherapy. There was no difference in chemotherapy and little difference in hormone therapy rates. Differences in overall survival (OS) were highly significant (p < 0.0001): 83 % 5-year OS for women with breast cancer (median survival 129 months) versus 74 % for men (median survival 101 months). Women had better 5-year OS (p < 0.0001) for stage 0 (94 vs. 90 %), stage I (90 vs. 87 %), and stage II (82 vs. 74 %) breast cancer. There were no differences in 5-year OS for stage III (56.9 vs. 56.5 %, p = 0.99) or stage IV (19 vs. 16 %, p = 0.20) disease. CONCLUSIONS At first glance, this large study demonstrated numerous gender-specific differences. However, after accounting for differences in presentation, absence of data on disease-specific survival, and inherent deficiencies in reporting cancer registry data, breast cancer in men and women appears more alike than different.
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Affiliation(s)
- Jon M Greif
- Carol Ann Read Breast Health Center, Oakland, CA, USA.
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