Male breast cancer: a single centre experience and current evidence

Clinicopathologic Features and Radiation Therapy Utilization in Patients with Male Breast Cancer: A National Cancer Database Study

Male breast cancer (MBC) accounts for approximately 1% of all breast cancers, limiting the data characterizing clinicopathologic features and treatment outcomes in patients with MBC. This paucity of data has led to most of our treatment guidance being extrapolated from patients with female breast cancer (FBC). From 1998 to 2012, data were captured using the National Cancer Database to identify patients with nonmetastatic MBC (n = 23 305) and FBC (n = 2 678 061). Tumor and clinicopathologic features were obtained and compared. Patients with MBC were more likely to have invasive disease, T2-4 tumors, centrally located tumors, positive lymph nodes, estrogen receptor–positive or progesterone receptor–positive tumors, lymphovascular space invasion, and were less likely to have Her2/neu-positive or triple-negative tumors. All of these differences were statistically significant (P < .001). Treatment comparisons showed that patients with MBC were more likely to undergo mastectomy and less likely to undergo breast-conserving surgery with postoperative radiation utilization found to be less in patients with MBC, both as part of breast-conserving therapy (BCT) and for postmastectomy radiation treatment (PMRT) (P < .001). Stage-by-stage comparisons showed that median survival, 5-year, and 10-year overall survival (OS) rates are lower in patients with MBC vs patients with FBC (P < .001). The utilization of adjuvant radiation, both BCT and PMRT, was shown to improve 5- and 10-year OS (P < .001). Male breast cancer clinicopathologic features appear to be unfavorable in relation to FBC and adjuvant radiation is shown beneficial in survival outcomes. Further investigation is needed to help guide future utilization and treatment with radiation, systemic, and endocrine manipulation in this small population of patients with MBC.

The surgical management of male breast cancer: Time for an easy access national reporting database?

INTRODUCTION

Male breast cancer is extremely rare with an incidence of less than 1% of all breast cancers. Literature reports a peak of incidence at roughly 71 years of age. Management currently follows the same clinical pathways as female breast cancer as a general rule.

METHODS

A retrospective search for all patients who were referred and diagnosed with male breast cancer at our centre was undertaken. Patients notes were then explored for demographics, histological staging, multidisciplinary team meeting outcome and treatment. A literature search including the search terms 'Male Breast Cancer AND Surgery' or 'Male Breast Cancer AND Experience' were used. Non English language articles, or those without abstracts were excluded.

RESULTS

Seven patients were reviewed over 3 years (2006-2009). Mean agea was 69 years and mean lesion size was 15 mm. Histology was invasive ductal carcinoma for all patients. All patients were ER receptor positive. Two patients were HER2 positive. Five patients were offered mastectomy. One patient refused treatment. In follow up at 36 months there were 3 recurrences. 1 patient was lost to follow up. There were 3 mortalities. The literature search identified 72 articles. Articles were subdivided into those that discussed the surgical management of male breast cancer (n = 8), articles that discussed male breast cancer as podium presentations or posters with no full text article publication (n = 13) and finally full text publications of case experience of male breast cancer (n = 21).

DISCUSSION

We report a series of seven cases of male breast cancer encountered over three years, evaluating patient demographics as well as treatment and outcomes. In our series patients were managed with mastectomy. New evidence is questioning the role of mastectomy against breast conserving surgery in male patients. Furthermore there is a lack of reporting infrastructure for national data capture of the benefits of surgical modalities. Literature review highlights the varied clinical experience between units that remains reported as podium presentation but not published. The establishment of an online international reporting registry would allow for efficient analysis of surgical outcomes to improve patient care from smaller single centres. This would facilitate large scale meta analysis by larger academic surgical centres.

Male breast cancer: a 24 year experience of a tertiary care hospital in Pakistan

BACKGROUND

Male breast cancer accounts for less than 1% of all cancers found in men. It usually presents at a later age and stage as compared to female breast cancer. Treatment strategies are extrapolated from the management of female breast cancer. Our study here looked at 18 patients diagnosed with and treated for male breast cancer at The Aga Khan University Hospital in Pakistan. We compared our findings with the existing data from Asian and Western countries.

MATERIALS AND METHODS

A retrospective study was conducted looking at patients with male breast cancer between January 1986 and December 2009. Patient and disease characteristics were analyzed and 5 year overall survival was calculated using Microsoft Excel and SPSS.

RESULTS

The average age at diagnosis was 52 years (38-67 years). Twelve (66.7%) patients had axillary lymphadenopathy. Stage II disease was the most common stage at presentation (9 patients, 50%). Infiltrating ductal carcinoma was seen in 16 patients (88.8%). Seven lesions were positive for both estrogen and progesterone receptors. Sixteen patients had surgery in the form of either modified radical mastectomy or radical mastectomy. Radiation was used in 7 patients in an adjuvant setting. The five year overall survival for stage I, II, III and IV disease was 100% vs 78% vs 50% vs 0%( p<0.05). Five year overall survival was 61%. None of the other prognostic factors were statistically significant. Median follow up was 15 months (3-202 months).

CONCLUSIONS

Male breast cancer may be on a slow rise but is still an uncommon disease. Tumor stage and lymph node status are important prognostic markers. Public awareness and screening may help in detecting the disease at an earlier stage. Prospective trials are needed to improve the management of this disease.