Clinicopathological study of male breast carcinoma: 24 years of experience

An update on existing therapeutic options and status of novel anti-metastatic agents in breast cancer: Elucidating the molecular mechanisms underlying the pleiotropic action of Withania somnifera (Indian ginseng) in breast cancer attenuation

Major significant advancements in pharmacology and drug technology have been made to heighten the impact of cancer therapies, improving the life expectancy of subjects diagnosed with malignancy. Statistically, 99% of breast cancers occur in women while 0.5-1% occur in men, the female gender being the strongest breast cancer risk factor. Despite several breakthroughs, breast cancer continues to have a worldwide impact and is one of the leading causes of mortality. Additionally, resistance to therapy is a crucial factor enabling cancer cell persistence and resurgence. As a result, the search and discovery of novel modulatory agents and effective therapies capable of controlling tumor progression and cancer cell proliferation is critical. Withania somnifera (L.) Dunal (WS), commonly known as Indian ginseng, has long been used traditionally for the treatment of several ailments in the Indian context. Recently, WS and its phytoconstituents have shown promising anti-breast cancer properties and, as such, can be employed as prophylactic as well as therapeutic adjuncts to the main line of breast cancer treatment. The present review is an attempt to explore and provide experimental evidences in support of the prophylactic and therapeutic potential of WS in breast cancer, along with a deeper insight into the multiple molecular mechanisms and novel targets through which it acts against breast and other hormonally-induced cancers viz. ovarian, uterine and cervical. This exploration might prove crucial in providing better understanding of breast cancer progression and metastasis and its use as an adjunct in improving disease prognosis and therapeutic outcome.

A Single Centric Quantitative Assessment of Male Breast Cancer Knowledge, Perception, and Awareness: Breaking the Stigma in Indian Population

Most people throughout the world are still uninformed of the problem of breast cancer in men. Despite increasing awareness programs targeting women, most people are unaware that breast cancer can also affect men. Our purpose is to assess the knowledge, perception, and awareness of male breast cancer among the adult male population. A descriptive cross-sectional survey included 128 male employees who agreed to participate in our study. We distributed pre-validated questionnaires to participants and gathered data following the one-on-one interview. The mean age of the participants was 37.71 years with a standard deviation of 7.65. About 55.5% of the participants were unaware that changes in the nipple position could be a sign of breast cancer. Majority of the participants, i.e., 60.9% believe positive family history will not increase the risk of breast cancer and 93% of participants have no idea about self-breast examination to detect lumps. On the other hand, 33.6% of participants stated that diagnosis and treatment of male breast cancer is embarrassing. Majority of the participants have no idea about the screening methods, 59.4% of participants have not heard about mammography, which is considered a modality of choice for early detection of breast cancer. The male university staff were lacking in knowledge and awareness about male breast cancer. In Indian community, because of shyness, they feel very embarrassed when it comes to openly discussing breast cancer. Because of this, it needs to receive more attention and to educate the male population about male breast cancer.

Male breast cancer: a 30 year retrospective analysis from a tertiary cancer care centre

Background

Male breast cancer (MBC) is one of the rare malignancies that account for less than 1% of all malignancies in males. However, the clinicopathological characteristics of MBC are not entirely similar to female breast cancer; but still, it is treated in line with the female breast cancer protocols.

Aims

To retrospectively analyse trends in MBC as to its distribution, presentation, treatment, and outcome.

Material and method

A total of 106 patients with MBC from 1991 to 2020 were analysed retrospectively. Frequency distribution analysis of the demographic and clinicopathological data and treatment variables was done.

Results

Median age of presentation was 57 years; ranging from 30 to 86 years. Either of the sides was almost equally affected with an R: L ratio of 1.2:1. The average duration of complaint was 26.2 months (range 1-240 months). History of gynaecomastia was noted in 18 patients, significant benign prostate hypertrophy in 13, and hypertension needing medical treatment in 14 patients. The majority of the patients were smokers (72/106) and alcoholics (43/106). Five patients reported positive family history. 21 patients had metastatic disease at presentation and received palliative treatment. Stage II was seen in 36.8%, stage III in 43.4%, and stage IV in 19.8% of patients. Node positives were 63.2%. Pathology was invariably (90.5%) infiltrative ductal carcinoma. Radiation was administered in 85.8% of the patients, chemotherapy in 72.6% of patients, and hormonal treatment was given in 47.2% of patients. The median overall survival (OS) was 78 months. OS at 5 and 10 years was 78% and 58% respectively.

Conclusion

Despite the possibility of MBC being apparent at an early stage, patients present with locally advanced disease. Radical surgery with adjuvant/neoadjuvant chemotherapy and adjuvant radiotherapy remains the gold standard. Cancer education campaigns must be run to catch the early disease and to radically treat the disease.

Evaluation of Rare Types of Breast Cancer among Indian Patients - a Retrospective Study from a Regional Cancer Center

Introduction

Breast cancer (BC) is the most common cancer among Indian women and invasive duct cell carcinoma (IDCC) the most common histology (80-90%) followed by noninvasive duct cell carcinoma (non-IDCC) subtypes (about 10%). Most of the non-IDCC are rare (<1-2%), and literature on this topic is sparse. Age is an important prognostic factor and varies with ethnicity. The aim of our study is to evaluate the incidence and age at presentation of different types of BC.

Material and Methods

This is a single institute retrospective observational study evaluating BC over the last 7 years at our institute. We evaluated the demographic and pathological features.

Results

There were a total of 2725 patients, of these 89.7% had IDCC and 10.2% had non-IDCC. There were 13 subtypes of non-IDCC, the most common being sarcoma/phyllodes (2.4%) and lobular (2.3%). The other subtypes were very rare (<1.5% each). The non-IDCC male BC was very rare (0.07%). The median age at presentation was similar for IDCC and non-IDCC types (50 years). The p value for age at presentation was significant for mucinous (0.0001), phyllodes (<0.0001), and sarcoma breast (0.009) when compared with IDCC.

Conclusion

The incidence of IDCC, non-IDCC, and rare subtypes of non-IDCC are comparable to literature except lobular (lower) and phyllodes/sarcoma (higher). Indian patients presented a decade earlier for both IDCC and non-IDCC types. Tubular and papillary presented at an age comparable to IDCC, in contrast to the West. Given these differences, the prognosis of non-IDCC needs to be evaluated in future studies on Indian BC patients.

Presentation and Spectrum of Male Breast Cancer in a Rural Cancer Center in a Subunit of Tata Memorial Center, India

This is a retrospective study of the incidence and clinical profile of male breast cancer (MBC) presenting to a rural cancer center in Punjab, India. All MBC cases registered over a period of 4.5 years from January 2015 to July 2019 were included. The study included 34 MBC patients accounting for 1.9% of all breast cancer cases with median age of 62.5 years. All patients were from Punjab except one, with majority from district Sangrur. Family history was present in 7 (20.6%) patients. Mean BMI (n = 23) was 24.8. The median duration of symptoms was 6 months (range 1-60 months). Main complaint was lump in 58.8% of patients followed by lump with ulceration (41.2%). All cases were mostly unilateral, left in 21 (61.8%) and right in 13 (38.2%), and one had bilateral breast cancer. Most tumors were centrally located (70.6%). Infiltrating ductal carcinoma and grade 3 were the commonest histology. ER positivity was high seen in 76.5% cases. In our study, 16 (47.1%) patients presented with distant metastasis at the time of diagnosis, and 10 (39.1%) were locally advance. Bone (41%) followed by lung (17%) were the most common sites of metastasis. Thirteen patients were treated radically, nine were treated with palliative intent, and twelve patients defaulted. Median follow-up period was 16.5 months. MBC constituted 1.9% of all breast cancers registered at our institute, which is higher than worldwide average. Our study population had a longer time to presentation, and majority were metastatic.

Male breast cancer: A retrospective review of clinical profile from a tertiary cancer care center of India

Aim:

Present study was done with an aim to analyse the clinicopathological and survival characteristics of male breast cancer patients.

Methods:

We did a retrospective review of our database and analysed total 27 patients who presented to breast oncology unit of Rajiv Gandhi cancer centre and research institute from January 2010 to April 2016.

Results:

Most common stage at presentation in our study was in stage II. The median follow up was 32.75 months. The actuarial 5-year survival was 92.30% and DFS was 76.30%. Only hormone receptor status was found as a significant prognostic variable among the prognostic factors studied for disease free survival.

Conclusions:

Carcinoma breast in male is a relatively rare disease and management principles are translated from our understanding of breast cancer in women. A relatively early stage at presentation is a contrasting finding of our series which may be responsible for a significantly better actuarial 5 year survival rates.

Male Breast Cancer: Current Trends-a Tertiary Care Centre Experience

Male breast cancer is a rare tumour in all parts of the world. About 1% of all breast cancers occur in men. Occurrence of male breast cancer peaks at age 71 years. Familial cases usually have BRCA2 rather than BRCA1 mutations. Presentation is usually a lump or nipple inversion, but is often late, with more than 40% of individuals having stage III or IV disease. We retrospectively reviewed 25 male patients with breast cancer who came to the HCG Cancer Centre, Ahmedabad between 2014 and 2018, and their demographic details, tumor profile, and radiological, histopathological as well as luminal profile findings were studied. The average age at presentation and detection of male breast cancer was 61.08 years. Incidence of male ca. breast over these 4 years was 4.75/year which had a significant increase compared with our own data in the last 8 years (3/year). Male to female ratio for ca. breast was 1:61. One out of 25 (4%) patients had gynaecomastia. The most common histology was invasive ductal carcinoma-not otherwise specified with none of the patients having lobular carcinoma. Majority of patients were ER/PR positive and HER-2 negative. Male breast cancer is having a rising incidence, which in our study is 1.56%. Males have relatively older age at presentation and stage-by-stage treatment remains the same. Males are more likely to be having prognostically favourable luminal subtypes. Male breast cancer in Indian population is currently experiencing an increasing trend. Improved awareness amongst patients and high index of suspicion by the clinicians along with accurate diagnostic techniques help detect the disease at an earlier stage culminating into prolonged overall and disease-free survival.

A study of mechanistic mapping of novel SNPs to male breast cancer

Alterations in BRCA2, PALB2, CHEK2, and p53 genes have been identified for their association with male breast cancer in various studies. The incidence of male breast cancer in India is consistent with its global rate. The present study was carried out with an aim to evaluate the genetic alterations in male breast cancer patients from Malwa region of Punjab, India. Four male breast cancer patients belonging to different families were recruited from Guru Gobind Singh Medical College and Hospital, Faridkot, India. A total of 51 genes reported with implications in the pathogenesis of breast cancer were screened using next generation sequencing. Germline variations were found in BRCA1, BRCA2, PMS2, p53, and PALB2 genes, previously reported to be associated with MBC as well as FBC. In addition to these, 13 novel missense alterations were detected in eight genes including STK11, FZR1, PALB2, BRCA2, NF2, BAP1, BARD1, and CHEK2. Impact of these missense alterations on structure and function of protein was also analyzed through molecular dynamics simulation. Structural analysis of these single nucleotide polymorphisms (SNPs) revealed significant impact on the encoded protein functioning.

Intracystic Papillary Carcinoma of the Breast in a Male Patient

We report a case of intracystic papillary carcinoma of the right breast in a 59-year old man presenting with bloody nipple discharge for 1 week prior to presentation. Mammography, ultrasonography, and core needle aspiration were consistent with intracystic papillary carcinoma. The patient underwent right simple mastectomy. Pathology was also consistent with low grade intracystic papillary carcinoma. The 21-gene assay revealed a recurrence score of 0, corresponding to a 3% risk of distant recurrence at 10 years. A patient did not receive chemotherapy or post-mastectomy radiotherapy. The patient was placed on tamoxifen and has been free of disease to date.

Male Breast Cancer in India: Series from a Cancer Research Centre

Male breast cancer (MBC) is an uncommon malignancy. The scarcity of cases has reduced the focus of research in this area as compared with female breast cancer. The incidence of breast cancer in males is slowly rising and it becomes important to study the biology of this uncommon illness. Aim of the present work was to study the clinico-pathological behaviour of male breast cancer at a cancer research institute in India. 18 cases of MBC were identified out of 1752 cases of breast cancer registered during a 10 year period. Clinical parameters and histopathological data were analysed. MBC comprised of 1.03 % of total breast cancer cases. Median age of presentation was 60 years. Most of the patients presented to us in advanced stage. Aggressive pattern of disease was recognised with high node positivity, more perineural spread and lymphovascular invasion. Most of the cases were positive for hormone receptors. Breast cancer is seen at a relatively early age in Indian males. Disease is aggressive in nature with high hormone receptor positivity.

Intracystic papillary carcinoma of the breast in males: a case report and review of the literature

Carcinoma of the male breast is a relatively rare disease that accounts for less than 1% of all the cases of cancer in men. Intracystic Papillary Carcinoma (IPC) is an extremely rare disease of the male breast, with a few case reports. The prognosis is excellent for the patients who are diagnosed with IPC, regardless of whether the tumour is in-situ or of an invasive type. We are reporting the case of a 50 year old man who presented with a painless cystic lump in the left breast. Ultrasonography revealed an intracystic tumour. Fine needle aspiration suggested a papillary tumour. The patient underwent simple mastectomy without a sentinel lymph node biopsy. The final pathologic examination revealed an intracystic papillary carcinoma of a low nuclear grade without an invasion.

Accuracy of BRCA1/2 mutation prediction models for different ethnicities and genders: experience in a southern Chinese cohort

Background

BRCA1/2 mutation prediction models (BRCAPRO, Myriad II, Couch, Shattuck-Eidens, BOADICEA) are well established in western cohorts to estimate the probability of BRCA1/2 mutations. Results are conflicting in Asian populations. Most studies did not account for gender-specific prediction. We evaluated the performance of these models in a Chinese cohort, including males, before BRCA1/2 mutation testing.

Methods

The five risk models were used to calculate the probability of BRCA mutations in probands with breast and ovarian cancers; 267 were non-BRCA mutation carriers (247 females and 20 males) and 43 were BRCA mutation carriers (38 females and 5 males).

Results

Mean BRCA prediction scores for all models were statistically better for carriers than noncarriers for females but not for males. BRCAPRO overestimated the numbers of female BRCA1/2 mutation carriers at thresholds ≥20% but underestimated if <20%. BRCAPRO and BOADICEA underestimated the number of male BRCA1/2 mutation carriers whilst Myriad II underestimated the number of both male and female carriers. In females, BRCAPRO showed similar discrimination, as measured by the area under the receiver operator characteristic curve (AUC) for BRCA1/2 combined mutation prediction to BOADICEA, but performed better than BOADICEA in BRCA1 mutation prediction (AUC 93% vs. 87%). BOADICEA had the best discrimination for BRCA1/2 combined mutation prediction (AUC 87%) in males.

Conclusions

The variation in model performance underscores the need for research on larger Asian cohorts as prediction models, and the possible need for customizing these models for different ethnic groups and genders.

Male breast cancer

Diagnosis and treatment modalities for female breast cancer have developed spectacularly in recent years. Unfortunately, this is not the case for male breast cancer. Because the disease is so rare, controlled clinical trials have almost never been performed and treatment is based on findings in women or small series of men. Similarly, while breast cancer in women is diagnosed at an increasingly early stage, male breast cancer is usually diagnosed late, when the chances of cure are diminished. This article reviews what is currently known about male breast cancer, with an emphasis on areas where evidence-based data are scarce. While it is possible that some recent developments in female breast cancer treatment could be applicable to men, but the way forward is to increase awareness of the disease, and for treatment centers to pool patients for inclusion in randomized clinical trials.

Male breast cancer: an update in diagnosis, treatment and molecular profiling

Significant advances have been made in the diagnosis and treatment of female breast cancer, resulting in a decline in incidence and a global improvement in clinical outcome. The statistics for male breast cancer (MBC) stand in sharp contrast-over the past several decades, there has been a steady rise in the incidence of this disease, and clinical outcome has improved at a much slower pace. In the current review, the clinicopathologic features of MBC are described in detail. An emphasis is placed on molecular profiling of MBC, which may identify candidate biomarkers and putative targets for pharmacologic intervention. The current role of cytotoxic chemotherapy and endocrine therapy (including tamoxifen, aromatase inhibitors and GnRH analogues) is defined in the context of currently available studies. Furthermore, the potential role of targeted agents, including HER2-directed therapies, PARP inhibitors, and angiogenesis inhibitors, is delineated.