Clinical profile, BRCA2 expression, and the androgen receptor CAG repeat region in Egyptian and Moroccan male breast cancer patients

Abstract

Introduction Male breast cancer (MBC) is a rare disease. Rates of MBC in Northern Africa vary by region. The age-standardized incidence for MBC is higher in Morocco than in Egypt, and the Egyptian rate is similar to the U.S of approximately 1/105 . This study aimed at investigating the clinical and molecular characteristics of MBC in Egypt and Morocco. Methods This case-case study included 211 cases from Egypt and 132 from Morocco. Tumor tissues were available for 47 Egyptian and 18 Moroccan patients. Medical record information was abstracted for patients’ demographics, medical history, and treatment. BRCA2 protein expression status was examined in Egyptian and Moroccan tumors. Androgen receptor CAG repeat length was analyzed using the tissue samples in Egyptian MBC tumors and controls. Limited amount of tissues from Morocco did not allow for the analysis of CAG repeats. Results Egyptian MBC patients had a significantly lower age at diagnosis (Egypt: 57.5 ± 15.1, Morocco: 63.9 ± 14.4, P = 0.0002) and a higher prevalence of liver cirrhosis (Egypt: 28.0%, Morocco: 0.8%, P =< 0.0001). MBC patients also had higher tumor grades [I (0.9%), II (81.0%), III (18.1%)] in Egypt vs. [I (10.7%), II (81.0%), III (8.3%)] in Morocco (P = 0.0017). The clinical and molecular characteristics of the groups from the 2 countries did not significantly differ. There was no significant difference with respect to BRCA2 expression amongst countries (Egypt: 28.9% non-wild type, Morocco: 27.8% non-wild type, P = 0.9297) or CAG lengths amongst BRCA2 expression types in Egyptians (Wild type: 54.6% with CAG repeat lengths of 20+, Non-wild type: 50% with CAG repeat lengths of 20+, P = 0.7947). Conclusions Differences in MBC between Egypt and Morocco are more likely due to differences in other risk factors such as consanguinity and use of xenoestrogenic pesticides.

Clinical trends and outcomes of male breast cancer: Experience of a tertiary oncology centre in India

“…Family history is relevant for both sexes 7,8 , and BRCA2 mutations and rearrangements play a particularly prominent role in male breast cancer. 9,10,11 Conditions that alter the ratio of estrogen to androgen have been linked to breast cancer risk in men. Klinefelter's syndrome, exogenous estrogen or testosterone use, obesity and a history of prostate cancer treated with estrogens have been implicated.…”

Breast Cancer in Men: A Systematic Review of the Literature from the Arab World

“…However, in a comparative study of Male BC between Egypt and Morocco [20], Gilbert et al found that Egyptian men have a younger mean age at diagnosis of 57.5 years, whereas the mean age at diagnosis of Moroccan men was 63.9 years (p=0.0002). Another highlight lays in the underlying liver damages that were noticed in 28 % of Egyptian patients vs only 0.8 % in the Moroccan patients (p<0.0001).…”

First report of bilateral synchronous male accessory breast cancer

“…Common clinical presentations of male breast cancer include painless subareolar lump and nipple discharge 6. Advanced age, family history of breast cancer and BRCA2 contribute to increased risk of developing breast cancer in man 7 8. Exogenous oestrogen usage, obesity, orchitis and Klinefelter’s syndrome, all of which contribute to a higher ratio of oestrogen to testosterone, resulted in elevated male breast cancer risk 5…”