Male breast cancer: Looking for better prognostic subgroups

Abreu, Miguel; Afonso, Noemia; Abreu, Pedro Henriques; Menezes, Francisco Duarte; Lopes, Paula; Henrique, Rui; Pereira, Deolinda; Lopes, Carlos

doi:10.1016/j.breast.2015.12.001

Cited by 35 publications

(40 citation statements)

References 31 publications

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“…Comparative analysis of clinicopathological data from our cohort with combined data extracted from 15 studies published over the last 21 years, reporting ≥30 cases101112141617181932333435363738 was investigated totalling 1984 cases. Key observations from our cohort were that the majority of patients present with ductal histology, grade 2, with high incidence of ER and PR expression, reflective of luminal A phenotype.…”

Section: Discussionmentioning

confidence: 99%

“…Information derived from these small numbers are at best anecdotal. In the last decade interest in MBC has grown, resulting in accumulation of more substantial numbers of cases allowing study of common biomarkers including estrogen receptor (ER) α, progesterone receptor (PR)910111213) and human epidermal growth factor receptor 2 (HER2)910111213 as well as less frequently evaluated biomarkers such as ERβ9 androgen receptor (AR)910121314), Bcl-21013, p53101213, Ki6710111315, FOXP114, GCDFP14, NAT116, HLA16, MGB14, COX-217, CD3418 and survivin17. BRCA mutations have also been studied19.…”

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confidence: 99%

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Characterisation of male breast cancer: a descriptive biomarker study from a large patient series

Humphries

Rajan

Honarpisheh

et al. 2017

Sci Rep

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Male breast cancer (MBC) is rare. We assembled 446 MBCs on tissue microarrays and assessed clinicopathological information, together with data from 15 published studies, totalling 1984 cases. By immunohistochemistry we investigated 14 biomarkers (ERα, ERβ1, ERβ2, ERβ5, PR, AR, Bcl-2, HER2, p53, E-cadherin, Ki67, survivin, prolactin, FOXA1) for survival impact. The main histological subtype in our cohort and combined analyses was ductal (81%, 83%), grade 2; (40%, 44%), respectively. Cases were predominantly ERα (84%, 82%) and PR positive (74%, 71%), respectively, with HER2 expression being infrequent (2%, 10%), respectively. In our cohort, advanced age (>67) was the strongest predictor of overall (OS) and disease free survival (DFS) (p = 0.00001; p = 0.01, respectively). Node positivity negatively impacted DFS (p = 0.04). FOXA1 p = 0.005) and AR p = 0.009) were both positively prognostic for DFS, remaining upon multivariate analysis. Network analysis showed ERα, AR and FOXA1 significantly correlated. In summary, the principle phenotype of MBC was luminal A, ductal, grade 2. In ERα+ MBC, only AR had prognostic significance, suggesting AR blockade could be employed therapeutically.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Characterisation of male breast cancer: a descriptive biomarker study from a large patient series

Humphries

Rajan

Honarpisheh

et al. 2017

Sci Rep

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“…Although tamoxifen is a beneficial treatment, it is not without clinical issues including side effects such as reduced libido and impotence (Arnould et al 2006), which may lead to a clinical or patient decision to stop treatment (Fentiman et al 2006). In addition, the prognostic indicators are not necessarily the same between male and female breast cancers, making it difficult to determine which patients truly require treatment (Abreu et al 2016, Leone et al 2016.…”

Section: Clinical Featuresmentioning

confidence: 99%

A review of estrogen receptor/androgen receptor genomics in male breast cancer

Severson¹,

Zwart²

2017

Endocrine-Related Cancer

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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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“…Male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancer cases . Recently and due to the increase in its incidence, some studies were published suggesting a worst outcome for male compared to female breast cancer (FBC) patients, justified by: comorbid conditions and delay in the diagnosis in male patients, different age and stage at diagnosis or even differences in tumors biology …”

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confidence: 99%

“…1,2 Recently and due to the increase in its incidence, 3 some studies were published suggesting a worst outcome for male 1,3-6 compared to female breast cancer (FBC) patients, justified by: comorbid conditions 7 and delay in the diagnosis in male patients, 1 different age and stage at diagnosis 3,5,8 or even differences in tumors biology. 6,9 Despite the remarkable improvements in breast cancer (BC) characterization, accurate prediction of breast cancer behavior is often still difficult to achieve, 10 particularly in luminal disease where the mechanisms of treatment resistance, late relapse and dormancy are still not well-understood. 11,12 Recurrence plays an important rule in BC prognosis and although new therapies and approaches might decrease the incidence of relapse, compared to past records, 13 the hazard of dying after metastization was equal for patients diagnosed between 1978 and 1984 and 1995 and 2003 in a populationbased study 13 demonstrate that a special focus to advanced disease is still required.…”

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confidence: 99%

Patterns of recurrence and treatment in male breast cancer: A clue to prognosis?

Abreu

Afonso

et al. 2016

Intl Journal of Cancer

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Male breast cancer (MBC) patients seem to have inferior survival compared to female (FBC) ones, which is not fully explained by usual prognostic factors. Recurrence analysis could show differences in relapse patterns and/or in patients' approaches that justify these outcomes. Retrospective analysis of MBC patients treated in a cancer center between 1990 and 2014, looking for relapse. For each patient, three matched FBC patients were selected by: diagnosis' year, age (within 5 years), stage and tumors' type (only luminal-like were considered). Differences between cohorts were assessed by χ(2) test and hierarchical clustering was performed to define subgroups according to relapse local. Survival curves were calculated by Kaplan-Meier and compared using log-rank test. Statistical significance was defined as p < 0.05. Groups were balanced according to age, histological grade, stage, expression of hormonal receptors and adjuvant treatments. Median time to recurrence was equivalent, p = 0.72, with the majority of patients presented with distant metastases, p = 0.69, with more lung involvement in male, p = 0.003. Male patients were more often proposed to symptomatic treatment (21.1% vs. 4.4%, p = 0.02). Overall and from recurrence survivals were poorer for male, median: 5 years [95% confidence interval (CI): 4.1-5.9 years] and 1 year (95% CI: 0-2.1 years) vs. 10 years (95% CI: 7.8-12.2 years) and 2 years (95% CI: 1.6-2.4 years), p < 0.001 and p = 0.004, respectively, and this tendency remained in the five cluster subgroups, that identified five patterns of relapse, p = 0.003. MBC patients had the worst survival, even after controlling important factors, namely the local of relapse. Palliative systemic treatment had favorable impact in prognosis and its frequently avoidance in male could justify the outcomes differences.

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Male breast cancer: Looking for better prognostic subgroups

Cited by 35 publications

References 31 publications

Characterisation of male breast cancer: a descriptive biomarker study from a large patient series

Characterisation of male breast cancer: a descriptive biomarker study from a large patient series

A review of estrogen receptor/androgen receptor genomics in male breast cancer

Patterns of recurrence and treatment in male breast cancer: A clue to prognosis?

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