Male Breast Cancer: Management and Follow-up Recommendations

Abstract

National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but similar guidelines on male breast cancers are less recognized. As an NCCN institution, our objective was to examine practice patterns and follow-up for male breast cancer compared to established guidelines for female patients. After Institutional Review Board approval, a prospective breast database from 1990 to 2009 was queried for male patients. Medical records were examined for clinico-pathological factors and follow-up. The 5-year survival rates with 95% confidence intervals were estimated using Kaplan-Meier method and Greenwood formula. Of the 19,084 patients in the database, 73 (0.4%) were male patients; 62 had complete data. One patient had bilateral synchronous breast cancer. The median age was 68.8 years (range 29-85 years). The mean/median invasive tumor size was 2.2/1.6 cm (range 0.0-10.0 cm). All cases had mastectomy (29 with axillary node dissection, 23 with sentinel lymph node biopsy only, 11 with sentinel node biopsy followed by completion axillary dissection). Lymph node involvement occurred in 25/63 (39.7%). Based on NCCN guidelines, chemotherapy, hormonal therapy, and radiation are indicated in 34 cases, 62 cases, and 14 cases, respectively. Only 20/34 (59%) received chemotherapy, 51/62 (82%) received hormonal therapy, and 10/14 (71%) received post-mastectomy radiation. Median follow-up was 26.2 months (range: 1.6-230.9 months). The 5-year survival estimates for node positive and negative diseases were 68.5% and 87.5%, respectively (p = 0.3). Despite the rarity of male breast cancer, treatment options based on current female breast tumors produce comparable results to female breast cancer. Increased awareness and a national registry for patients could help improve outcomes and tailor treatment recommendations to the male variant.

Gender Differences in Breast Cancer: Analysis of 13,000 Breast Cancers in Men from the National Cancer Data Base

“…A recent example is reported from the Moffitt Cancer Center, looking at their 20-year experience of over 19,000 patients treated for breast cancer. 12 Only 73 (0.4 %) were men, and of these, only 62 had sufficient data recorded for inclusion in the study. The largest population-based data repository in the United States is the surveillance, epidemiology, and end results (SEER) program, a registry program of the National Cancer Institute, but it collects data from only a limited sample of registries in just 12 states, mainly on the basis of ''their ability to operate and maintain a high quality population-based cancer reporting system and for their epidemiologically significant population subgroups.''…”

Should Adjuvant Radiation Therapy Be Systematically Proposed for Male Breast Cancer? A Systematic Review

“…Lartigau et al reported a significant difference in 10-year disease-specific survival between those with T4 and those with T1 tumors (32% versus 87%, p=0.001) (11); Cutuli et al reported 10-year disease-specific survival rates for those with T0-T1, T2 and T3-T4 of 81%, 80% and 69%,respectively (20). Lymph node involvement was a strong prognostic factor in most MBC studies (15,31,34,36,37). The 10-year survival was 28% when lymph nodes were not involved versus 58% when involved (12).…”

Surgical Management of Male Breast Cancer: A Tertiary Care Centre Experience

“…In node positive patients, the five and ten year survival rate decrease to 73% and 50% respectively. Due to advanced stage of neoplasm at the time of presentation, Modified Radical Mastectomy is the most often operation in male breast cancer [15] . Role of Breast-conserving therapy in male breast cancer is unclear [16] .…”