Male breast cancer

Male breast cancer is uncommon but important. The diagnosis is easily made by breast biopsy, and patients are presenting earlier in the course of the disease than in the past. Despite this, patients are often first seen with tumors that have metastasized to the axillary nodes, which markedly decreases the survival rate. Therapy of localized disease includes simple excision, modified radical mastectomy, and radical mastectomy, but there is no consensus for which operation is appropriate. Radiation therapy should be strongly considered in patients with metastases to the axillary nodes, but the role of adjuvant hormonal therapy or chemotherapy is unclear. For treatment of disseminated disease, tamoxifen seems to be replacing orchiectomy. The favorable response rate, especially in patients with estrogen-receptor-positive tumors, the lack of side effects, and the high level of patient acceptability make it an attractive therapeutic choice.     

Male inflammatory breast cancer

We report herein the case of a 68-year-old man diagnosed with inflammatory breast cancer. The patient presented following the rapid onset of redness and swelling over the left anterior chest wall. On examination, the left chest wall and left axilla were extensively hard, and the left upper limb was swollen. Ultrasonography and computed tomography (CT) scanning disclosed a mass in the left breast, about 2 cm in diameter with an unclear margin, and swelling of the major and minor pectoral muscles. Needle biopsy of the breast mass confirmed invasive lobular carcinoma. As a radical operation was considered contraindicated, systemic and intraarterial chemotherapy using 5-fluorouracil (5-FU) and Adriamycin (ADR) were performed. Nevertheless, the patient died of carcinomatous pleurisy 6 months after the initial onset of the disease.     

Male breast cancer: Austrian experience

Data were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5-year recurrence-free survival for the entire group was 55%, and the estimated 5-year overall survival was 62%. Although stage-adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence-free survival p=0.00001; overall survival p=0.03) and axillary lymph node status (recurrence-free survival p=0.0001; overall survival p=0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence-free survival p=0.001; overall survival p=0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.

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Resumen Se recolectaron datos en 169 hombres tratados por cáncer mamario en 16 departamentos quirúrgicos de Austria en el período 1970 a 1991. En el presente estudio reportamos diferentes características clínicas y tratamos de definir la importancia de factores establecidos de pronóstico. Luego de un período promedio de observación de 51 meses, se observó recurrencia en 60 pacientes (35%). La tasa estimada de sobrevida libre de enfermedad recurrente para la totalidad del grupo fue 55% y la tasa estimada de sobrevida global a 5 años fue 62%. En tanto que la estadificación de los datos es comparable a la de las mujeres con cáncer mamario, el resultado final en esta serie puede ser atribuido a una frecuencia relativamente alta de tumor en estados avanzados. El tamaño del tumor (sobrevida libre de recurrencia p=0.0001; sobrevida global p=0.03) y estado de los ganglios axilares (sobrevida libre de recurrencia p=0.00001; sobrevida global p=0.0001) demostró tener impacto en cuanto al pronós neo. En el análisis multivariable, el estado de los ganglios linfáticos axilares (sobrevida libre de recurrencia p=0.0001; sobrevida global p=0.01) retuvo su influencia pronóstica. Los diferentes procedimientos operatorios de tratamiento local no demostraron efecto en cuanto a la recurrencia local.

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Résumé On a analysé les dossiers de 169 hommes traités pour un cancer du sein dans 36 centres chirurgicaux en Autriche entre 1970 et 1991. Les données cliniques ont été analysés et des facteurs pronostiques établis. Après une période d'observation médiane de 51 mois, 60 patients (35%) avaient une récidive. La survie à 5 ans sans maladie a été évaluée à 55% pour le groupe entier, alors que la survie à 5 ans globale a été de 62%. Lorsqu'on a comparé ces cas à des cancers de sein chez la femme, on s'est rendu compte que l'évolution dans cette série était peut-être en rapport avec un nombre plus important de stades avancés de patients avec cancer. On a démontré que la taille de la tumeur (survie sans récidive; p =0.0001; survie globale p=0.03) et l'état des ganglions axillaires (survie sans récidive p=0,00001, survie globale p=0,0001) avaient une valeur pronostique. En analyse multifactorielle, l'état ganglionnaire axillaire était toujours considéré comme facteur pronostique (survie sans récidive p=0.0001; survie globale p=0.01). Les interventions locales n'avaient aucune influence pronostique sur les récidives locales.

     

Male breast cancer in patients with a familial history of breast cancer

We describe herein the clinical characteristics of five male breast carcinoma (MBC) patients with a familial history of breast carcinoma (FHBC). Four of these patients suffered from multiple primary cancers, being gastric and prostate cancer in 1, gastric cancer in 1, and asynchronous bilateral breast cancers in 2. The average age of these patients at diagnosis was not lower than that of MBC patients with no such familial history. The aggregation of cancer in these families had three prominent characteristics: (1) The families included women with early-onset breast cancers which had occurred at the ages of 38, 38, and 35 years, respectively, and/or early-onset uterine cancer which had occurred at the age of 35 years. (2) The incidence of multiple primary cancers was significantly higher in the siblings of MBC patients with a FHBC than without. (3) There were many cancers in hormone-related organs in two families.     

Male breast cancer: 6-year experience

AIM: Breast cancer in men is a very rare neoplasm accounting 1% of all breast cancer with an incidence ratio of 1:100 of men to women and about 1% of all malignancies in men. On the basis of the literature review the authors tried to determine the main characteristics of this rare neoplasm in terms of epidemiology, diagnosis, prognosis, treatment and survival. METHODS: The authors report the experience of the Breast Unit of the San Giovanni Addolorata Hospital in Rome, where 4 cases of male breast cancer were observed and treated over 784 breast cancers. RESULTS: All tumours were ductal carcinomas. The extent of disease was as follows: 3 cases with stage I and 1 case with Stage IIIB; in two cases estrogen and progesterone receptors expression was 100% and in the other two cases it was 20-80%. Median follow up was 57.5 months. At present, after 6-year follow up the three patients with stage I are in good conditions; the patient with stage III died after 27 months with metastatic disease. CONCLUSIONS: Surgical treatment remains the gold standard in male breast cancer. The prognosis for males with breast cancer is similar to female patients on equal terms of stage of disease. Adjuvant therapy is based on retrospective studies of male breast cancer conducted over the past 20 years using the guidelines for breast cancer in women.     

Male breast cancer: 19 case reports

Breast cancer is rarely encountered in men. In developed countries, it accounts for less than 1% of cancers in men, whereas in women it represents about 23% of all cancers. A retrospective review was performed on 19 cases of men who underwent surgery for breast carcinoma between 1989 and 2000. The aim of this work was to analyse epidemiological and etiological aspects, circumstances of discovery, pathological characteristics, therapy modalities as well as prognostic factors. The mean age was 65.3 years. A high incidence of overweight, diabetes, hypertension and hypercholesterolemia was found. The most frequent clinical presentation was a firm subareolar lump, at a low stage (stage I 23% and stage II 41%). The most common pathological type was an infiltrating ductal carcinoma (89%). Hormone receptors where most often positive (92% for oestrogen and 100% for progesterone receptors). 84% of patients underwent simple mastectomy and axillary dissection, 74% chest wall irradiation after surgery, 26% received chemotherapy and 42% hormonal therapy. Median follow-up was 52 months. The estimated 2-year overall survival (OS) and disease-free survival (DFS) was respectively 93% and 87.5% and the 5-year OS and DFS respectively 86% and 75%. The management of male and female breast carcinoma is identical, as well as their prognosis at equal stages. However male breast carcinoma is more often diagnosed at a more advanced stage, thus a breast screening in men would permit a sooner diagnosis and a better prognosis.     

Male cancer: a qualitative study of male breast cancer

Breast cancer is a rare condition in males. There is a dearth of information about the psychological and social impact of this condition. Data from six in-depth interviews with men who had breast cancer identified seven major issues. These were associated with delay in diagnosis, shock, stigma, body image, causal factors, the provision of information and emotional support. The findings from this small study suggest that there are psychological and social factors for men diagnosed with breast cancer which have implications for their care and management. The recommendations arising from this study are the development of a structured education programme aimed at all primary health-care professionals; with availability of pre and postoperative gender-specific information to alleviate the potential psychological problems associated with the diagnosis; and provision of appropriate support/counselling services for partners of patients.     

Male breast cancer: management and follow-up recommendations

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.     

男性乳腺癌42例分析

为探讨男性乳腺癌的临床特征和评价预后的指标,作者对１９６０年至１９９６年诊治的４２例男性乳腺癌患者进行了随访分析。经过６年４个月的中位随访期,５年总生存率为６４．３％,无瘤生存率为５７．１％。在预后指标单因素分析中,发现腋淋巴结转移为唯一的临床预后指标,而肿瘤大小、年龄等因素都对预后没有影响。     

Male patients with diagnoses of both breast cancer and prostate cancer

Abstract: Recently cancer susceptibility syndromes have been characterized that suggest possible genetic linkages between breast cancer and prostate cancer within families. Despite these connections, male breast cancer and prostate cancer in an individual man has rarely been reported. The clinical features of 10 patients with both of these cancers are described here. One hundred sixty-one patients with male breast cancer were seen at the Dana-Farber Cancer Institute and Massachusetts General Hospital between 1977 and 2000. Of these, 10 were identified who also had prostate cancer. A retrospective review of records from these 10 patients was performed. Breast cancer preceded prostate cancer in eight of these men. The mean age of diagnosis of breast cancer was 65.7 years (range 47–72 years). Twenty percent had nodal involvement at diagnosis and two patients ultimately developed evidence of metastatic disease. The mean age of diagnosis of prostate cancer was 68.0 years (range 51–76 years) with a median prostate-specific antigen (PSA) level at diagnosis of 6 ng/ml (range 1.8–47.5 ng/ml). Seven patients had a family history of female breast cancer in a first-degree relative, while one had a family history of prostate cancer. At a median follow-up of 6.5 years from initial cancer diagnosis, one patient had died of metastatic breast cancer and another had died of metastatic prostate cancer. The clinical features and course of the breast cancers diagnosed in this series do not appear significantly different from those described for the general population of male breast cancer patients. In addition, these men do not appear to develop prostate cancer at an earlier age or more aggressive stage than the general population.     

男性乳腺癌：附17例报告

目的:探讨男性乳腺癌的诊断、治疗及预后。方法:回顾性分析17例男性乳腺癌患者的临床资料。结果:17例患者平均年龄为59.6岁。其中Ⅰ期3例，Ⅱ期5例，Ⅲ期7例，Ⅳ期2例。以典型浸润性导管癌为主，乳腺癌的雌、孕激素受体阳性率分别为82.4 %和72.5 %。均行根治性手术治疗，术后辅以放疗、内分泌治疗和（或）化疗。其中1例失访，2例术后8个月~3年死于其它疾病，余14例术后已生存1～12年。结论:男性乳腺癌发病率低，发病年龄偏大,易误诊;内分泌治疗首选他莫昔芬;影响其预后的因素很多，其中最重要的是诊断时肿瘤的分期和淋巴结受累情况。     

男性乳腺癌临床分析：附14例报告

目的探讨男性乳腺癌的临床特点及治疗方法。方法回顾性分析14年余本院收治的14例男性乳腺癌患者的临床资料。结果 14例中髓样癌占7.1%(1/14),浸润性导管癌占92.9%(13/14)。长径1.5～5.2cm。1例(82岁)行单纯乳房切除,3例行乳癌根治术,10例行改良根治术;14例均行患侧腋窝淋巴结清除术,淋巴结转移率71.4%。12例随访9个月至14年,3例死亡,3例带瘤生存,6例无瘤生存;2例失访。随访期间5年生存率58.3%,10年生存率16.7%。采用乳腺癌根治术3例以及采用乳腺癌改良根治术10例均治愈。结论本组中以浸润性导管癌为主,易发生淋巴转移,预后差,10年生存率低。     

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目的探讨男性乳腺癌的特点、治疗及预后。方法回顾性总结14例男性乳腺癌的临床特点及治疗方法。结果男性乳腺癌发病年龄偏晚(平均58岁),病程长,腋窝淋巴结转移发生率为43%,肿块大小及淋巴结的转移程度与预后关系密切。结论男性乳腺癌的手术治疗应注重彻底清扫腋窝淋巴结,术后须辅以放化疗及内分泌治疗。     

Male breast cancer: Looking for better prognostic subgroups

PurposeMale Breast Cancer (MBC) remains a poor understood disease. Prognostic factors are not well established and specific prognostic subgroups are warranted.Patients/methodsRetrospectively revision of 111 cases treated in the same Cancer Center. Blinded-central pathological revision with immunohistochemical (IHQ) analysis for estrogen (ER), progesterone (PR) and androgen (AR) receptors, HER2, ki67 and p53 was done. Cox regression model was used for uni/multivariate survival analysis. Two classifications of Female Breast Cancer (FBC) subgroups (based in ER, PR, HER2, 2000 classification, and in ER, PR, HER2, ki67, 2013 classification) were used to achieve their prognostic value in MBC patients. Hierarchical clustering was performed to define subgroups based on the six-IHQ panel.ResultsAccording to FBC classifications, the majority of tumors were luminal: A (89.2%; 60.0%) and B (7.2%; 35.8%). Triple negative phenotype was infrequent (2.7%; 3.2%) and HER2 enriched, non-luminal, was rare (≤1% in both). In multivariate analysis the poor prognostic factors were: size >2 cm (HR:1.8; 95%CI:1.0–3.4years, p = 0.049), absence of ER (HR:4.9; 95%CI:1.7–14.3years, p = 0.004) and presence of distant metastasis (HR:5.3; 95%CI:2.2–3.1years, p < 0.001). FBC subtypes were independent prognostic factors (p = 0.009, p = 0.046), but when analyzed only luminal groups, prognosis did not differ regardless the classification used (p > 0.20). Clustering defined different subgroups, that have prognostic value in multivariate analysis (p = 0.005), with better survival in ER/PR+, AR-, HER2-and ki67/p53 low group (median: 11.5 years; 95%CI: 6.2–16.8 years) and worst in PR-group (median:4.5 years; 95%CI: 1.6–7.8 years).ConclusionFBC subtypes do not give the same prognostic information in MBC even in luminal groups. Two subgroups with distinct prognosis were identified in a common six-IHQ panel. Future studies must achieve their real prognostic value in these patients.     

Male breast cancer. Five years experience and literature review

Male breast cancer is an uncommon disease and its aetiology, clinical behaviour and treatment is not well-known . Retrospective studies show that age and stage-matched breast cancer in men and women are compared. Nevertheless, the poor mammary tissue in man allow a rapid local infiltration, late diagnosis and poor survival rate. The Authors report their five years experience and with a short literature review they summarise what is currently known about this uncommon neoplasm in terms of prognostic factors, therapy and survival.     

Male breast cancer: clinical, pathologic and immunohistochemical study

Forty-three cases of male breast cancer treated in the past 3 decades, comprising 1.92% of total cases of breast cancer in both sexes during the same period, were analyzed. Local skin involvement occurred in half of the patients. 67.7% of the patients presented axillary lymph node metastases and 82.9% were in stage II and III. Non-infiltrative and infiltrative specific cancers were diagnosed in 2 cases each, and infiltrative non-specific in 39 cases. Retrospective determination of estrogen receptor (ER) and carcinoembryonic antigen (CEA) in 33 specimens revealed positive ER in 57.6% and positive CEA in 72.7%. The more advanced the clinical stage, the higher is the positive rate of ER. Cases with positive CEA usually carried a more invasive process and a poorer prognosis. Immunohistochemical investigation in male breast cancer patients was valuable in the selection of post-operative adjuvant endocrine therapy or chemotherapy. Postoperative rise in serum CEA in patients with positive CEA may indicate recurrence.