Male breast cancer is a relatively rare cancer in men that originates from the breast. As it presents a similar pathology as female breast cancer, assessment and treatment relies on experiences and guidelines that have been developed in female patients. The optimal treatment is currently not known.
There are significant differences between male and female breast cancer. Lesions are easier to find in men due to the smaller breast size; however, lack of awareness may postpone seeking medical attention.
The presence of gynecomastia may mask the condition. The diagnosis is made later in men—at age 67 on average—than in women with their average at 63.
Lesions are less contained in men as they do not have to travel far to infiltrate skin, nipple, or muscle tissue. Thus, lesions in men tend to be more advanced.
Indeed, almost half of male breast cancer patients are stage III or IV. In familial cases, male BRCA2 carriers are at risk, rather than BRCA1 carriers. With the relative infrequency of male breast cancer, randomized studies are lacking.
The initial treatment is surgical and consists of a modified radical mastectomy with axillary dissection or lumpectomy and radiation therapy with similar treatment results as in women.
Also, mastectomy with sentinel lymph node biopsy is a treatment option. In men with node-negative tumors, adjuvant therapy is applied under the same considerations as in women with node-negative breast cancer.
Similarly, with node-positive tumors, men increase survival using the same adjuvants as affected women, namely both chemotherapy plus tamoxifen and other hormonal therapy.
There are no controlled studies in men comparing adjuvant options. In the vast majority of men with breast cancer hormone receptor studies are positive, and those situations are typically treated with hormonal therapy.
Locally recurrent disease is treated with surgical excision or radiation therapy combined with chemotherapy.
Distant metastases are treated with hormonal therapy, chemotherapy, or a combination of both. Bones can be affected either by metastasis or weakened from hormonal therapy; bisphosphonates and calcitonin may be used to counterbalance this process and strengthen bones.
There are significant differences between male and female breast cancer. Lesions are easier to find in men due to the smaller breast size; however, lack of awareness may postpone seeking medical attention.
The presence of gynecomastia may mask the condition. The diagnosis is made later in men—at age 67 on average—than in women with their average at 63.
Lesions are less contained in men as they do not have to travel far to infiltrate skin, nipple, or muscle tissue. Thus, lesions in men tend to be more advanced.
Indeed, almost half of male breast cancer patients are stage III or IV. In familial cases, male BRCA2 carriers are at risk, rather than BRCA1 carriers. With the relative infrequency of male breast cancer, randomized studies are lacking.
Treatment
Treatment largely follows patterns that have been set for the management of postmenopausal breast cancer.The initial treatment is surgical and consists of a modified radical mastectomy with axillary dissection or lumpectomy and radiation therapy with similar treatment results as in women.
Also, mastectomy with sentinel lymph node biopsy is a treatment option. In men with node-negative tumors, adjuvant therapy is applied under the same considerations as in women with node-negative breast cancer.
Similarly, with node-positive tumors, men increase survival using the same adjuvants as affected women, namely both chemotherapy plus tamoxifen and other hormonal therapy.
There are no controlled studies in men comparing adjuvant options. In the vast majority of men with breast cancer hormone receptor studies are positive, and those situations are typically treated with hormonal therapy.
Locally recurrent disease is treated with surgical excision or radiation therapy combined with chemotherapy.
Distant metastases are treated with hormonal therapy, chemotherapy, or a combination of both. Bones can be affected either by metastasis or weakened from hormonal therapy; bisphosphonates and calcitonin may be used to counterbalance this process and strengthen bones.
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