Breast Cancer in Men
Breast Cancer in Men
The review by Dr. Buzdar emphasizes
a variety of clinical
features observed in male breast
cancer. Although this is an uncommon
diagnosis even in a busy oncology
practice (representing less than 1%
of all breast cancers), it is occasionally
Unlike women with breast cancer,
who often present with an abnormal
mammogram, men present with a palpable
mass. Given the low frequency
of male breast cancer, screening mammography
has no utility in this population.
Ductal carcinoma is the usual
histology seen in men; lobular carcinoma
is rare, as lobules are notusually
formed. As in women, it is
important to obtain a family history.
There is an association between male
breast cancer and BRCA2 mutations.
In terms of local management, unlike women, men are usually treated with a mastectomy. Breast-conserving therapy with lumpectomy and radiation is not technically feasible in men and lacks the cosmetic/functional advantages that exist for women. However, when it comes to systemic treatment either in the adjuvant or metastatic setting, the strategy is similar to the treatment of women with breast cancer. In the adjuvant setting after disease stage has been established, intervention should be comparable to that used in women with breast cancer. In patients with low-risk disease and hormone-receptor-positive tumors, endocrine intervention is appropriate. Higher-risk patients or those with estrogen-receptor-negative disease should be considered for chemotherapy. Numerous regimens are now available for women with breast cancer. Presumably, these regimens are also efficacious in men. That said, this is- sue of efficacy cannot be addressed directly with randomized trials because of the rarity of the disease in men. Regarding therapy for metastatic breast cancer, again the same principles are used in men and women. Endocrine therapy should be initiated in hormone-receptor-positive disease and given sequentially in patients who respond. The trend has been to use single- agent chemotherapy in favor of combination chemotherapy unless the patient has some form of life-threatening involvement, such as visceral crisis or lymphangitic spread. The use of trastuzumab (Herceptin) should be considered for HER2-positive tumors. Conclusions
In summary, the treatment principles that are used in women with breast cancer can generally be transferred to men with breast cancer. Likewise, advances in treatment demonstrated from randomized trials in women can be extrapolated to men with breast cancer.