Men with breast cancer had a higher mortality rate when compared with women with breast cancer, reported a cohort study recently published in JAMA Oncology. This overall finding aligns with what previous studies have found and highlight the need for better awareness about male breast cancer.
“Most people with breast cancer are found to have breast cancer because they have a lump in their breast, and you would think that in men it would be easier to find a lump in the breast,” said Joanne Mortimer, MD, director of City of Hope’s Women’s Cancer Programs, who was not involved with the study, during an interview with CancerNetwork. “Unfortunately, people's suspicion about what's going on in the breast of a man is not the same as a woman.”
The study was conducted using the National Cancer Database, and 1,816,733 patients with a breast cancer diagnosis between January 1, 2004, and December 31, 2014 were identified. The totals were 1,800,708 women— and 16,025 men.
Men with breast cancer had a significantly worse overall survival (OS) rate (45.8% vs 60.4%; P < .001), 3-year OS rate (86.4% vs 91.7%; P < .001), and 5-year OS rate (77.6% vs 86.4%; P < .001) compared with women with breast cancer, according to the data.
Even when men were diagnosed at the same disease stage as women, their survival outcomes were still inferior. For the 5-year OS rate, men had worse survival than women at stage I (87.8% vs 92.5%; P < .001), stage II (78.9% vs 85.9%; P < .001), stage III (63.3% vs 70.1%; P < .001), and stage IV disease (21.4% vs 25.1%; P = .007).
Several factors were associated with a higher mortality rate among men, including age, clinical characteristics, treatment received, access to care, and race/ethnicity.
However, when all these factors were controlled for, men still have worse survival. The study authors pointed out that this suggests that other factors, particularly additional biological attributes, treatment compliance, and lifestyle factors, should be identified to help in eliminating this disparity.
Clinical and treatment characteristics were the primary factors linked to worse survival, they added.
“Clinical characteristics and undertreatments were associated with 63.3% of the excess mortality among male patients,” the authors wrote.
The cohort study also revealed that a higher proportion of men were diagnosed with more advanced disease, yet less likely to receive standard treatment. For example, men with hormone receptor-positive breast cancer were less likely to receive adjuvant endocrine therapy compared with women.
“These endocrine therapies are very effective at increasing the cure rate of breast cancer,” Mortimer. “It's unfortunate that these men did not get endocrine therapy as part of their treatment.”
In fact, Don Hoffman, a male breast cancer patient who Mortimer helped care for, exemplifies the importance of early detection and proper treatment for men.
“Man or woman, early detection is a lifesaver,” said Hoffman. He noticed the nipple and areola on his left breast were flatter than usual and had his breast checked by his primary care physician. A mammogram showed a small mass, which was treated. “My early detection probably made me a better candidate to live longer.”
To Hoffman, one reason why men may be diagnosed later on, when outcomes are worse, is a man’s attitude toward seeking medical care. “A man's attitude is, ‘Oh, I can tough this out, this is not a big deal,’” Hoffman said. “I think that mindset works against men.”
Wang F, Shu X, Meszoely I. Overall Mortality After Diagnosis of Breast Cancer in Men vs Women. JAMA Oncol. Published online September 19, 2019.