|
Table of Contents Purpose of This PDQ Summary
General Information
Treatment Options for Male Breast Cancer
Get More Information From NCI
Changes to This Summary (09/25/2008)
More Information
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.
Information about the following is included in this summary:
- Risk factors.
- Prognostic factors.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version, written in less technical language, and in Spanish.
Back to Top General Information
Note: Estimated new cases and deaths from breast cancer (men only) in the United States in 2008:[1]
- New cases: 1,990.
- Deaths: 450.
Male breast cancer is rare.[2] Less than 1% of all breast carcinomas occur in
men.[3,4] The mean age at diagnosis is between 60 and 70 years, though men of all
ages can be affected with the disease.
Predisposing risk factors [5] appear to include radiation exposure, estrogen
administration, and diseases associated with hyperestrogenism, such as
cirrhosis or Klinefelter syndrome.[6] Definite familial
tendencies are evident with an increased incidence seen in men who have a number of female
relatives with breast cancer. An increased risk of male breast cancer has been
reported in families in which the BRCA2 mutation on chromosome 13q has been
identified.[7,8]
The pathology is similar to that of female breast cancer, and infiltrating
ductal cancer is the most common tumor type.[9] Intraductal cancer has been
described as well. Inflammatory carcinoma and Paget disease of the nipple
have also been seen in men, but lobular carcinoma in situ has not.[9] Lymph
node involvement and the hematogenous pattern of spread are similar to those
found in female breast cancer. The TNM staging system for male breast cancer
is identical to the staging system for female breast cancer. (Refer to the PDQ
summary on Breast Cancer Treatment for more information.)
Prognostic factors that have been evaluated include the size of the lesion and the
presence or absence of lymph node involvement, both of which correlate well
with prognosis.[5,10] Whether ploidy and S phase correlate with survival is
uncertain.[11] Estrogen-receptor and progesterone-receptor status and HER2/neu gene amplification should be reported.[12]
Overall survival is similar to that of women with breast cancer. The
impression that male breast cancer has a worse prognosis may stem from the
tendency toward diagnosis at a later stage.[2,5,13]
References
-
American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. Last accessed October 1, 2008.
-
Giordano SH, Cohen DS, Buzdar AU, et al.: Breast carcinoma in men: a population-based study. Cancer 101 (1): 51-7, 2004.
[PUBMED Abstract]
-
Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992.
[PUBMED Abstract]
-
Fentiman IS, Fourquet A, Hortobagyi GN: Male breast cancer. Lancet 367 (9510): 595-604, 2006.
[PUBMED Abstract]
-
Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.
[PUBMED Abstract]
-
Hultborn R, Hanson C, Köpf I, et al.: Prevalence of Klinefelter's syndrome in male breast cancer patients. Anticancer Res 17 (6D): 4293-7, 1997 Nov-Dec.
[PUBMED Abstract]
-
Wooster R, Bignell G, Lancaster J, et al.: Identification of the breast cancer susceptibility gene BRCA2. Nature 378 (6559): 789-92, 1995 Dec 21-28.
[PUBMED Abstract]
-
Thorlacius S, Tryggvadottir L, Olafsdottir GH, et al.: Linkage to BRCA2 region in hereditary male breast cancer. Lancet 346 (8974): 544-5, 1995.
[PUBMED Abstract]
-
Dickson RB, Pestell RG, Lippman ME: Cancer of the breast. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1399-1487.
-
Cutuli B, Lacroze M, Dilhuydy JM, et al.: Male breast cancer: results of the treatments and prognostic factors in 397 cases. Eur J Cancer 31A (12): 1960-4, 1995.
[PUBMED Abstract]
-
Gattuso P, Reddy VB, Green L, et al.: Prognostic significance of DNA ploidy in male breast carcinoma. A retrospective analysis of 32 cases. Cancer 70 (4): 777-80, 1992.
[PUBMED Abstract]
-
Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.
[PUBMED Abstract]
-
Ravandi-Kashani F, Hayes TG: Male breast cancer: a review of the literature. Eur J Cancer 34 (9): 1341-7, 1998.
[PUBMED Abstract]
Back to Top Treatment Options for Male Breast Cancer
Initial Surgical Management
Primary standard treatment is a modified radical mastectomy with axillary
dissection.[1-3] Responses are generally similar to those seen in women with breast cancer.[2] Breast conservation surgery with lumpectomy and radiation therapy has also been used and results have been similar to those seen in women with breast cancer.[4] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
Adjuvant Therapy
In men with node-negative tumors, adjuvant therapy should be considered on the same
basis as for a woman with breast cancer since there is no evidence that
response to therapy is different for men or women.[5]
In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal
therapy have been used and can increase survival to the same extent as in women
with breast cancer. Currently, no controlled studies have compared adjuvant
treatment options. Approximately 85% of all male breast cancers are estrogen
receptor–positive, and 70% of them are progesterone receptor–positive.[2,6] Response
to hormone therapy correlates with presence of receptors. Hormonal therapy has
been recommended in all receptor-positive patients.[1,2] Tamoxifen
use, however, is associated with a high rate of treatment-limiting symptoms, such as hot
flashes and impotence in male breast cancer patients.[7] (Refer to the PDQ summaries on Fever, Sweats, and Hot Flashes and Sexuality and Reproductive Issues for more information on these symptoms.) Responses are generally similar to those seen in women with breast cancer.[2] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
Adjuvant chemotherapy regimens include:
- CMF: cyclophosphamide plus methotrexate plus fluorouracil.[8]
-
CAF: cyclophosphamide plus doxorubicin plus fluorouracil.
- Trastuzumab (under clinical evaluation).[9]
- Tamoxifen (under clinical evaluation).[9]
Locally Recurrent Disease
Surgical excision or radiation therapy combined with chemotherapy is
recommended.[2] Responses are generally similar to those seen in women with breast cancer.[2,5] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
Distant Metastases
Hormonal therapy, chemotherapy, or a combination of both have been used with
some success. Initially, hormonal therapy is recommended.[2,5]
Hormonal modalities
include:
- Orchiectomy.
- Luteinizing hormone-releasing hormone agonist with or without total
androgen blockage (anti-androgen).
- Tamoxifen for estrogen receptor–positive patients.[1]
- Progesterone.
- Aromatase inhibitors.[10,11,9]
Hormonal therapies may be used sequentially. Standard chemotherapy
combinations of CMF and CAF are recommended after failure of hormonal therapy.
Responses are generally similar to those seen in women with breast cancer.[2] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
References
-
Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992.
[PUBMED Abstract]
-
Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.
[PUBMED Abstract]
-
Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991.
[PUBMED Abstract]
-
Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007.
[PUBMED Abstract]
-
Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007.
[PUBMED Abstract]
-
Joshi MG, Lee AK, Loda M, et al.: Male breast carcinoma: an evaluation of prognostic factors contributing to a poorer outcome. Cancer 77 (3): 490-8, 1996.
[PUBMED Abstract]
-
Anelli TF, Anelli A, Tran KN, et al.: Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74 (1): 74-7, 1994.
[PUBMED Abstract]
-
Walshe JM, Berman AW, Vatas U, et al.: A prospective study of adjuvant CMF in males with node positive breast cancer: 20-year follow-up. Breast Cancer Res Treat 103 (2): 177-83, 2007.
[PUBMED Abstract]
-
Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.
[PUBMED Abstract]
-
Cocconi G, Bisagni G, Ceci G, et al.: Low-dose aminoglutethimide with and without hydrocortisone replacement as a first-line endocrine treatment in advanced breast cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 10 (6): 984-9, 1992.
[PUBMED Abstract]
-
Gale KE, Andersen JW, Tormey DC, et al.: Hormonal treatment for metastatic breast cancer. An Eastern Cooperative Oncology Group Phase III trial comparing aminoglutethimide to tamoxifen. Cancer 73 (2): 354-61, 1994.
[PUBMED Abstract]
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (09/25/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Back to Top More Information
About PDQ
Additional PDQ Summaries
Important:
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Back to Top |
