Treatment Options for Male Breast Cancer
Initial Surgical Management
Adjuvant Therapy
Locally Recurrent Disease
Distant Metastases
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
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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]
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Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.
[PUBMED Abstract]
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Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991.
[PUBMED Abstract]
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Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007.
[PUBMED Abstract]
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Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007.
[PUBMED Abstract]
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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]
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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]
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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]
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Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.
[PUBMED Abstract]
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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]
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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]
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