- Male breast cancer accounts for less than 1% of all breast cancers:
- There have been no randomized control trials for surgical management of breast cancer in men
- Although breast conservation is increasing:
- The current surgical management remains simple mastectomy with sentinel lymph node biopsy
- Sentinel lymph node biopsy has been demonstrated to be accurate in men
- There are no data to support staging studies:
- Such as positron emission tomography (PET) or computed tomography (CT):
- In early-stage breast cancer in either men or women
- Such as positron emission tomography (PET) or computed tomography (CT):
- The role of the 21-gene signature assay is an emerging field in male breast cancer
- Approximately 10% of male breast cancers are associated with genetic mutations:
- BRCA2 is the most common among the mutations:
- With a lifetime risk of 5% to 10% among BRCA2 carriers
- BRCA2 is the most common among the mutations:
- Klinefelter’s is also associated with an increased risk of male breast cancer:
- With an incidence between 3% and 7%
- All male breast cancer patients should be referred for genetic counseling and testing
- Endocrine therapy is indicated for ER+ breast cancer:
- Aromatase inhibitors can be used but have not been well-studied in men
- Tamoxifen is the best-studied drug for male breast cancer
- The role of hormonal therapy in male breast cancer has not been evaluated by a prospective, randomized trial
- Nevertheless, the rationale for estrogen blockade in male breast cancer is the same as that for female breast cancer:
- With numerous prospective, randomized trials supporting the role of endocrine therapy:
- To reduce risk of breast cancer recurrence and death
- Anti-hormone therapy may also provide chemoprevention for the contralateral breast in men treated by ipsilateral mastectomy
- With numerous prospective, randomized trials supporting the role of endocrine therapy:
- Nevertheless, the rationale for estrogen blockade in male breast cancer is the same as that for female breast cancer:
- The majority of male breast cancer is ER+ and thus eligible for targeted antiestrogen therapy
- Men who have breast cancer:
- Should not take testosterone therapy:
- Because it may stimulate breast cancer growth by modulating increased estrogenic activity
- The balance between estrogen and testosterone in men may have physiologic effects on breast tissue
- Should not take testosterone therapy:
- References
- Fentiman IS. Surgical options for male breast cancer. Breast Cancer Res Treat. 2018;172(3):539-544.
- Gentilini O, Chagas E, Zurrida S, Intra M, De Cicco C, Gatti G, et al. Sentinel lymph node biopsy in male patients with early breast cancer. Oncologist. 2007;12(5):512-515.
- Massarweh SA, Sledge GW, Miller DP, McCullough D, Petkov VI, Shak S. Molecular characterization and mortality from breast cancer in men. J Clin Oncol 2018;36:1396-1404.
- Giordano SH. Breast cancer in men. N Engl J Med. 2018;378(24):2311–2320.
- Korde LA, Zujewski JA, Kamin L, et al. Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol. 2010;28(12):2114-2122.
- Greif JM, Pezzi CM, Klimberg VS, Bailey L, Zuraek M. Gender differences in breast cancer: analysis of 13,000 breast cancers in men from the National Cancer Data Base. Ann Surg Oncol. 2012;19:3199-3204.
- Kiluk JV, Lee MC, Park CK, Meade T, et al. Male breast cancer: management and follow-up recommendations. Breast J. 2011;17:503-509.
#Arrangoiz #BreastSurgeon #BreastCancer #MaleBreastCancer #SurgicalOncologist #CancerSurgeon #Miami #CASO #CenterforAdvancedSurgicalOncology
Rodrigo Arrangoiz MS, MD, FACS, FSSO 