Male Breast Cancer

  • 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
  • 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
  • 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
  • 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
  • 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

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