Male breast cancer accounts for less than 1% of all breast cancers but it does behave in a similar way to postmenopausal breast cancer in women.
Male breast cancer does not have a worse biology or prognosis then female breast cancer, males just tend to present at later stages and therefore have worse overall survival.
Approximately a third of men will present with stage III disease.
Approximately 4% to 40% of male breast cancers result from BRCA mutations.
The first step in treatment of male breast cancer is surgical excision.
Men should have mastectomy because the small amount of breast tissue is not conducive to breast conservation. Sentinel node biopsy should be performed and followed by axillary dissection only if the sentinel node is tumor-positive; axillary node dissection is not required in all male patients. It is important to note, however, that the ACOSOG Z011 randomized trial did not include men, so omission of completion axillary dissection for a tumor-positive sentinel node is not recommended.
Adjuvant therapy for male breast cancer is similar to that for female breast cancer. Radiation therapy should be administered for larger tumors with multiple tumor positive nodes. Men can receive hormone therapy if the tumor is estrogen receptor (ER)-positive and studies have shown that hormone therapy improves disease-free and overall survival for men. It is not known if aromatase inhibitors improve survival for men because most of the studies involving men have used tamoxifen. Similarly, the indications for adjuvant chemotherapy are similar to those for women but whether taxanes or dose-dense regimens should be administered is not known. In general, guidelines regarding chemotherapy use for women are used for men.
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Rodrigo Arrangoiz MS, MD, FACS, FSSO 