We searched PubMed with the term male breast cancer in combination with the terms “epidemiology”, “risk factors”, “genetic”, “endocrine”, “pathology”, “diagnosis”, “prognostic factors”, “tamoxifen”, “aromatase inhibitors”, “surgery”, “reconstruction”, “radiotherapy”, “hormonotherapy”, and “chemotherapy”. We selected up to date reviews and highly regarded older papers. Search was not restricted by language.
SeminarMale breast cancer
Section snippets
Epidemiology
The annual prevalence of male breast cancer in Europe is 1 in 100 000, and less than 1% of all breast cancer patients are male.3 Rates of male breast cancer vary widely between countries: in Uganda and Zambia the annual incidence rates are 5% and 15%, respectively.4, 5 These relatively high rates have been attributed to endemic infectious diseases causing liver damage, leading to hyperoestrogenism. By contrast, the annual incidence of male breast cancer in Japan is less than five per million,
Risk Factors
Risk factors for male breast cancer are summarised in the panel.
Clinical features
As with women, the most common symptom of breast cancer is a painless lump, which alone or with other problems arises in 75% of cases.74, 75, 76, 77, 78 Pain is associated with a lump in only 5%.79 Nipple involvement is a fairly early event, with retraction in 9%, discharge in 6%, and ulceration in 6%, although ulceration was separate from the nipple in half the cases. Paget's disease is rare, being the presenting feature in only 1%, with a mean age of 60 years, similar to that of other men
Histopathology
Since male breast tissue is rudimentary, it does not usually differentiate and undergo lobule formation unless exposed to increased concentrations of endogenous or exogenous oestrogen. Thus the predominant histological type of disease is invasive ductal, which forms more than 90% of all male breast tumours (table 4).75, 76, 84, 85, 86, 87 Much rarer tumour types include invasive papillomas and medullary lesions. In large series reporting tumour grade, 12–20% were grade I, 54–58% grade II, and
Diagnosis
In most cases diagnosis is made by triple assessment: clinical assessment, mammography or ultrasonography, and fine-needle aspiration cytology or core biopsy. Core biopsy is preferred because it enables a definitive diagnosis of invasive breast cancer to be made. The presence of malignant cells on a cytology specimen may be the result of ductal carcinoma in situ rather than invasive disease, and the treatment of the two diseases is different.
Mammography in men with breast lesions is an
Surgery
As with female breast cancer, for most of the 20th century the standard treatment for localised breast cancer in men was radical mastectomy, which has now been superseded by less invasive procedures such as modified radical or simple mastectomy, with no detectable decline in survival.76 Wide excision in male breast cancer will almost always include resection of the nipple due to the small amount of breast tissue, and there is some evidence that this is not the most effective method of local
Treatment of advanced disease
For the past five decades hormonal therapy has been, and continues to be, the mainstay of treatment for metastatic carcinoma of the male breast.76, 130, 131 Initial hormonal therapies were ablative: orchidectomy, adrenalectomy, and hypophysectomy. After Farrow and Adair132 first described a response to orchidectomy in 1942, orchidectomy became the standard of care for treatment of advanced disease. A review of 447 patients indicated response rates of 55% to orchidectomy, 80% to adrenalectomy,
Prognosis
The most important prognostic indicators are stage at diagnosis and lymph node status. Estimates for overall 5-year survival are around 40–65%,76, 78, 83, 124 but when grouped by stage at presentation, 5-year survival is 75–100% for stage I disease, 50–80% for stage II disease, and falling to 30–60% for stage III disease.76 Some studies suggested that breast cancer has a worse prognosis in men than in women, but if age- matched and stage-matched breast cancer is compared, there is no difference
Conclusions
Despite evidence that testicular or hepatic failure will increase the risk of male breast cancer, most patients have no identifiable risk factors. Men with breast lumps need assessment in the same way as women and most will prove to have benign gynaecomastia. Carcinoma of the male breast has many similarities to breast cancer in women, but the rarity of the disease precludes large clinical trials necessary to define optimum treatment. Local treatment has to be tailored to stage at presentation
Search strategy and selection criteria
References (142)
- et al.
Cancer in the elderly: why so badly treated?
Lancet
(1990) - et al.
Electromagnetic fields and male breast cancer
Lancet
(1990) Cancer of breast among men in electrical occupations
Lancet
(1992)- et al.
Bromocriptine adjuvant treatment for operable breast cancer: a double-blind controlled pilot study
Lancet
(1988) - et al.
Carcinoma of prostate metastatic to breast
Urology
(1980) The safety and tolerability of low-dose irradiation for the management of gynaecomastia caused by antiandrogen monotherapy
Lancet Oncology
(2003)- et al.
A review of the management of the male breast carcinoma based on an analysis of 420 treated cases
Breast
(1996) - et al.
Male breast cancer: results of the treatments and prognostic factors in 397 cases
Eur J Cancer
(1995) - et al.
In situ and infiltrating carcinoma of the male breast
Hum Pathol
(1989) - et al.
Status of HER-2 in male and female breast carcinomas
Am J Surg
(2001)
Pictorial review: the imaging features of male breast disease
Clin Radiol
Is male breast cancer similar or different from female breast cancer?
Br Cancer Res Treat
Racial/ethnic differences in survival rates in a population-based series of men with breast cancer
Cancer
Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiological factors
Int J Cancer
Carcinoma of the male breast in Mulago Hospital, Kampala
East Afr Med J
Carcinoma of the male breast in Zambia
East Afr Med J
Male breast cancer in Israel: selected epidemiologic aspects
J Med Sci
Risk factors for male breast cancer
J Natl Cancer Inst
Descriptive epidemiology of male breast cancer in Europe
Int J Cancer
Breast carcinoma in men. A population-based study
Cancer
Risk factors for male breast cancer - a case-control study from Scandinavia
Acta Oncol
Genetic and hormonal risk factors in breast cancer
J Natl Cancer Inst
Study of a single BRCA2 mutation with high carrier frequency in a small population
Am J Hum Genet
Mutation analysis of BRCA1 and BRCA2 in a male breast cancer population
Am J Hum Genet
BRCA1 and BRCA2 mutations in a population-based study of male breast cancer
Breast Cancer Res
Clinical characteristics of individuals with germline mutations in BRCA1 and BRCA2: analysis of 10,000 individuals
J Clin Oncol
Genes other than BRCA1 and BRCA2 involved in breast cancer susceptibility
J Med Genet
Male breast cancer in Cowden syndrome patients with germline PTEN mutations
J Med Genet
Low-penetrance susceptibility to breast cancer due to CHEK2(*)1100delC in non-carriers of BRCA1 or BRCA2 mutations
Nat Genet
CHEK2 1100delC is not a risk factor for male breast cancer population
Int J Cancer
CHEK2*1100delC and male breast cancer risk in Israel
Int J Cancer
A germline mutation in the androgen receptor gene in two brothers with breast cancer and Reifenstein syndrome
Nat Genet
Androgen receptor gene mutation in male breast cancer
Nat Genet
The length and location of CAG trinucleotide repeats in the androgen receptor N-terminal domain affect transactivation function
Nucleic Acids Res
The CAG repeat within the androgen receptor in male breast cancer patients
J Med Genet
Androgen receptor gene alterations in Finnish male breast cancer
Breast Cancer Res Treat
Polycystic ovaries and premature male pattern baldness are associated with one allele of the steroid metabolism gene CYP17
Hum Mol Genet
A polymorphism in the CYP17 gene is associated with male breast cancer
Br J Cancer
CYP17 promoter polymorphism and breast cancer risk among males and females in relation to BRCA2 status
Br J Cancer
A gene-environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer
Eur J Cancer
Occupational risks for male breast cancer in Sweden
Br J Indust Med
Risk factors for male breast cancer: a Franco-Swiss case-control study
Int J Cancer
Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products
Am J Ind Med
Mortality in Florida firefighters, 1972 to 1999
Am J Ind Med
The relationship between genetic damage from polycylic aromatic hydrocarbons in breast tissue and normal tissue
Carcinogenesis
DNA-repair genetic polymorphisms and breast cancer risk
Cancer Epidemiol Biomarkers Prev
The relationship between electromagnetic field and light exposures by melatonin and breast cancer risk
J Pineal Res
Occupational exposure to electromagnetic fields and breast cancer in men
Am J Epidemiol
Breast cancer, occupation, and exposure to electromagnetic fields among Swedish men
Am J Ind Med
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