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Male breast cancer: a different disease than female breast cancer?

An estimated 1,450 new cases of male breast cancer were diagnosed in the United States in 2004 compared with 215,990 new cases of breast cancer in women and only 470 men as compared with 40,110 women died as a result of breast cancer. (1) These facts show the lower incidence of breast cancer in men and its comparable higher cancer-specific death rate.

Despite the increasing incidence of male breast cancer, it remains an uncommon cancer, accounting for less than 1% of all cancers in men. Because of the rarity of this cancer, randomized and prospective data are lacking. All studies are based on a small series of patients. Optimal management is not clearly established and is based on treatment guidelines that have been extrapolated from the data on female breast cancer.

We know that male breast cancer differs from female breast cancer with respect to age at diagnosis (men are older at the time of diagnosis than women), (2) and frequency of histologic subtypes (the majority of men have invasive ductal carcinoma, but lobular carcinoma is rare in men when compared with women, probably due to lack of terminal lobules in the male breast). (2) In addition, male and female breast cancers differ in regards to expression of steroid hormone receptors (men are more likely to have estrogen and progesterone receptor positive tumors), (2) molecular markers (CerbB-2 and BCL-2 protooncogenes may have no prognostic significance in men, while in women it is associated with poor and favorable prognosis, respectively), (3) and genetics (as in women, men with BRCA-2 mutations are predisposed to develop breast cancer but BRCA-1 mutation does not seem to be a risk factor for breast cancer in men, although it has been described in affected men). (4,5)

Men generally present with larger tumors, more frequent lymph node involvement and higher stage disease than women. This may be due to the fact that women are diagnosed by screening mammography, with smaller, early stage tumors, or it may be due to lack of awareness of breast carcinoma in males. (2) As with female breast cancer, axillary lymph node status, tumor size, histologic grade and hormone receptor status have been shown to be significant prognostic factors in men with breast cancer, with lymph node involvement being the most important negative prognostic factor. (2,3) A number of studies have suggested that clinical outcomes for male and female breast cancer are similar when matched for age, treatment and stage of disease. (3)

Since the epidemiology and biology of male breast cancer differs significantly from female breast cancer, it would be prudent to say that it is a different disease when compared with female breast cancer. However, based on the available evidence at this time, men with breast cancer should be treated similarly to women, with appropriate surgery, nodal assessment, radiotherapy, chemotherapy and hormonal manipulation. Only prospective national clinical trials through cooperative groups would further enhance our understanding of the biology and treatment of this uncommon disease.

References

1. Jemal A, Tiwari RC, Murray T, et al. American Cancer Society. Cancer statistics, 2004. CA Cancer J Clin 2004;54:8-29.

2. Giordano SH, Cohen DS, Buzdar AU, et al. Breast carcinoma in men: a population based study. Cancer 2004;101:51-57.

3. Giordano SH, Buzdar AU, Hortobagyi GN. Breast cancer in men. Ann Intern Med 2002;137:678-687.

4. Wooster R, Neuhausen SL, Mangion J, et al. Localisation of breast cancer susceptibility gene, BRCA-2, to chromosome13q12-13. Science 1994;265:2088-2090.

5. Struewing JP, Brody LC, Erdos MR, et al. Detection of eight BRCA-1 mutations in 10 breast/ovarian cancer families, including 1 family with male breast cancer. Am J Hum Genet 1995;57:1-7.

Ashok Kumar Malani, MD

From St. Joseph Oncology Inc., St. Joseph, MO.

Reprint requests to Ashok Kumar Malani. MD, St. Joseph Oncology Inc., 901 North Riverside Road, Suite 200, St. Joseph, MO 64507. Email: drmalani@yahoo.com

Accepted August 25, 2005.
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Title Annotation:Brief Review
Author:Malani, Ashok Kumar
Publication:Southern Medical Journal
Article Type:Disease/Disorder overview
Geographic Code:1USA
Date:Feb 1, 2007
Words:657
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