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Male breast cancer

Published:March 02, 2010DOI:https://doi.org/10.1016/j.ctrv.2010.02.002

      Summary

      Male breast cancer accounts for around 1% of all breast cancer cases, but the incidence has increased over the past 25 years. The rarity of this entity precludes prospective randomized clinical trials. Although breast carcinoma in both genders share certain characteristics, notable differences have emerged. Familial cases usually have BRCA2 rather than BRCA1 mutations. Klinefelter syndrome is the strongest risk factor for developing male breast carcinoma. Men tend to be diagnosed at an older age than women. Presentation is usually a painless lump, but is often late, with more than 40% of individuals having stage III or IV disease. When survival is adjusted for age at diagnosis and stage of disease, outcomes for male and female patients with breast cancer is similar. Surgery is usually mastectomy with axillary clearance or sentinel node biopsy. Because 90% of tumors are hormonal receptor positive, tamoxifen is standard adjuvant therapy. Indications for radiotherapy and chemotherapy are similar to female breast cancer. For metastatic disease, hormonal therapy is the main treatment, but chemotherapy can also provide palliation.

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      References

        • Fentiman I.S.
        • Fourquet A.
        • Hortobagyi G.N.
        Male breast cancer.
        Lancet. 2006; 367: 595-604
        • Jemal A.
        • Siegel R.
        • Ward E.
        • et al.
        Cancer statistics, 2009.
        CA Cancer J Clin. 2009; 59: 225
        • Weiss J.R.
        • Moysich K.B.
        • Swede H.
        Epidemiology of breast cancer.
        Cancer Epidemiol Biomarkers Prev. 2005; 14: 20-26
        • Giordano S.H.
        • Cohen D.S.
        • Buzdar A.U.
        • et al.
        Breast carcinoma in men: a population-based study.
        Cancer. 2004; 101: 51-57
        • Brinton L.A.
        • Richesson D.A.
        • Gierach G.L.
        • et al.
        Prospective evaluation of risk factors for male breast cancer.
        J Natl Cancer Inst. 2008; 100: 1477
        • Sasco A.J.
        • Lowenfels A.B.
        • Pasker-de Jong P.
        Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiological factors.
        Int J Cancer. 1993; 53: 538-549
        • Thomas D.B.
        • Jimenez L.M.
        • McTiernan A.
        • et al.
        Breast cancer in men: risk factors with hormonal implications.
        Am J Epidemiol. 1992; 135: 734-748
        • Brenner B.
        • Fried G.
        • Levitzki P.
        • et al.
        Male breast carcinoma in Israel: higher incident but possibly prognosis in Ashkenazi Jews.
        Cancer. 2002; 94: 2128-2133
        • Olsson H.
        • Alm P.
        • Aspegren K.
        • et al.
        Increased plasma prolactin levels in a group of men with breast cancer – a preliminary study.
        Anticancer Res. 1990; 10: 59
        • McClure J.A.
        • Higgins C.C.
        Bilateral carcinoma of male breast after estrogen therapy.
        JAMA. 1951; 146: 7-9
        • Symmers W.S.C.
        Carcinoma of breast in trans-sexual individuals after surgical and hormonal interference with the primary and secondary sex characteristics.
        Brit Med J. 1968; 2: 83-85
        • Ballerini P.
        • Recchione C.
        • Cavalleri A.
        • et al.
        Hormones in male breast cancer.
        Tumori. 1990; 76: 26
        • Harnden D.G.
        • Maclean N.
        • Langlands A.O.
        Carcinoma of the breast and Klinefelter’s syndrome.
        J Med Genet. 1971; 8: 460-461
        • Hultborn R.
        • Hanson C.
        • Kopf I.
        • et al.
        Prevalence of Klinefelter’s syndrome in male breast cancer patients.
        Anticancer Res. 1997; 17: 4293-4297
        • Rosenblatt K.A.
        • Thomas D.B.
        • McTiernan A.
        • et al.
        Breast cancer in men: aspects of familial aggregation.
        J Natl Cancer Inst. 1991; 83: 849-854
        • Giordano S.H.
        • Buzdar A.U.
        • Hortobagyi G.N.
        Breast cancer in men.
        Ann Intern Med. 2002; 137: 678
        • Martin A.M.
        • Weber B.L.
        Genetic and hormonal risk factors in breast cancer.
        J Natl Cancer Inst. 2000; 92: 1126-1135
        • Ottini L.
        • Masala G.
        • D’Amico C.
        • et al.
        BRCA1 and BRCA2 mutation status and tumor characteristics in male breast cancer: a population-based study in Italy.
        Cancer Res. 2003; 63: 342
        • Liede A.
        • Karlan B.Y.
        • Narod S.A.
        Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: a review of the literature.
        J Clin Oncol. 2004; 22: 735
        • Machado P.M.
        • Brandao R.D.
        • Cavaco B.M.
        • et al.
        Screening for a BRCA2 rearrangement in high-risk breast/ovarian cancer families: evidence for a founder effect and analysis of the associated phenotypes.
        J Clin Oncol. 2007; 25: 2027
        • Tai Y.C.
        • Domchek S.
        • Parmigiani G.
        • Chen S.
        Breast cancer risk among male BRCA1 and BRCA2 mutation carriers.
        J Natl Cancer Inst. 2007; 99: 1811
        • Basham V.M.
        • Lipscombe J.M.
        • Ward J.M.
        • et al.
        BRCA1 and BRCA2 mutations in a population-based study of male breast cancer.
        Breast Cancer Res. 2002; 4: R2
        • Friedman L.S.
        • Gayther S.A.
        • Kurosaki T.
        • et al.
        Mutation analysis of BRCA1 and BRCA2 in a male breast cancer population.
        Am J Hum Genet. 1997; 60: 313-319
        • Mavraki E.
        • Gray I.C.
        • Bishop D.T.
        • Spurr N.K.
        Germline BRCA2 mutations in men with breast cancer.
        Brit J Cancer. 1997; 76: 1428
        • Haraldsson K.
        • Loman N.
        • Zhang Q.X.
        • et al.
        BRCA2 germ-line mutations are frequent in male breast cancer patients without a family history of the disease.
        Cancer Res. 1998; 58: 1367
        • Couch F.J.
        • Farid L.M.
        • DeShano M.L.
        • et al.
        BRCA2 germline mutations in male breast cancer cases and breast cancer families.
        Nat Genet. 1996; 13: 123-125
        • Thorlacius S.
        • Sigurdsson S.
        • Bjarnadottir H.
        • et al.
        Study of a single BRCA2 mutation with high carrier frequency in a small population.
        Am J Hum Genet. 1997; 60: 1079-1084
        • Csokay B.
        • Udvarhelyi N.
        • Sulyok Z.
        • et al.
        High frequency of germ-line BRCA2 mutations among Hungarian male breast cancer patients without family history.
        Cancer Res. 1999; 59: 995-998
        • Diez O.
        • Cortes J.
        • Domenech M.
        • et al.
        BRCA2 germ-line mutations in Spanish male breast cancer patients.
        Ann Oncol. 2000; 11: 81-84
        • Sverdlov R.S.
        • Barshack I.
        • Bar Sade R.B.
        • et al.
        Genetic analyses of male breast cancer in Israel.
        Genet Test. 2000; 4: 313-317
        • Frank T.S.
        • Deffenbaugh A.M.
        • Reid J.E.
        • et al.
        Clinical characteristics of individuals with germline mutations in BRCA1 and BRCA2: analysis of 10,000 individuals.
        J Clin Oncol. 2002; 20: 1480-1490
        • Kwiatkowska E.
        • Teresiak M.
        • Filas V.
        • et al.
        BRCA2 mutations and androgen receptor expression as independent predictors of outcome of male breast cancer patients.
        Clin Cancer Res. 2003; 9: 4452-4459
      1. National Comprehensive Cancer Network (NCCN). Guidelines available online at www.nccn.org.

        • Fackenthal J.D.
        • March D.J.
        • Richardson A.L.
        • et al.
        Male breast cancer in Cowden syndrome patients with germline PTEN mutations.
        J Med Genet. 2001; 38: 159
        • Boyd J.
        • Rhei E.
        • Federici M.G.
        • et al.
        Male breast cancer in the hereditary nonpolyposis colorectal cancer syndrome.
        Breast Cancer Res Treat. 1999; 53: 87
        • Giordano S.H.
        A review of the diagnosis and management of male breast cancer.
        Oncologist. 2005; 10: 471-479
        • Sorensen H.T.
        • Friis S.
        • Olsen J.H.
        • et al.
        Risk of breast cancer in men with liver cirrhosis.
        Am J Gastroenterol. 1998; 93: 231-233
        • Weiderpass E.
        • Ye W.
        • Adami H.O.
        • et al.
        Breast cancer risk in male alcoholics in Sweden.
        Cancer Cause Control. 2001; 12: 661-664
        • Hsing A.W.
        • McLaughlin J.K.
        • Cocco P.
        • et al.
        Risk factors for male breast cancer (United States).
        Cancer Cause Control. 1998; 9: 269-275
        • Evans G.F.
        • Anthony T.
        • Turnage R.H.
        • et al.
        The diagnostic accuracy of mammography in the evaluation of male breast disease.
        Am J Surg. 2001; 181: 96-100
        • Appelbaum A.H.
        • Evans G.F.
        • Levy K.R.
        • et al.
        Mammographic appearances of male breast disease.
        Radiographics. 1999; 19: 559
        • Singletary S.E.
        • Allred C.
        • Ashley P.
        • et al.
        Revision of the American Joint Committee on Cancer staging system for breast cancer.
        J Clin Oncol. 2002; 20: 3628-3636
        • Visfeldt J.
        • Scheike O.
        Male breast cancer. 1: histologic typing and grading of 187 Danish cases.
        Cancer. 1973; 32: 985-990
        • Stalsberg H.
        • Thomas D.B.
        • Rosenblatt K.A.
        • et al.
        Histologic types and hormone receptors in breast cancer in men: a population-based study in 282 United States men.
        Cancer Cause Control. 1993; 4: 143-151
        • Wick M.R.
        • Sayadi H.
        • Ritter J.H.
        • et al.
        Low-stage carcinoma of the male breast. A histologic, immunohistochemical, and flow cytometric comparison with localized female breast carcinoma.
        Am J Clin Pathol. 1999; 111: 59-69
        • Willsher P.C.
        • Leach I.H.
        • Ellis I.O.
        • et al.
        Male breast cancer: pathological and immunohistochemical features.
        Anticancer Res. 1997; 17: 2335-2338
        • Rayson D.
        • Erlichman C.
        • Suman V.J.
        • et al.
        Molecular markers in male breast carcinoma.
        Cancer. 1998; 83: 1947-1955
        • Pich A.
        • Margaria E.
        • Chiusa L.
        • et al.
        Androgen receptor expression in male breast carcinoma: lack of clinicopathological association.
        Brit J Cancer. 1999; 79: 959-964
        • Kidwai N.
        • Gong Y.
        • Sun X.
        • et al.
        Expression of androgen receptor and prostate-specific antigen in male breast carcinoma.
        Breast Cancer Res. 2004; 6: R18-R23
        • Bloom K.J.
        • Govil H.
        • Gattuso P.
        • et al.
        Status of HER-2 in male and female breast carcinoma.
        Am J Surg. 2001; 182: 389-392
        • Muir D.
        • Kanthan R.
        • Kanthan S.C.
        Male versus female breast cancers. A population-based comparative immunohistochemical analysis.
        Arch Pathol Lab Med. 2003; 127: 36-41
        • Rudlowski C.
        • Friedrichs N.
        • Farldl A.
        • et al.
        Her-2/neu gene amplification and protein expression in primary male breast cancer.
        Breast Cancer Res Treat. 2004; 84: 215
        • Sorlie T.
        • Perou C.M.
        • Tibshirani R.
        • et al.
        Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications.
        Proc Natl Acad Sci USA. 2001; 98: 10869-10874
        • Sorlie T.
        • Tibshirani R.
        • Parker J.
        • et al.
        Repeated observation of breast tumor subtypes in independent gene expression data sets.
        Proc Natl Acad Sci USA. 2003; 100: 8418-8423
        • Sotiriou C.
        • Neo S.Y.
        • McShane L.M.
        • et al.
        Breast cancer classification and prognosis based on gene expression profiles from a population-based study.
        Proc Natl Acad Sci USA. 2003; 100: 10393-10398
        • Ge Y.
        • Sneige N.
        • Eltorky M.A.
        • et al.
        Immunohistochemical characterization of subtypes of male breast carcinoma.
        Brit Cancer Res. 2009; 11: R28https://doi.org/10.1186/bcr2258
        • Ouriel K.
        • Lotze M.T.
        • Hinshaw J.R.
        Prognostic factors of carcinoma of the male breast.
        Surg Gynecol Obstet. 1984; 159: 373-376
        • Gough D.B.
        • Donohue J.H.
        • Evans M.M.
        • et al.
        A 50-year experience of male breast cancer: is outcome changing?.
        Surg Oncol. 1993; 2: 325-333
        • Cutuli B.
        • Lacroze M.
        • Dilhuydy J.M.
        • et al.
        Male breast cancer: results of the treatments and prognostic factors in 397 cases.
        Eur J Cancer. 1995; 31A: 1960-1964
        • Maddox W.A.
        • Carpenter Jr, J.T.
        • Laws H.L.
        • et al.
        A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients.
        Ann Surg. 1983; 198: 207-212
        • Yildirim E.
        • Berberoglu U.
        Male breast cancer: a 22-year experience.
        Eur J Surg Oncol. 1998; 24: 548-552
        • Albo D.
        • Ames F.C.
        • Hunt K.K.
        • et al.
        Evaluation of lymph node status in male breast cancer patients: a role for sentinel lymph node biopsy.
        Breast Cancer Res Treat. 2003; 77: 9-14
        • Cimmino V.M.
        • Degnim A.C.
        • Sabel M.S.
        • et al.
        Efficacy of sentinel lymph node biopsy in male breast cancer.
        J Surg Oncol. 2004; 86: 74-77
        • Goyal A.
        • Horgan K.
        • Kissin M.
        • et al.
        Sentinel lymph node biopsy in male breast cancer patients.
        Eur J Surg Oncol. 2004; 30: 480-483
        • Port E.R.
        • Fey J.V.
        • Cody 3rd, H.S.
        • et al.
        Sentinel lymph node biopsy in patients with male breast carcinoma.
        Cancer. 2001; 91: 319-323
        • De Cicco C.
        • Baio S.M.
        • Veronesi P.
        • et al.
        Sentinel node biopsy in male breast cancer.
        Nucl Med Commun. 2004; 25: 139-143
        • Gentilini O.
        • Chagas E.
        • Zurida S.
        • et al.
        Sentinel lymph node biopsy in male patients with early breast cancer.
        Oncologist. 2007; 12: 512
        • Boughey J.C.
        • Bedroslan I.
        • Meric-Bernstam F.
        • et al.
        Comparative analysis of sentinel lymph node operation in male and female breast cancer patients.
        J Am Coll Surg. 2006; 203: 475
        • Lyman G.H.
        • Giuliano A.E.
        • Smerfield M.R.
        • et al.
        American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer.
        J Clin Oncol. 2005; 23: 7703
        • Donegan W.L.
        • Redlich P.N.
        • Lang P.J.
        • et al.
        Carcinoma of the breast in males: a multiinstitutional survey.
        Cancer. 1998; 83: 498-509
        • Spence R.A.
        • MacKenzie G.
        • Anderson J.R.
        • et al.
        Long-term survival following cancer of the male breast in Northern Ireland. A report of 81 cases.
        Cancer. 1985; 55: 648-652
        • Erlichman C.
        • Murphy K.C.
        • Elhakim T.
        Male breast cancer: a 13-year review of 89 patients.
        J Clin Oncol. 1984; 2: 903-909
        • Schuchart U.
        • Seegenschmiedt M.H.
        • Kirschner M.J.
        • et al.
        Adjuvant radiotherapy for breast carcinoma in men: a 20-year clinical experience.
        Am J Clin Oncol. 1996; 19: 330
        • Scott-Conner C.E.
        • Hochimsen P.R.
        • Menck H.R.
        • Winchester D.J.
        An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.
        Surgery. 1999; 126: 775
        • Goss P.E.
        • Reid C.
        • Pintilie M.
        • et al.
        Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955–1996.
        Cancer. 1999; 85: 629-639
        • Ribeiro G.
        • Swindell R.
        • Harris M.
        • et al.
        A review of the management of the male breast carcinoma based on an analysis of 420 treated cases.
        Breast. 1996; 5: 141-146
        • Ribeiro G.
        • Swindell R.
        Adjuvant tamoxifen for male breast cancer (MBC).
        Brit J Cancer. 1992; 65: 252-254
        • Giordano S.H.
        • Perkins G.
        • Garcia S.M.
        • et al.
        Male breast cancer: the M.D. Anderson experience with adjuvant therapy.
        Breast Cancer Res Treat. 2003; 82: S42
        • Anelli T.F.
        • Anelli A.
        • Tran K.N.
        • et al.
        Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients.
        Cancer. 1994; 74: 74-77
      2. Adjuvant tamoxifen in the management of operable breast cancer: the Scottish Trial. Report from the Breast Cancer Trials Committee, Scottish Cancer Trials Office (MRC), Edinburgh. Lancet 1987;2:171–5.

        • Giordano S.H.
        • Valero V.
        • Buzdar A.U.
        • et al.
        Efficacy of anastrozole in male breast cancer.
        Am J Clin Oncol. 2002; 25: 235-237
        • Zabolotny B.P.
        • Zalai C.V.
        • Meterissian S.H.
        Successful use of letrozole in male breast cancer: a case report and review of hormonal therapy for male breast cancer.
        J Surg Oncol. 2005; 90: 26-30
        • Mauras N.
        • O’Brien K.O.
        • Klein K.O.
        • et al.
        Estrogen suppression in males: metabolic effects.
        J Clin Endocrinol Metab. 2000; 85: 2370-2377
        • Bagley C.S.
        • Wesley M.N.
        • Young R.C.
        • et al.
        Adjuvant chemotherapy in males with cancer of the breast.
        Am J Clin Oncol. 1987; 10: 55-60
        • Patel H.Z.
        • Buzdar A.U.
        • Hortobagyi G.N.
        Role of adjuvant chemotherapy in male breast cancer.
        Cancer. 1989; 64: 1583-1585
        • Izquierdo M.A.
        • Alonso C.
        • De Andres L.
        • et al.
        Male breast cancer. Report of a series of 50 cases.
        Acta Oncol. 1994; 33: 767-771
        • Giordano S.H.
        • Perkins G.H.
        • Brogio K.
        • et al.
        Adjuvant systemic therapy for male breast carcinoma.
        Cancer. 2005; 104: 2359
        • Farrow J.
        • Adair F.
        Effect of orchiectomy on skeletal metastases from cancer of the male breast.
        Science. 1942; 95: 654
        • Jaiyesimi I.A.
        • Buzdar A.U.
        • Sahin A.A.
        • et al.
        Carcinoma of the male breast.
        Ann Intern Med. 1992; 117: 771-777
        • Lopez M.
        • Di Lauro L.
        • Lazzaro B.
        • et al.
        Hormonal treatment of disseminated male breast cancer.
        Oncology. 1985; 42: 345-349
        • Labrie F.
        • Dupont A.
        • Belanger A.
        • et al.
        Complete response to combination therapy with an LHRH agonist and flutamide in metastatic male breast cancer: a case report.
        Clin Invest Med. 1990; 13: 275-278
        • Lopez M.
        • Natali M.
        • Di Lauro L.
        • et al.
        Combined treatment with buserelin and cyproterone acetate in metastatic male breast cancer.
        Cancer. 1993; 72: 502-505
        • Doberauer C.
        • Niederle N.
        • Schmidt C.G.
        Advanced male breast cancer treatment with the LH–RH analogue buserelin alone or in combination with the antiandrogen flutamide.
        Cancer. 1988; 62: 474-478
        • Italiano A.
        • Largillier R.
        • Marcy P.Y.
        • et al.
        Complete remission obtained with letrozole in a man with metastatic breast cancer.
        Rev Med Interne. 2004; 25 ([French]): 323-324
        • Agrawal A.
        • Cheung K.L.
        • Robertson J.F.
        Fulvestrant in advanced males breast cancer.
        Breast Cancer Res Treat. 2007; 101: 123
        • Yap H.Y.
        • Tashima C.K.
        • Blurmenschein G.R.
        • et al.
        Chemotherapy for advanced male breast cancer.
        JAMA. 1980; 243: 1739
        • Guinee V.F.
        • Olsson H.
        • Moller T.
        • et al.
        The prognosis of breast cancer in males. A report of 335 cases.
        Cancer. 1993; 71: 154-161
        • Anderson W.F.
        • Althuis M.D.
        • Brinton L.A.
        • Devesa S.S.
        Is male breast cancer similar or different than female breast cancer?.
        Breast Cancer Res Treat. 2004; 83: 77
        • Herman K.
        • Lowaziewicz W.
        • Stotnicki P.
        • et al.
        Male breast cancer. Does the prognosis differ compared to female?.
        Neoplasma. 2000; 47: 191
        • Borgen P.I.
        • Senle R.T.
        • McKinnon W.M.
        • Rosen P.P.
        Carcinoma of the male breast: analysis of prognosis compared with matched female patients.
        Ann Surg Oncol. 1997; 173: 185
        • Willsher P.C.
        • Leach I.H.
        • Ellis I.O.
        • et al.
        A comparison outcome of male breast cancer with females breast cancer.
        Am J Surg. 1997; 173: 185
        • Crew K.D.
        • Neugult A.I.
        • Wang X.
        • et al.
        Racial disparities in treatment and survival of male breast cancer.
        J Clin Oncol. 2007; 25: 1089
        • Weber-Chappuis K.
        • Bieri-Burger S.
        • Hurlimann J.
        Comparison of prognostic markers detected by immunochemistry in male and female breast carcinomas.
        Eur J Cancer. 1996; 32A: 1686
        • Pich A.
        • Margaria E.
        • Chilusa L.
        Oncogenes and male breast carcinoma: c-erbB2 and p53 coexpression predicts poor survival.
        J Clin Oncol. 2000; 18: 2948
        • Wang-Rodríguez J.
        • Cross K.
        • Gallagher S.
        • et al.
        Male breast carcinoma: correlation of ER, PR, Ki-67, Her2-Neu and p53 with treatment and survival. A study of 65 cases.
        Mod Pathol. 2002; 15: 853
        • Shpitz B.
        • Bomsein Y.
        • Sternberg A.
        • et al.
        Angiogenesis, p53, and c-erbB-2 immunoreactivity and clinicopathological features in male breast cancer.
        J Surg Oncol. 2000; 75: 5287
        • Look M.P.
        • van Putten W.L.
        • Duffy M.J.
        • et al.
        Pooled analysis of prognostic impact of urokinase-type plasminogen activator and its inhibitor PAI-1 in 8377 breast cancer patients.
        J Natl Cancer Inst. 2002; 94: 116
        • Meijer-van Gelder M.E.
        • Look M.P.
        • Bolt-de Vries J.
        • et al.
        Clinical relevance or biologic factors in male breast cancer.
        Breast Cancer Res Treat. 2001; 68: 249
        • Auvinen A.
        • Curtis R.E.
        • Ron E.
        Risk of subsequent cancer following breast cancer in men.
        J Natl Cancer Inst. 2002; 94: 1330-1332
        • Dong C.
        • Hemminki K.
        Second primary breast cancer in men.
        Breast Cancer Res Treat. 2001; 66: 171-172