Male Breast Cancer Treatment (PDQ®)

As a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, a core part of our mission is to educate patients and the community about cancer. The following summary is trusted information from the NCI.

General Information About Male Breast Cancer

Incidence and Mortality

Estimated new cases and deaths from breast cancer (men only) in the United States in 2014:

  • New cases: 2,360.
  • Deaths: 430.

Male breast cancer is rare. Less than 1% of all breast carcinomas occur in men. The mean age at diagnosis is between 60 and 70 years, though men of all ages can be affected with the disease.

Risk Factors

Predisposing risk factors appear to include radiation exposure, estrogen administration, and diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter syndrome. Definite familial tendencies are evident with an increased incidence seen in men who have a number of female relatives with breast cancer. An increased risk of male breast cancer has been reported in families in which the BRCA2 mutation on chromosome 13q has been identified.

Histopathology

The pathology is similar to that of female breast cancer, and infiltrating ductal cancer is the most common tumor type. Intraductal cancer has been described as well. Inflammatory carcinoma and Paget disease of the nipple have also been seen in men, but lobular carcinoma in situ has not. Lymph node involvement and the hematogenous pattern of spread are similar to those found in female breast cancer. The TNM staging system for male breast cancer is identical to the staging system for female breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Prognostic Factors

Prognostic factors that have been evaluated include the size of the lesion and the presence or absence of lymph node involvement, both of which correlate well with prognosis. Whether ploidy and S phase correlate with survival is uncertain. Estrogen-receptor and progesterone-receptor status and HER2/neu gene amplification should be reported.

Survival

Overall survival is similar to that of women with breast cancer. The impression that male breast cancer has a worse prognosis may stem from the tendency toward diagnosis at a later stage.

References:
  • American Cancer Society: Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer Society, 2014. Available online. Last accessed May 21, 2014.
  • Giordano SH, Cohen DS, Buzdar AU, et al.: Breast carcinoma in men: a population-based study. Cancer 101 (1): 51-7, 2004.
  • Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992.
  • Fentiman IS, Fourquet A, Hortobagyi GN: Male breast cancer. Lancet 367 (9510): 595-604, 2006.
  • Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.
  • Hultborn R, Hanson C, Köpf I, et al.: Prevalence of Klinefelter's syndrome in male breast cancer patients. Anticancer Res 17 (6D): 4293-7, 1997 Nov-Dec.
  • Wooster R, Bignell G, Lancaster J, et al.: Identification of the breast cancer susceptibility gene BRCA2. Nature 378 (6559): 789-92, 1995 Dec 21-28.
  • Thorlacius S, Tryggvadottir L, Olafsdottir GH, et al.: Linkage to BRCA2 region in hereditary male breast cancer. Lancet 346 (8974): 544-5, 1995.
  • Burstein HJ, Harris JR, Morrow M: Malignant tumors of the breast. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1401-46.
  • Cutuli B, Lacroze M, Dilhuydy JM, et al.: Male breast cancer: results of the treatments and prognostic factors in 397 cases. Eur J Cancer 31A (12): 1960-4, 1995.
  • Gattuso P, Reddy VB, Green L, et al.: Prognostic significance of DNA ploidy in male breast carcinoma. A retrospective analysis of 32 cases. Cancer 70 (4): 777-80, 1992.
  • Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.
  • Ravandi-Kashani F, Hayes TG: Male breast cancer: a review of the literature. Eur J Cancer 34 (9): 1341-7, 1998.

Treatment Options for Male Breast Cancer

Initial Surgical Management

Primary standard treatment is a modified radical mastectomy with axillary dissection. Responses are generally similar to those seen in women with breast cancer. Breast conservation surgery with lumpectomy and radiation therapy has also been used and results have been similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Adjuvant Therapy

In men with node-negative tumors, adjuvant therapy should be considered on the same basis as for a woman with breast cancer since there is no evidence that response to therapy is different for men or women.

In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal therapy have been used and can increase survival to the same extent as in women with breast cancer. Currently, no controlled studies have compared adjuvant treatment options. Approximately 85% of all male breast cancers are estrogen receptor–positive, and 70% of them are progesterone receptor–positive. Response to hormone therapy correlates with presence of receptors. Hormonal therapy has been recommended in all receptor-positive patients. Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence in male breast cancer patients. (Refer to the PDQ summaries on Hot Flashes and Night Sweats and Sexuality and Reproductive Issues for more information on these symptoms.) Responses are generally similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

  • CMF: cyclophosphamide plus methotrexate plus fluorouracil.
  • CAF: cyclophosphamide plus doxorubicin plus fluorouracil.
  • Trastuzumab (under clinical evaluation).
  • Tamoxifen (under clinical evaluation).

Locally Recurrent Disease

Surgical excision or radiation therapy combined with chemotherapy is recommended. Responses are generally similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Distant Metastases

Hormonal therapy, chemotherapy, or a combination of both have been used with some success. Initially, hormonal therapy is recommended.

  • Orchiectomy.
  • Luteinizing hormone-releasing hormone agonist with or without total androgen blockage (anti-androgen).
  • Tamoxifen for estrogen receptor–positive patients.
  • Progesterone.
  • Aromatase inhibitors.

Hormonal therapies may be used sequentially. Standard chemotherapy combinations of CMF and CAF are recommended after failure of hormonal therapy. Responses are generally similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

References:
  • Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992.
  • Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.
  • Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991.
  • Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007.
  • Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007.
  • Joshi MG, Lee AK, Loda M, et al.: Male breast carcinoma: an evaluation of prognostic factors contributing to a poorer outcome. Cancer 77 (3): 490-8, 1996.
  • Anelli TF, Anelli A, Tran KN, et al.: Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74 (1): 74-7, 1994.
  • Walshe JM, Berman AW, Vatas U, et al.: A prospective study of adjuvant CMF in males with node positive breast cancer: 20-year follow-up. Breast Cancer Res Treat 103 (2): 177-83, 2007.
  • Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.
  • Cocconi G, Bisagni G, Ceci G, et al.: Low-dose aminoglutethimide with and without hydrocortisone replacement as a first-line endocrine treatment in advanced breast cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 10 (6): 984-9, 1992.
  • Gale KE, Andersen JW, Tormey DC, et al.: Hormonal treatment for metastatic breast cancer. An Eastern Cooperative Oncology Group Phase III trial comparing aminoglutethimide to tamoxifen. Cancer 73 (2): 354-61, 1994.


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