Male Breast Cancer

Summary Type: Treatment
Summary Audience: Health professionals
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of male breast cancer.

Male Breast Cancer

General Information

Note: Estimated new cases and deaths from breast cancer (men only) in the United States in 2007:^1,

• New cases: 2,030.
• Deaths: 450.

Male breast cancer is rare.² Less than 1% of all breast carcinomas occur in men.^3,4 The mean age at diagnosis is between 60 and 70 years, though men of all ages can be affected with the disease.

Predisposing risk factors ⁵ appear to include radiation exposure, estrogen administration, and diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter’s syndrome.⁶ 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.^7,8,

The pathology is similar to that of female breast cancer, and infiltrating ductal cancer is the most common tumor type.⁹ Intraductal cancer has been described as well. Inflammatory carcinoma and Paget’s disease of the nipple have also been seen in men, but lobular carcinoma in situ has not.⁹ 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 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.^5,10 Whether ploidy and S phase correlate with survival is uncertain.¹¹ Estrogen-receptor and progesterone-receptor status and HER2/neu gene amplification should be reported.^12,

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.^2,5,13,

¹ American Cancer Society.: Cancer Facts and Figures 2007. Atlanta, Ga: American Cancer Society, 2007. Also available online. Last accessed March 5, 2007.

² Giordano SH, Cohen DS, Buzdar AU, et al.: Breast carcinoma in men: a population-based study. Cancer 101 (1): 51-7, 2004.

³ 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.

⁴ Fentiman IS, Fourquet A, Hortobagyi GN: Male breast cancer. Lancet 367 (9510): 595-604, 2006.

⁵ Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.

⁶ 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.

⁷ 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.

⁸ Thorlacius S, Tryggvadottir L, Olafsdottir GH, et al.: Linkage to BRCA2 region in hereditary male breast cancer. Lancet 346 (8974): 544-5, 1995.

⁹ Dickson RB, Pestell RG, Lippman ME: Cancer of the breast. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1399-1487.

¹⁰ 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.

¹¹ 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.

¹² Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.

¹³ Ravandi-Kashani F, Hayes TG: Male breast cancer: a review of the literature. Eur J Cancer 34 (9): 1341-7, 1998.

Treatment Option Overview

The designations in PDQ that treatments are “standard” or “under clinical evaluation” are not to be used as a basis for reimbursement determinations.

Treatment Options for Male Breast Cancer

Initial Surgical Management

Primary standard treatment is a modified radical mastectomy with axillary dissection.^1,2,3 Responses are generally similar to those seen in women with breast cancer.² (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.^2,4 Response to hormone therapy correlates with presence of receptors. Hormonal therapy has been recommended in all receptor-positive patients.^1,2 Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence in male breast cancer patients.⁵ Responses are generally similar to those seen in women with breast cancer.² (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Adjuvant chemotherapy regimens include:
• CMF: cyclophosphamide + methotrexate + fluorouracil.
• CAF: cyclophosphamide + doxorubicin + fluorouracil.
• Trastuzumab (under clinical evaluation).^6,
• Tamoxifen (under clinical evaluation).^6,

Locally Recurrent Disease

Surgical excision or radiation therapy combined with chemotherapy is recommended.² Responses are generally similar to those seen in women with breast cancer.² (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.^2,

Hormonal modalities include:
• Orchiectomy.
• Luteinizing hormone-releasing hormone agonist with or without total androgen blockage (antiandrogen).
• Tamoxifen for estrogen receptor–positive patients.^1,
• Progesterone.
• Aromatase inhibitors.^6,7,8,

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.² (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

¹ 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.

² Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.

³ Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991.

⁴ 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.

⁵ 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.

⁶ Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.

⁷ 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.

⁸ 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.

Changes to This Summary (04/04/2007)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information

Added Fentiman et al. as reference 4.

More Information

About PDQ

• PDQ® - NCI's Comprehensive Cancer Database.
  • Full description of the NCI PDQ database.

Additional PDQ Summaries

• PDQ® Cancer Information Summaries: Adult Treatment
  • Treatment options for adult cancers.
• PDQ® Cancer Information Summaries: Pediatric Treatment
  • Treatment options for childhood cancers.
• PDQ® Cancer Information Summaries: Supportive Care
  • Side effects of cancer treatment, management of cancer-related complications and pain, and psychosocial concerns.
• PDQ® Cancer Information Summaries: Screening/Detection (Testing for Cancer)
  • Tests or procedures that detect specific types of cancer.
• PDQ® Cancer Information Summaries: Prevention
  • Risk factors and methods to increase chances of preventing specific types of cancer.
• PDQ® Cancer Information Summaries: Genetics
  • Genetics of specific cancers and inherited cancer syndromes, and ethical, legal, and social concerns.
• PDQ® Cancer Information Summaries: Complementary and Alternative Medicine
  • Information about complementary and alternative forms of treatment for patients with cancer.

Important:

This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) .