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Humphries MP, Jordan VC, Speirs V. Obesity and male breast cancer: provocative parallels? BMC Med 2015; 13:134. [PMID: 26044503 PMCID: PMC4457166 DOI: 10.1186/s12916-015-0380-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/19/2015] [Indexed: 01/17/2023] Open
Abstract
While rare compared to female breast cancer the incidence of male breast cancer (MBC) has increased in the last few decades. Without comprehensive epidemiological studies, the explanation for the increased incidence of MBC can only be speculated. Nevertheless, one of the most worrying global public health issues is the exponential rise in the number of overweight and obese people, especially in the developed world. Although obesity is not considered an established risk factor for MBC, studies have shown increased incidence among obese individuals. With this observation in mind, this article highlights the correlation between the increased incidence of MBC and the current trends in obesity as a growing problem in the 21(st) century, including how this may impact treatment. With MBC becoming more prominent we put forward the notion that, not only is obesity a risk factor for MBC, but that increasing obesity trends are a contributing factor to its increased incidence.
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Affiliation(s)
- Matthew P Humphries
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK.
| | - V Craig Jordan
- Department of Breast Medical Oncology and Molecular and Cellular Oncology, MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Valerie Speirs
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, UK.
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202
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Teoh ZH, Archampong D, Gate T. Breast cancer in male-to-female (MtF) transgender patients: is hormone receptor negativity a feature? BMJ Case Rep 2015; 2015:bcr-2015-209396. [PMID: 25994431 DOI: 10.1136/bcr-2015-209396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 41-year-old male-to-female (MtF) transgender patient presented with a symptomatic tender lump in the left breast. There was no family history of breast cancer. She had been receiving estrogen therapy for 14 years to maintain her secondary sexual characteristics. Triple assessment revealed a 13 mm triple-negative grade 3 invasive ductal carcinoma. The tumour was completely excised following a left wide local excision and sentinel lymph node biopsy. There was no regional lymph node involvement. She was referred to the oncologist for adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Zhi Hao Teoh
- Breast Surgery Unit, Wrexham Maelor Hospital, Wrexham, UK
| | | | - Tim Gate
- Wrexham Maelor Hospital, Wrexham, UK
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203
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Mitri ZI, Jackson M, Garby C, Song J, Giordano SH, Hortobágyi GN, Singletary CN, Hashmi SS, Arun BK, Litton JK. BRCAPRO 6.0 Model Validation in Male Patients Presenting for BRCA Testing. Oncologist 2015; 20:593-7. [PMID: 25948675 DOI: 10.1634/theoncologist.2014-0425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 02/05/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND BRCAPRO is a risk assessment model to estimate the risk of carrying a BRCA mutation. BRCA mutation carriers are at higher risk of developing breast, ovarian, pancreatic, and prostate cancer. BRCAPRO was developed for women and found to be superior to other risk assessment models. The present study evaluated the validity of BRCAPRO at predicting the risk of male patients carrying a BRCA mutation. PATIENTS AND METHODS A total of 146 men who presented for genetic counseling and testing from February1997 to September 2011, and their test results were included in the present study. BRCAPRO risk assessment for all patients was calculated using the BRCAPRO clinical CancerGene assessment software. RESULTS The mean age at presentation was 57 years. Of the 146 patients, 48 had breast cancer, 18 had pancreatic cancer, 39 had prostate cancer, 27 had other primary cancers, and 37 had no cancer. Fifty patients (34%) tested positive for a BRCA mutation (22 BRCA1, 27 BRCA2, and 1 BRCA1 and BRCA2). The mean BRCAPRO score for all patients was 24.96%. The BRCAPRO score was significantly higher for patients who tested positive for a BRCA mutation (46.19% vs. 13.9%, p < .01). The area under the receiver operating characteristics curve was 0.83 for all patients for the BRCAPRO score to predict the risk of carrying a BRCA mutation. At a cutoff point of 30.02%, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.74, 0.81, 0.67, and 0.86, respectively. CONCLUSION BRCAPRO appears to be a valid risk assessment tool for determining the risk of carrying a BRCA mutation in men. IMPLICATIONS FOR PRACTICE Men carrying genetic mutations in the BRCA gene have a greater risk than the general population of developing certain types of cancer, including breast, pancreatic, and prostate cancer. BRCAPRO is a risk assessment model that predicts the risk of carrying a BRCA mutation. The present study aimed at validating BRCAPRO for use with men seen for genetic counseling, whether affected by cancer or not. The data available for 146 patients revealed that BRCAPRO was effective at identifying patients at risk of BRCA mutation. These findings could help in identifying a subset of high-risk patients who should proceed to genetic testing.
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Affiliation(s)
- Zahi I Mitri
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Michelle Jackson
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Carolyn Garby
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Juhee Song
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Sharon H Giordano
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Gabriel N Hortobágyi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Claire N Singletary
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - S Shahrukh Hashmi
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Banu K Arun
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
| | - Jennifer K Litton
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA; University of Texas Health and Science Center at Houston, Houston, Texas, USA
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204
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Masci G, Caruso M, Caruso F, Salvini P, Carnaghi C, Giordano L, Miserocchi V, Losurdo A, Zuradelli M, Torrisi R, Di Tommaso L, Tinterri C, Testori A, Garcia-Etienne CA, Gatzemeier W, Santoro A. Clinicopathological and Immunohistochemical Characteristics in Male Breast Cancer: A Retrospective Case Series. Oncologist 2015; 20:586-92. [PMID: 25948676 DOI: 10.1634/theoncologist.2014-0243] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 01/15/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Due to its rarity, male breast cancer (mBC) remains an inadequately characterized disease, and current evidence for treatment derives from female breast cancer (FBC). METHODS We retrospectively analyzed the clinicopathological characteristics, treatment patterns, and outcomes of mBCs treated from 2000 to 2013. RESULTS From a total of 97 patients with mBC, 6 (6.2%) with ductal in situ carcinoma were excluded, and 91 patients with invasive carcinoma were analyzed. Median age was 65 years (range: 25-87 years). Estrogen receptors were positive in 88 patients (96.7%), and progesterone receptors were positive in 84 patients (92.3%). HER-2 was overexpressed in 13 of 85 patients (16%). Median follow-up was 51.5 months (range: 0.5-219.3 months). Five-year progression-free survival (PFS) was 50%, whereas overall survival (OS) was 68.1%. Patients with grades 1 and 2 presented 5-year PFS of 71% versus 22.5% for patients with grade 3 disease; 5-year OS was 85.7% for patients with grades 1 and 2 versus 53.3% of patients with grade 3. Ki-67 score >20% and adjuvant chemotherapy were also statistically significant for OS on univariate analyses. Twenty-six of 87 patients (29.8%) experienced recurrent disease and 16 of 91 patients (17.6%) developed a second neoplasia. CONCLUSION Male breast cancer shows different biological patterns compared with FBC, with higher positive hormone-receptor status and lower HER-2 overexpression. Grade 3 and Ki-67 >20% were associated with shorter OS. IMPLICATIONS FOR PRACTICE There is little evidence that prognostic features established in female breast cancer, such as grading and Ki-67 labeling index, could be applied to male breast cancer as well. This study found that grade 3 was associated with shorter overall survival and a trend for Ki-67 >20%; this could help in choosing the best treatment option in the adjuvant setting. Many questions remain regarding the impact of HER-2 positivity on survival and treatment with adjuvant anti-HER-2 therapy. Regarding metastatic male breast cancer, the results suggest that common regimens of chemo-, endocrine and immunotherapy used in female breast cancer are safe and effective for men. Male breast cancer patients show a higher incidence of second primary tumors, especially prostate and colon cancers and should therefore be carefully monitored.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms, Male/classification
- Breast Neoplasms, Male/drug therapy
- Breast Neoplasms, Male/genetics
- Breast Neoplasms, Male/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/drug therapy
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Disease-Free Survival
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Middle Aged
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Prognosis
- Receptor, ErbB-2/biosynthesis
- Receptor, ErbB-2/genetics
- Receptors, Estrogen/genetics
- Receptors, Progesterone/genetics
- Retrospective Studies
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Affiliation(s)
- Giovanna Masci
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Michele Caruso
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Francesco Caruso
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Piermario Salvini
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Carlo Carnaghi
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Laura Giordano
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Vittoria Miserocchi
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Agnese Losurdo
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Monica Zuradelli
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Rosalba Torrisi
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Luca Di Tommaso
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Corrado Tinterri
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Alberto Testori
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Carlos A Garcia-Etienne
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Wolfgang Gatzemeier
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Humanitas Centro Catanese di Oncologia, Catania, Italy; Humanitas Gavazzeni, Bergamo, Italy; Humanitas Mater Domini, Castellanza, Italy
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205
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Sineshaw HM, Freedman RA, Ward EM, Flanders WD, Jemal A. Black/White Disparities in Receipt of Treatment and Survival Among Men With Early-Stage Breast Cancer. J Clin Oncol 2015; 33:2337-44. [PMID: 25940726 DOI: 10.1200/jco.2014.60.5584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the extent of black/white disparities in receipt of treatment and survival for early-stage breast cancer in men age 18 to 64 and ≥ 65 years. PATIENTS AND METHODS We identified 725 non-Hispanic black (black) and 5,247 non-Hispanic white (white) men diagnosed with early-stage breast cancer from 2004 to 2011 in the National Cancer Data Base. We used multivariable logistic regression and calculated standardized risk ratios to predict receipt of treatment and a proportional hazards model to estimate overall hazard ratios (HRs) in black versus white men age 18 to 64 and ≥ 65 years, separately. RESULTS Receipt of treatment was remarkably similar between blacks and whites in both age groups. Black and white older men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively). Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR, 1.76; 95% CI, 1.11 to 2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR, 1.37; 95% CI, 0.83 to 2.24). In those age ≥ 65 years, the excess risk of death in blacks versus whites was nonsignificant and not affected by adjustment for covariates. CONCLUSION The excess risk of death in black versus white men diagnosed with early-stage breast cancer was largely confined to those age 18 to 64 years and became nonsignificant after adjustment for differences in insurance and income. These findings suggest the importance of improving access to care in reducing racial disparities in male breast cancer mortality.
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Affiliation(s)
- Helmneh M Sineshaw
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA.
| | - Rachel A Freedman
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth M Ward
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - W Dana Flanders
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Ahmedin Jemal
- Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
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206
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Oger AS, Boukerrou M, Cutuli B, Campion L, Rousseau E, Bussières E, Raro P, Classe JM. [Male breast cancer: prognostic factors, diagnosis and treatment: a multi-institutional survey of 95 cases]. ACTA ACUST UNITED AC 2015; 43:290-6. [PMID: 25818033 DOI: 10.1016/j.gyobfe.2015.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 02/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The optimal treatment for male breast cancer is not known because male breast cancer is a rare disease. It represents as little as 0.6% of all breast cancers and less than 1% of human cancers. The aim was to analyze the clinical, histological and therapeutic characteristics of 95 men cared for breast cancer between 2000 and 2010 in four hospitals, and determine predictors of poor prognosis to improve care of male breast cancer. METHODS This study is a multi-institutional survey, retrospective, involving four French institutions: Cancer Institute of the West (ICO), Reunion Island South hospital group, the hospital group of Dax, and the Bergonié Institute. All carcinomas in situ or invasive breast occurred in male patients were included. An analysis of clinical, histological and therapeutic features was performed. Statistical analysis of our study focused on the overall survival of patients and specific method of Kaplan-Meier, enabling search for predictors of poor prognosis. RESULTS The mean age was 65 years. Thirty-seven percent of patients were overweight or obese. It was in 88% of cases of palpable tumor whose average size was 26.29mm. Ninety patients, none had a lesion palpable T0, 44% T1 tumors, 38% T2 tumors, 3% had a T3 tumors, and finally 10% T4 tumors. The histological type was the most common invasive ductal carcinoma (87%). He found a similar proportion of patients with or without lymph node involvement. N+ patients, capsular rupture was observed in 29% of cases. Receptor positivity was found, estrogen in 95% of cases and progesterone in 83% of cases. Additional irradiation was performed in 75% of patients and chemotherapy in 37% of patients. Overall survival was 79.2% at five years and 70.8% at ten years. Age, tumor size and histological capsular rupture are factors that significantly influence the overall survival and specific. CONCLUSION Male breast cancer is a different pathology of breast cancer in women. The majority of recommendations suggest treating men who are diagnosed with breast cancer, using the guidelines applied to postmenopausal women treatments. There is no study based on male population that has evaluated these treatment modalities in terms of impact on survival. The diagnosis is usually made at later stages, and tumor size is often greater. Histological characteristics also differ. However, the treatment is almost identical.
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Affiliation(s)
- A-S Oger
- ICO Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France.
| | - M Boukerrou
- CHU de la Réunion, groupe hospitalier Sud Réunion BP 350, 97448 Saint-Pierre cedex, Réunion
| | | | - L Campion
- ICO René-Gauducheau, 44805 Saint-Herblain cedex, France
| | - E Rousseau
- Centre hospitalier de Dax, 40107 Dax, France
| | | | - P Raro
- ICO Paul-Papin, 2, rue Moll, 49933 Angers cedex 9, France
| | - J-M Classe
- ICO René-Gauducheau, 44805 Saint-Herblain cedex, France
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207
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Khan MH, Allerton R, Pettit L. Hormone Therapy for Breast Cancer in Men. Clin Breast Cancer 2015; 15:245-50. [PMID: 26165199 DOI: 10.1016/j.clbc.2015.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 01/19/2023]
Abstract
Breast cancer in men is rare, but its incidence is increasing, in keeping with the aging population. The majority of breast cancers in men are estrogen receptor positive. There is a paucity of clinical trials to inform practice, and much has been extrapolated from breast cancer in women. Hormone therapy represents the mainstay of adjuvant and palliative therapy but may have contraindications or poor tolerability. We review the evidence for choice of hormone therapy in both the adjuvant and palliative setting in breast cancer in men.
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Affiliation(s)
| | | | - Laura Pettit
- Royal Shrewsbury Hospital NHS Trust, Shropshire, UK.
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208
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Sipetic-Grujicic SB, Murtezani ZH, Neskovic-Konstatinovic ZB, Marinkovic JM, Kovcin VN, Andric ZG, Kostic SV, Ratkov IS, Maksimovic JM. Multivariate analysis of prognostic factors in male breast cancer in Serbia. Asian Pac J Cancer Prev 2015; 15:3233-8. [PMID: 24815476 DOI: 10.7314/apjcp.2014.15.7.3233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to analyze the demographic and clinical characteristics of male breast cancer patients in Serbia, and furthermore to determine overall survival and predictive factors for prognosis. MATERIALS AND METHODS In the period of 1996-2006 histopathological diagnosis of breast cancer was made in 84 males at the Institute for Oncology and Radiology of Serbia. For statistical analyses the Kaplan-Meier method, long-rank test and Cox proportional hazards regression model were used. RESULTS The mean age at diagnosis with breast cancer was 64.3±10.5 years with a range from 35-84 years. Nearly 80% of the tumors showed ductal histology. About 44% had early tumor stages (I and II) whereas 46.4% and 9.5% of the male exhibited stages III and IV, respectively. Only 7.1% of male patients were grade one. One-fifth of all patients had tumors measuring ≤2 cm, and 14.3% larger than 5 cm. Lymph node metastasis was recorded in 40.4% patients and 47% relapse. Estrogen and progesterone receptor expression was positive in 66.7% and 58.3%, respectively. Among 14.3% of individuals tumor was HER2 positive. About two-thirds of all male patients had radical mastectomy (66.7%). Adjuvant hormonal (tamoxifene), systematic chemotherapy (CMF or FAC) and adjuvant radiotherapy were given to 59.5%, 35.7% and 29.8% patients respectively. Overall survival rates at five and ten years for male breast cancer were 55.0% and 43.9%, respectively. According to the multivariate Cox regression predictive model, a lower initial disease stage, a lower tumor grade, application of adjuvant hormone therapy and no relapse occurrence were significant independent predictors for good overall survival. CONCLUSIONS Results of the treatment would be better if disease is discovered earlier and therefore health education and screening are an imperative in solving this problem.
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O'Leary KA, Shea MP, Schuler LA. Modeling prolactin actions in breast cancer in vivo: insights from the NRL-PRL mouse. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 846:201-20. [PMID: 25472540 DOI: 10.1007/978-3-319-12114-7_9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Elevated exposure to prolactin (PRL) is epidemiologically associated with an increased risk of aggressive ER+ breast cancer. To understand the underlying mechanisms and crosstalk with other oncogenic factors, we developed the NRL-PRL mouse. In this model, mammary expression of a rat prolactin transgene raises local exposure to PRL without altering estrous cycling. Nulliparous females develop metastatic, histotypically diverse mammary carcinomas independent from ovarian steroids, and most are ER+. These characteristics resemble the human clinical disease, facilitating study of tumorigenesis, and identification of novel preventive and therapeutic approaches.
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Affiliation(s)
- Kathleen A O'Leary
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA,
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210
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Chu QD, Kim RH. Early Breast Cancers. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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211
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Tumour-to-tumour metastasis: male breast carcinoma metastasis arising in an extrapleural solitary fibrous tumour - a case report. Diagn Pathol 2014; 9:203. [PMID: 25420931 PMCID: PMC4260247 DOI: 10.1186/s13000-014-0203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tumour-to-tumour metastasis (TTM) occurs when one tumour metastasises to a separate tumour within the same individual. TTM is observed frequently in breast cancer but has not been described in male breast cancer. In addition reports describing solitary fibrous tumours (SFT) of the pleura hosting other neoplasms' metastases are limited. We report an exceptional case of male breast cancer metastasising to an extrapleural SFT, occurring in the subcutaneous tissue of the back of a 68-year old Caucasian patient. CASE PRESENTATION A 68-year old male was diagnosed with a metastasising ductal breast cancer. He was treated by mastectomy of the right breast and axillary lymph-adenectomy. Further staging revealed an increasing subcutaneous expansion located on the patient's back. Excision biopsy confirmed a SFT hosting a breast cancer metastasis. The patient received palliative chemotherapy but died of disease seven years after initial diagnosis. CONCLUSIONS The abundance of blood vessels within these lesions might predispose SFTs for an involvement in TTM. This case describes the possibility of concurrent rare occurrences and reminds clinicians, as well as pathologists, to be open-minded and fastidious about their differential diagnoses, sampling and examination of histological specimens. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_203.
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Ferraro GA, De Francesco F, Romano T, Grandone A, D'Andrea F, Miraglia Del Giudice E, Perrone L, Nicoletti G. Clinical and surgical management of unilateral prepubertal gynecomastia. Int J Surg Case Rep 2014; 5:1158-61. [PMID: 25437663 PMCID: PMC4275969 DOI: 10.1016/j.ijscr.2014.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/28/2014] [Accepted: 11/13/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Gynecomastia is the benign proliferation of the glandular tissue in the male breast. This condition is thought to be caused by the imbalance between estrogen action relative to androgen action at the breast tissue level. Bilateral gynecomastia is frequently found in the neonatal period, early in puberty, and with increasing age. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. PRESENTATION OF CASE We present an otherwise healthy boy of 12 years old with unilateral breast masses. No abnormalities were found on ultrasonography and on all endocrine parameters. Treatment consisted in a new "modified" Webster technique. DISCUSSION The results confirmed validity of this technique in terms of esthetic and functional results, and patient satisfaction. Atypical presentations of gynecomastia are often not recognized. The main pathophysiology of gynecomastia is alteration in the balance between the stimulatory effect of estrogen and the inhibitory effects of androgens on the development of the breast. If there is no causal treatment, surgical resection is the therapy of first choice. CONCLUSION The exact mechanism of unilateral gynecomastia formation in our case is unclear. The evaluation of unilateral gynecomastia can therefore be complex. In conclusion, the surgical treatment of unilateral gynecomastia requires an individual approach, based on an appropriate diagnostic algorithm.
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Affiliation(s)
- Giuseppe Andrea Ferraro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Francesco De Francesco
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
| | - Tiziana Romano
- Department of Pediatrics "F.Fede", Second University of Naples, Naples, Italy
| | - Anna Grandone
- Department of Pediatrics "F.Fede", Second University of Naples, Naples, Italy
| | - Francesco D'Andrea
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | | | - Laura Perrone
- Department of Pediatrics "F.Fede", Second University of Naples, Naples, Italy
| | - Gianfranco Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
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213
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Rich TA, Woodson AH, Litton J, Arun B. Hereditary breast cancer syndromes and genetic testing. J Surg Oncol 2014; 111:66-80. [DOI: 10.1002/jso.23791] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/09/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Thereasa A. Rich
- Clinical Cancer Genetics Program; Department of Surgical Oncology; M. D. Anderson Cancer Center; Houston Texas
| | - Ashley H. Woodson
- Clinical Cancer Genetics Program; Department of Breast Medical Oncology; M. D. Anderson Cancer Center; Houston Texas
| | - Jennifer Litton
- Clinical Cancer Genetics Program; Department of Breast Medical Oncology; M. D. Anderson Cancer Center; Houston Texas
| | - Banu Arun
- Clinical Cancer Genetics Program; Department of Breast Medical Oncology; M. D. Anderson Cancer Center; Houston Texas
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214
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Kozakiewicz B, Dmoch-Gajzlerska E, Chądzyńska M, Stefaniak M, Jodkiewicz Z. Assessment of 20 year survival in men with breast cancer. Clin Oncol (R Coll Radiol) 2014; 27:184-5. [PMID: 25455845 DOI: 10.1016/j.clon.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Affiliation(s)
- B Kozakiewicz
- Medical University of Warsaw, Warsaw, Poland; Oncology Centre, Institute in Warsaw, Warsaw, Poland
| | | | - M Chądzyńska
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M Stefaniak
- Medical University of Warsaw, Warsaw, Poland
| | - Z Jodkiewicz
- Oncology Centre, Institute in Warsaw, Warsaw, Poland
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Abstract
Gynaecomastia (enlargement of the male breast tissue) is a common finding in the general population. Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited. Breast cancer in men is much less common than benign gynaecomastia, and the two conditions can usually be distinguished by a careful physical examination. Estrogens are known to stimulate the growth of breast tissue, whereas androgens inhibit it; most cases of gynaecomastia result from deficient androgen action or excessive estrogen action in the breast tissue. In some cases, such as pubertal gynaecomastia, the breast enlargement resolves spontaneously. In other situations, more active treatment might be required to correct an underlying condition (such as hyperthyroidism or a benign Leydig cell tumour of the testis) or medications that could cause breast enlargement (such as spironolactone) might need to be discontinued. For men with hypogonadism, administration of androgens might be helpful, as might antiestrogen therapy in men with endogenous overproduction of estrogens. Surgery to remove the enlarged breast tissue might be necessary when gynaecomastia does not resolve spontaneously or with medical therapy.
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Affiliation(s)
- Harmeet S Narula
- Medical Service, Veterans Affairs Medical Center, 6900 Pecos Road, North Las Vegas, NV 89086, USA
| | - Harold E Carlson
- Department of Medicine, Endocrinology Division, Stony Brook University School of Medicine, HSC T15-060, Stony Brook, NY 11794-8154, USA
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216
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Outcome of Male Breast Cancer: A Matched Single-Institution Series. Clin Breast Cancer 2014; 14:371-7. [DOI: 10.1016/j.clbc.2014.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 01/06/2023]
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218
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Duijnhoven RG, Straus SMJM, Souverein PC, de Boer A, Bosch JLHR, Hoes AW, De Bruin ML. Long-term use of 5α-reductase inhibitors and the risk of male breast cancer. Cancer Causes Control 2014; 25:1577-82. [PMID: 25135615 DOI: 10.1007/s10552-014-0455-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/31/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 5α-reductase inhibitors (5-ARI) finasteride and dutasteride are indicated for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. Case reports have suggested that 5-ARIs increase the risk for male breast cancer, with no conclusive evidence. The objective of this study was to quantify the association between use of 5-ARIs and the risk for male breast cancer. METHODS A case-control study was conducted with data from the United Kingdom Clinical Practice Research Datalink database among all men aged 45 years and older in the period 1 January 1992 to 31 December 2011. Cases of men diagnosed with breast cancer were matched to up 10 controls on age and general practice. Crude and adjusted odds ratios were estimated for the risk of breast cancer associated with the use of 5-ARIs. RESULTS Three hundred and ninety-eight cases were identified and matched to 3,930 controls. Ever use of 5-ARIs was associated with an adjusted odds ratio for breast cancer of 1.08 (95 % CI 0.62-1.87) compared to non-users. Increasing cumulative duration of treatment showed no increasing risks: adjusted odds ratios for use for less than 280, for 280 to 1,036 and for more than 1,036 days were 1.21 (95 % CI 0.47-3.10), 0.94 (95 % CI 0.36-2.41) and 1.29 (95 % CI 0.54-3.08), respectively. CONCLUSIONS In this study, there was no evidence of an association between short- or long-term treatment with 5-ARIs and the risk for breast cancer in older men.
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Affiliation(s)
- Ruben G Duijnhoven
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands,
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219
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Díaz García N, Cuadrado Rouco C, Vich P, Alvarez-Hernandez C, Brusint B, Redondo Margüello E. [Breast cancer update in primary care: (V/V)]. Semergen 2014; 41:76-88. [PMID: 25002350 DOI: 10.1016/j.semerg.2014.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians ought to know thoroughly this pathology to optimize the health care services for these patients making the best use of available resources. A series of five articles on breast cancer is presented below. It is based on a review of the scientific literature over the last ten years. In this final section, the social, psychological, occupational and family issues related to the disease will be reviewed, as well as presenting some special situations of breast cancer, including breast cancer in men, during pregnancy and last stages of life. This summary report aims to provide a current and practical review about this disease, providing answers to family doctors and helping them to be by the patients for their benefit throughout their illness.
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Affiliation(s)
| | | | - Pilar Vich
- Centro de Salud Los Alpes, Madrid, España
| | | | | | - Esther Redondo Margüello
- Centro de Salud Internacional, Madrid Salud, Grupo de Actividades Preventivas de SEMERGEN, España
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Wang WW, Chen L, Ouyang XN. Misdiagnosed male breast cancer with an unknown primary tumor: A case report. Oncol Lett 2014; 8:190-192. [PMID: 24959243 PMCID: PMC4063581 DOI: 10.3892/ol.2014.2111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 03/04/2014] [Indexed: 11/06/2022] Open
Abstract
Compared with female breast cancer, male breast cancer (MBC) has an extremely low morbidity, later staging and fewer breast tissues. The lumps are easier to invade in the center and the majority of the cases are positive for metastatic lymph node, with the typical clinical manifestation as a painless mass in partial breast. MBC with an unknown primary tumor is rare and is often prone to misdiagnosis, resulting in a delay in correct treatment. Such a case is extremely significant for clinical reference. The current study presents a 58-year-old male who developed a painless mass in the left armpit and received armpit mass biopsy and pathological examination which showed glandular cancer, with a high possibility of mammary primary tumor. The patient was administered four cycles of paclitaxel plus oxaliplatin chemotherapy. However, three months later, the patient identified novel disseminated lymph nodes in the left armpit. The initial pathological section and paraffin blocks were re-examined and the patient was finally diagnosed with breast invasive ductal carcinoma based on the metastases pathology and immunohistochemical examination. No breast mass was found on physical examination of the patient and the tumor markers, including cancer antigen 125 and carcinoembryonic antigen, were normal. No primary tumors were observed in the mammography and PET-CT and the primary tumor was not found following the left breast modified radical mastectomy.
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Affiliation(s)
- Wen-Wu Wang
- Department of Medicine Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian 350025, P.R. China
| | - Lang Chen
- Department of Medicine Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian 350025, P.R. China
| | - Xue-Nong Ouyang
- Department of Medicine Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, Fujian 350025, P.R. China
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221
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Olivier-Van Stichelen S, Abramowitz LK, Hanover JA. X marks the spot: does it matter that O-GlcNAc transferase is an X-linked gene? Biochem Biophys Res Commun 2014; 453:201-7. [PMID: 24960196 DOI: 10.1016/j.bbrc.2014.06.068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 01/07/2023]
Abstract
O-GlcNAcylation has emerged as a critical post-translational modification important for a wide array of cellular processes. This modification has been identified on a large pool of intracellular proteins that have wide-ranging roles, including transcriptional regulation, cell cycle progression, and signaling, among others. Interestingly, in mammals the single gene encoding O-GlcNAc Transferase (OGT) is located on the X-chromosome near the Xist locus suggesting that tight dosage regulation is necessary for normal development. Herein, we highlight the importance of OGT dosage and consider how its genomic location can contribute to a gender-specific increased risk for a number of diseases.
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Affiliation(s)
- Stéphanie Olivier-Van Stichelen
- Laboratory of Cellular and Molecular Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD 20892, USA
| | - Lara K Abramowitz
- Laboratory of Cellular and Molecular Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD 20892, USA
| | - John A Hanover
- Laboratory of Cellular and Molecular Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD 20892, USA.
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Grenader T, Yerushalmi R, Tokar M, Fried G, Kaufman B, Peretz T, Geffen DB. The 21-gene recurrence score assay (Oncotype DX™) in estrogen receptor-positive male breast cancer: experience in an Israeli cohort. Oncology 2014; 87:1-6. [PMID: 24970679 DOI: 10.1159/000360793] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/14/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The 21-gene recurrence score (RS) assay has been widely adopted for use in early estrogen receptor (ER)-positive breast cancer to assess the risk for distant recurrence and the potential benefit of adjuvant chemotherapy. The primary aim of this study was to assess RS distribution in Israeli male breast cancer (MBC) patients. METHODS The study population included 65 newly diagnosed Israeli MBC patients. Clinical and pathologic data were collected at the time of referral. Pathologic examinations were conducted at the pathology departments of the referring centers. The RS assay (Oncotype DX™) was performed on paraffin-embedded tumor samples at Genomic Health laboratories. RESULTS The mean age of the patients was 65.1 years (range 38-88 years). Low-risk (RS<18), intermediate-risk (RS 18-30) and high-risk (RS≥31) scores were noted in 29 patients (44.6%), 27 patients (41.5%) and 9 patients (13.9%), respectively. The distribution of RS in male patients was similar to the distribution in 2,455 female patients from Israel referred during the same time period. CONCLUSION Our data suggest that the distribution of Oncotype DX RS in ER-positive MBC patients is similar to that of female breast cancer patients.
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Affiliation(s)
- Tal Grenader
- Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
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223
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Pure invasive micropapillary carcinoma of the male breast: report of a rare case with C-MYC amplification. Pathol Res Pract 2014; 210:1164-6. [PMID: 25042382 DOI: 10.1016/j.prp.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 05/02/2014] [Accepted: 06/10/2014] [Indexed: 12/25/2022]
Abstract
Male breast cancer is rare. The most common histological subtypes include invasive carcinoma "of no special type" and papillary carcinoma. Other variants, including pure micropapillary carcinoma, have been described as well but are extremely rare. Pure micropapillary carcinoma has been recently characterized by a C-MYC gene amplification in women. We report here, occurring in a 73-year-old man, the first case of pure micropapillary carcinoma with amplification of the C-MYC gene.
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224
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Groheux D, Hindié E, Marty M, Espié M, Rubello D, Vercellino L, Bousquet G, Ohnona J, Toubert ME, Merlet P, Misset JL. ¹⁸F-FDG-PET/CT in staging, restaging, and treatment response assessment of male breast cancer. Eur J Radiol 2014; 83:1925-33. [PMID: 24985086 DOI: 10.1016/j.ejrad.2014.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Male breast cancer (BC) is a rare disease, with patterns different from those found in women. Most tumors are detected at more advanced stages than in women. The aim of this study was to analyze the performance of [18F]fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in staging, restaging, and therapy response assessment. METHODS We performed a systematic analysis in the database of Saint-Louis Hospital to identify male patients with BC referred for PET/CT. (18)F-FDG-PET/CT findings considered suspicious for malignancy were compared to biopsy results, further work-up and/or patient follow-up of at least 6 months. Performances of (18)F-FDG-PET/CT were compared to that of conventional imaging (CI) using the McNemar test. The impact of PET/CT on management was evaluated. RESULTS During 6 consecutive years, among 12,692 (18)F-FDG-PET/CT oncology studies, 30 were performed in 15 men with BC: 7 examinations for initial staging, 11 for restaging, and 12 for response assessment. Tumors profile was ER+ and one had HER2 overexpression. PET/CT sensitivity, specificity, positive predictive value, negative predictive value and accuracy to detect distant metastases were 100%, 67%, 86%, 100% and 89%, respectively. PET/CT was more informative than CI in 40% of studies (p=0.03; 95% confidence interval: 3.26 - 40%). Findings from (18)F-FDG-PET/CT led to modification in the planned treatment in 13/30 cases (43%). CONCLUSION Although all the tumors were ER+, primary lesions and metastases were diagnosed with high sensitivity. (18)F-FDG-PET/CT seems to be a powerful imaging method to perform staging, restaging and treatment response assessment in male patients with BC.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Doctoral School of Biology and Biotechnology, University Institute of Hematology, University of Paris VII, Paris, France.
| | - Elif Hindié
- Department of Nuclear Medicine, Haut-Lévêque Hospital, CHU Bordeaux, University Bordeaux-Segalen, Bordeaux, France
| | - Michel Marty
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Centre for Therapeutic Innovation, Saint-Louis Hospital, Paris, France
| | - Marc Espié
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
| | - Domenico Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia, Rovigo Hospital, Rovigo, Italy
| | - Laetitia Vercellino
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Doctoral School of Biology and Biotechnology, University Institute of Hematology, University of Paris VII, Paris, France
| | - Guilhem Bousquet
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; INSERM U728, University Institute of Hematology, University of Paris VII, Paris, France
| | - Jessica Ohnona
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
| | | | - Pascal Merlet
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Doctoral School of Biology and Biotechnology, University Institute of Hematology, University of Paris VII, Paris, France
| | - Jean-Louis Misset
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
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226
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Mukherjee A, Saha A, Chattopadhyay S, Sur P. Clinical trends and outcomes of male breast cancer: Experience of a tertiary oncology centre in India. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0203.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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227
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Johansson I, Killander F, Linderholm B, Hedenfalk I. Molecular profiling of male breast cancer - lost in translation? Int J Biochem Cell Biol 2014; 53:526-35. [PMID: 24842109 DOI: 10.1016/j.biocel.2014.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer form in women and it has been extensively studied on the molecular level. Male breast cancer (MBC), on the other hand, is rare and has not been thoroughly investigated in terms of transcriptional profiles or genomic aberrations. Most of our understanding of MBC has therefore been extrapolated from knowledge of female breast cancer. Although differences in addition to similarities with female breast cancer have been reported, the same prognostic and predictive markers are used to determine optimal management strategies for both men and women diagnosed with breast cancer. This review is focused on prognosis for MBC patients, prognostic and predictive factors and molecular subgrouping; comparisons are made with female breast cancer. Information was collected from relevant literature on both male and female breast cancer from the MEDLINE database between 1992 and 2014. MBC is a heterogeneous disease, and on the molecular level many differences compared to female breast cancer have recently been revealed. Two distinct subgroups of MBC, luminal M1 and luminal M2, have been identified which differ from the well-established intrinsic subtypes of breast cancer in women. These novel subgroups of breast cancer therefore appear unique to MBC. Furthermore, several studies report inferior survival for men diagnosed with breast cancer compared to women. New promising prognostic biomarkers for MBC (e.g. NAT1) deserving further attention are reviewed. Further prospective studies aimed at validating the novel subgroups and recently proposed biomarkers for MBC are warranted to provide the basis for optimal patient management in this era of personalized medicine. This article is part of a Directed Issue entitled: Rare Cancers.
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Affiliation(s)
- Ida Johansson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Fredrika Killander
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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Maráz R, Boross G, Pap-Szekeres J, Markó L, Rajtár M, Ambrózay É, Bori R, Cserni G. The role of sentinel node biopsy in male breast cancer. Breast Cancer 2014; 23:85-91. [DOI: 10.1007/s12282-014-0535-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Bian C, Zhao Y, Guo Q, Xiong Y, Cai W, Zhang J. Aromatase inhibitor letrozole downregulates steroid receptor coactivator-1 in specific brain regions that primarily related to memory, neuroendocrine and integration. J Steroid Biochem Mol Biol 2014; 141:37-43. [PMID: 24434281 DOI: 10.1016/j.jsbmb.2013.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/26/2013] [Accepted: 12/27/2013] [Indexed: 01/15/2023]
Abstract
As one of the third generation of aromatase inhibitors, letrozole is a favored drug for the treatment of hormone receptor-positive breast cancer with some adverse effects on the nervous system, but the knowledge is limited and the results are controversial, the mechanism underlying its central action is also unclear. Accumulated evidences have demonstrated that estrogens derived from androgens by aromatase play profound roles in the brain through their receptors, which needs coactivator for the transcription regulation, among which steroid receptor coactivator-1 (SRC-1) has been shown to be multifunctional potentials in the brain, but whether it is regulated by letrozole is currently unknown. In this study, we examined letrozole regulation on SRC-1 expression in adult mice brain using immunohistochemistry. The results showed that letrozole induced dramatic decrease of SRC-1 in the medial septal, hippocampus, medial habenular nucleus, arcuate hypothalamic nucleus and superior colliculus (p<0.01). Significant decrease was detected in the dorsal lateral septal nucleus, bed nucleus of stria terminalis, ventral taenia tecta, dorsomedial and ventromedial hypothalamic nuclei, dorsomedial periaqueductal gray, superior paraolivary nucleus and pontine nucleus (p<0.05). In the hippocampus, levels of estradiol content, androgen receptor, estrogen receptor α and β also decreased significantly after letrozole injection. The above results demonstrated letrozole downregulation of SRC-1 in specific regions that are primarily related to learning and memory, cognition and mood, neuroendocrine as well as information integration, indicating that SRC-1 may be one important downstream central target of letrozole. Furthermore, these potential central adverse effects of letrozole should be taken into serious considerations.
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Affiliation(s)
- Chen Bian
- Department of Neurobiology, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Yangang Zhao
- Department of Neurobiology, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Qiang Guo
- Department of Neurobiology, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Ying Xiong
- Department of Neurobiology, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Wenqin Cai
- Department of Neurobiology, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China.
| | - Jiqiang Zhang
- Department of Neurobiology, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China.
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Andres SA, Smolenkova IA, Wittliff JL. Gender-associated expression of tumor markers and a small gene set in breast carcinoma. Breast 2014; 23:226-33. [PMID: 24656773 DOI: 10.1016/j.breast.2014.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 02/06/2014] [Accepted: 02/22/2014] [Indexed: 11/28/2022] Open
Abstract
Breast carcinomas in both genders share pathological features, although differences in incidence, prognosis and survival are reported. Expression of 33 genes was investigated in male and female breast carcinomas in association with ER, PR, HER-2/neu and EGF-receptor. Among 98 male breast cancers, 82 were ER+ and 78 were PR+. ER and PR protein levels were greater in males compared to females, although no differences were observed in ESR1 and PGR expression. A difference was observed in binding affinities of PR but not ER between genders. No differences were observed in HER-2/neu, EGFR protein, or patient age. Expression of NAT1, TBC1D9, IL6ST, RABEP1, PLK1 and LRBA was elevated in carcinomas of males compared to those of females, in which ER status appeared to be related to expression. Over-expression of protein products of these genes represents novel molecular targets for development of gender-specific therapeutics and companion diagnostics.
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Affiliation(s)
- Sarah A Andres
- Department of Biochemistry & Molecular Biology, J. Graham Brown Cancer Center and Institute for Molecular Diversity & Drug Design, University of Louisville, Louisville, KY 40202, USA
| | - Irina A Smolenkova
- Department of Biochemistry & Molecular Biology, J. Graham Brown Cancer Center and Institute for Molecular Diversity & Drug Design, University of Louisville, Louisville, KY 40202, USA
| | - James L Wittliff
- Department of Biochemistry & Molecular Biology, J. Graham Brown Cancer Center and Institute for Molecular Diversity & Drug Design, University of Louisville, Louisville, KY 40202, USA.
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231
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Roberts BM, Chumpolkulwong K, Tayamun S, Inamnuay L, Rungsipipat A, Lombardini ED. Mammary carcinoma in a male rhesus macaque (Macaca mulatta): histopathology and immunohistochemistry of ductal carcinoma in situ. J Med Primatol 2014; 43:213-6. [PMID: 24646188 DOI: 10.1111/jmp.12110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND A mammary nodule was noted in a male rhesus macaque during physical examination. METHODS AND RESULTS Histopathological and immunohistochemical analysis was performed. Ductal carcinoma in situ was confirmed. CONCLUSIONS To date, there are two reports of mammary carcinoma in male non-human primates, and none in the rhesus macaque.
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Affiliation(s)
- Bradley M Roberts
- Divisions of Comparative Pathology and Veterinary Medical Research, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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232
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Lorphelin H, Mortemousque I, Marret H, Body G, Ouldamer L. [Men with breast cancer have increased risk of other cancers]. Presse Med 2014; 43:e33-8. [PMID: 24612706 DOI: 10.1016/j.lpm.2013.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/28/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the frequency of family history of breast cancer in male patients with breast cancer and the association with other cancers. PATIENTS AND METHODS The patient group consisted of consecutive male patients managed for primary breast cancer in our institution between January 1997 and July 2012. Clinical data included comorbidities, BMI, personal and familial history of other cancers were searched. RESULTS Thirty-one male patients with the diagnosis of 32 primary breast cancers were enrolled during the study period. Thirty-two percent patients had family history of breast cancer, 29% patients had other primary cancers, and 16.1% of patients had associated prostate cancer. DISCUSSION AND CONCLUSION Male breast cancer frequently occurs in a context of family history of breast cancer. Its diagnosis must lead to the screening of prostate cancer especially in young men with family history.
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Affiliation(s)
- Henri Lorphelin
- CHRU de Tours, hôpital Bretonneau, département de gynécologie, 37044 Tours, France; Faculté de médecine François-Rabelais, 37000 Tours, France
| | | | - Henri Marret
- CHRU de Tours, hôpital Bretonneau, département de gynécologie, 37044 Tours, France; Faculté de médecine François-Rabelais, 37000 Tours, France
| | - Gilles Body
- CHRU de Tours, hôpital Bretonneau, département de gynécologie, 37044 Tours, France; Faculté de médecine François-Rabelais, 37000 Tours, France
| | - Lobna Ouldamer
- CHRU de Tours, hôpital Bretonneau, département de gynécologie, 37044 Tours, France; Faculté de médecine François-Rabelais, 37000 Tours, France; Unité Inserm 1069, 37032 Tours cedex, France.
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233
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Breast cancer: trends in international incidence in men and women. Br J Cancer 2014; 110:1891-7. [PMID: 24518595 PMCID: PMC3974084 DOI: 10.1038/bjc.2014.66] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/13/2014] [Accepted: 01/15/2014] [Indexed: 12/29/2022] Open
Abstract
Background: The age-standardised incidence of breast cancer varies geographically, with rates in the highest-risk countries more than five times those in the lowest-risk countries. Methods: We investigated the correlation between male (MBC) and female breast cancer (FBC) incidence stratified by female age-group (<50 years, and ⩾50 years) and used Poisson regression to examine male incidence rate ratios according to female incidence rates. Results: Age-adjusted breast cancer incidence rates for males and females share a similar geographic distribution (Spearman's correlation=0.51; P<0.0001). A correlation with male incidence rates was found for the entire female population and for women aged 50 years and over. Breast cancer incidence rates in males aged <50 years were not associated with FBC incidence, whereas those in males aged ⩾50 years were. MBC incidence displays a small ‘hook' similar to the Clemmesen's hook for FBC, but at a later age than the female hook. Interpretation: Further investigation of possible explanations for these patterns is warranted. Although the incidence of breast cancer is much lower in men than in women, it may be possible to identify a cause common to both men and women.
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234
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Van Asten K, Neven P, Lintermans A, Wildiers H, Paridaens R. Aromatase inhibitors in the breast cancer clinic: focus on exemestane. Endocr Relat Cancer 2014; 21:R31-49. [PMID: 24434719 DOI: 10.1530/erc-13-0269] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breast cancer is the most prevalent type of cancer in women and responsible for significant female cancer-related mortality worldwide. In the Western world, over 80% of breast cancers are hormone-receptor positive for which endocrine therapy is administered. The main anti-estrogen treatments in use consist of selective estrogen-receptor modulators, such as tamoxifen, and third-generation aromatase inhibitors (AIs), such as exemestane, letrozole, and anastrozole. In this review, the focus will lie on exemestane, its clinical use, and its side-effect profile. Exemestane is the only third-generation steroidal AI. Its efficacy as a first-line treatment in metastatic breast cancer has been demonstrated. Therefore, exemestane could be considered a valid first-line therapeutic option, but it also can be used in second-line or further situations. Exemestane is mostly used as part of sequential adjuvant treatment following tamoxifen, but in this setting it is also active in monotherapy. Furthermore, this AI has been studied in the neoadjuvant setting as presurgical treatment, and even as chemoprevention in high-risk healthy postmenopausal women. It may reverse side effects of tamoxifen, such as endometrial changes and thromboembolic disease but may also cause some inconvenient side effects itself. Additionally, there is a lack of total cross-resistance between exemestane and nonsteroidal AIs as far as their anti-tumoral efficacy is concerned; moreover the two classes of AIs display a nontotal overlapping toxicity profile. Taking together, exemestane can be considered as a useful treatment option at all stages of breast cancer.
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Affiliation(s)
- Kathleen Van Asten
- KU Leuven, Department of Oncology, Leuven, Belgium University Hospitals Leuven, Department of Gynecology and Obstetrics, Leuven, Belgium University Hospitals Leuven, Department of General Medical Oncology, Leuven, Belgium
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235
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Verschuur-Maes AHJ, Kornegoor R, de Bruin PC, Oudejans JJ, van Diest PJ. Do columnar cell lesions exist in the male breast? Histopathology 2014; 64:818-25. [PMID: 24267518 DOI: 10.1111/his.12333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/11/2013] [Accepted: 11/19/2013] [Indexed: 11/27/2022]
Abstract
AIMS In females, columnar cell lesions (CCLs) have been recognized as putative precursor lesions of low-grade breast cancer, but their role in male breast carcinogenesis is as yet unclear. METHODS AND RESULTS We reviewed surgical resections from males with breast cancer (n = 89), gynaecomastia (n = 20) and normal breast specimens from autopsies (n = 5) for the presence of CCL. In addition, we performed immunohistochemistry for cytokeratin 5/6 (CK5/6), CK14 and oestrogen receptor alpha (ER). In 19 of 89 resections (two DCIS cases and 17 invasive carcinoma), some individual ducts were found to contain cells with snouts on the luminal border but lacking further typical columnar cell lesion features. We mainly found three-layered ductal epithelium, characteristic for gynaecomastia and confirmed by immunohistochemistry. Moreover, we found a few ducts in male breast cancer sections that were clonally negative for basal cytokeratins. CONCLUSION We found no lesions with convincing CCL morphology at the periphery of invasive male breast cancers, in gynaecomastia or in normal male breast specimens. Although we cannot completely exclude the existence of CCLs in the male breast, these lesions seem to be very uncommon and are therefore unlikely to play a major role in male breast carcinogenesis.
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236
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Moncayo VM, Aarsvold JN, Grant SF, Bartley SC, Alazraki NP. Status of sentinel lymph node for breast cancer. Semin Nucl Med 2014; 43:281-93. [PMID: 23725990 DOI: 10.1053/j.semnuclmed.2013.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Long-awaited results from randomized clinical trials designed to test the validity of sentinel lymph node biopsy (SLNB) as replacement of axillary lymph node dissection (ALND) in management of early breast cancer have recently been published. All the trials conclude SLNB has survival rates comparable to those of ALND (up to 10 years in one study) and conclude SLNB has less morbidity than ALND. All the trials support replacing ALND with SLNB for staging in early breast cancer; all support SLNB as the standard of care for such cancer. The SLNB protocols used in the trials varied, and no consensus that would suggest a standard protocol exists. The results of the trials and of other peer-reviewed research do, however, suggest a framework for including some specific methodologies in accepted practice. This article highlights the overall survival and disease-free survival data as reported from the clinical trials. This article also reviews the status of SLN procedures and the following: male breast cancer, the roles of various imaging modalities (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, and ultrasound), ductal carcinoma in situ, extra-axillary SLNs, SLNB after neoadjuvant chemotherapy, radiation exposure to patients and medical personnel, and a new radiotracer that is the first to label SLNs not by particle trapping but by specific macrophage receptor binding. The proper Current Procedural Terminology (CPT) code for lymphoscintigraphy and SLN localization prior to surgery is 78195.
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Affiliation(s)
- Valeria M Moncayo
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Atlanta, GA 30322, USA.
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237
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Kwong A, Chau WW, Mang OWK, Wong CHN, Suen DTK, Leung R, Wong K, Lee A, Shea C, Morse E, Law SCK. Male Breast Cancer: A Population-Based Comparison with Female Breast Cancer in Hong Kong, Southern China: 1997–2006. Ann Surg Oncol 2013; 21:1246-53. [DOI: 10.1245/s10434-013-3377-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Indexed: 12/22/2022]
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238
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Carcinome papillaire intrakystique du sein : une tumeur rare chez l’homme. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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239
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Bird ST, Brophy JM, Hartzema AG, Delaney JA, Etminan M. Male Breast Cancer and 5α-Reductase Inhibitors Finasteride and Dutasteride. J Urol 2013; 190:1811-4. [DOI: 10.1016/j.juro.2013.04.132] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Steven T. Bird
- U.S. Department of Health and Human Services/U.S. Food and Drug Administration/Center for Drug Evaluation and Research/Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology/Department of Epidemiology, Silver Spring, Maryland
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - James M. Brophy
- Department of Medicine, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Abraham G. Hartzema
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Joseph A.C. Delaney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Mahyar Etminan
- Child & Family Research Institute of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
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240
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Eggemann H, Ignatov A, Stabenow R, von Minckwitz G, Röhl FW, Hass P, Costa SD. Male breast cancer: 20-year survival data for post-mastectomy radiotherapy. ACTA ACUST UNITED AC 2013; 8:270-5. [PMID: 24132074 DOI: 10.1159/000354122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The goal of this population-based study was to determine the impact of post-mastectomy radiation therapy on long-term overall survival (OS) of male patients with breast cancer. PATIENTS AND METHODS We investigated 20-year OS rates of 664 patients diagnosed with primary stage I-III breast cancer in former East Germany between 1970 and 1989. Patients had a radical mastectomy with axillary lymph node dissection without systemic adjuvant therapy. RESULTS Median follow-up time was 26.2 years (range 19-38 years). 52.4% of the patients had post-mastectomy radiotherapy. Radiotherapy showed different effects in each stage group after 20 years. Whereas there was an OS trend for radiotherapy to harm patients with stage I disease (hazard ratio (HR) 1.45; 95% confidence interval (CI) 0.98-2.15; p = 0.065), radiotherapy showed no benefit in patients with stage II disease (HR 0.82; 95% CI 0.62-1.1; p = 0.15). There was a significant survival benefit for patients with stage III disease receiving radiotherapy (HR 0.60; 95% CI 0.41-0.88; p = 0.008). CONCLUSION Post-mastectomy radiotherapy is associated with longer OS in male patients with stage III breast cancer. Male breast cancer patients at stages I and II do not seem to benefit from radiotherapy, but obsolete irradiation techniques might explain adverse long-term effects in earlier stages.
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Affiliation(s)
- Holm Eggemann
- University Women's Clinic, Otto von Guericke University, Magdeburg, Berlin
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241
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Ghosh A, Kanan A. Lobular carcinoma of male breast diagnosed on fine needle aspiration cytology--a case report. Cytopathology 2013; 25:210-2. [PMID: 24033887 DOI: 10.1111/cyt.12094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Ghosh
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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242
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La Verde N, Collovà E, Lonardi S, Generali D, Moretti A, Atzori F, Cazzaniga M, Saggia C, Tondulli L, Marcon I, Gentile AL, Rossello R, Martelli O, Aglione S, Farina G, Cinquini M, Garassino M. Male Breast Cancer: Clinical Features and Multimodal Treatment in a Retrospective Survey Analysis at Italian Centers. TUMORI JOURNAL 2013; 99:596-600. [DOI: 10.1177/030089161309900506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background We report a collection of data about early breast cancer in male patients from 13 Italian institutions. Methods and study design We obtained data from patient charts and performed statistical analysis. The primary end points were overall survival and disease-free survival. Results A total of 205 men with invasive breast cancer was identified, with a median age of 66 years. Pathological characteristics were heterogeneous for T stage, N stage and HER2 status. Histological subtype was predominantly ductal infiltrating carcinoma. Most of them were hormone receptor positive. Mastectomy was the most common strategy. Postsurgical treatment was not standardized. Patients with large tumors were more likely to be treated with chemotherapy. Disease recurrence was associated with an ER+ and PR+ status. Conclusions We identified a correlation between relapse and hormone receptor expression, as is the case in female breast cancer.
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Affiliation(s)
- Nicla La Verde
- AO Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | - Elena Collovà
- Hospital of Legnano, Division of Medical Oncology, Legnano
| | - Sara Lonardi
- Veneto Oncology Institute IRCCS, Medical Oncology Unit 1, Padua
| | - Daniele Generali
- Azienda Istituti Ospitalieri di Cremona, UO Multidisciplinare di Patologia Mammaria, Cremona
| | - Anna Moretti
- AO Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | | | | | | | - Luca Tondulli
- AO Universitaria Integrata di Verona Borgo Trento Hospital, Department of Oncology, Verona
| | - Ilaria Marcon
- Ospedale di Circolo e Fondazione Macchi, Department of Oncology, Varese
| | | | - Rosalba Rossello
- Policlinico Universitario “G Martino”, Department of Human Pathology, Medical Oncology and Integrated Therapies Unit, Messina
| | - Olga Martelli
- AO S Giovanni-Addolorata, Medical Oncology Unit, Rome
| | | | | | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research, Department of Oncology, Milan
| | - Marina Garassino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Oncology Unit 1, Milan, Italy
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243
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Serra R, Buffone G, Perri P, Renne M, Amato B, de Franciscis S. Male breast cancer manifesting as cephalic vein thrombosis. Ann Vasc Surg 2013; 27:1188.e9-11. [PMID: 23988541 DOI: 10.1016/j.avsg.2013.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/30/2012] [Accepted: 01/12/2013] [Indexed: 12/18/2022]
Abstract
Male breast cancer is an uncommon disease with a low annual prevalence in Western countries. Venous thromboembolism may be associated during malignancy of the breast. We report a 70-year-old man who presented with superficial vein thrombosis of right upper limb that predicted the diagnosis of breast invasive ductal carcinoma. Key issues surrounding the diagnosis, treatment, and relationship between breast cancer and venous disorders are discussed. Breast cancer and venous thromboembolism are 2 conditions that are often correlated more than expected, and attention to the combination of these clinical presentations is required.
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MESH Headings
- Aged
- Anticoagulants/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Breast Neoplasms, Male/complications
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/therapy
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/therapy
- Chemotherapy, Adjuvant
- Humans
- Male
- Mastectomy, Simple
- Treatment Outcome
- Ultrasonography, Doppler, Duplex
- Upper Extremity/blood supply
- Venous Thromboembolism/diagnosis
- Venous Thromboembolism/drug therapy
- Venous Thromboembolism/etiology
- Venous Thrombosis/diagnosis
- Venous Thrombosis/drug therapy
- Venous Thrombosis/etiology
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Affiliation(s)
- Raffaele Serra
- Department of Medical and Surgical Science, University Magna Gracia of Catanzaro, Viale Europa, Località Germaneto, Catanzaro, Italy.
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244
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Chen X, Liu X, Zhang L, Li S, Shi Y, Tong Z. Poorer survival of male breast cancer compared with female breast cancer patients may be due to biological differences. Jpn J Clin Oncol 2013; 43:954-63. [PMID: 23935206 DOI: 10.1093/jjco/hyt116] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The objective of the study was to compare disease-free survival and overall survival in a group of matched males and females with breast cancer, and to analyze possible treatment- and gender-related differences. METHODS We retrospectively analyzed the data of 150 operable male breast cancer patients treated in our hospital from December 1980 to June 2012. Each male breast cancer patient recorded in the database was matched with two female breast cancer patients of equal stage. Prognosis in terms of disease-free survival and overall survival was evaluated. RESULTS The mean age at diagnosis was 58.6 ± 9.7 years for males and 57.2 ± 10.3 years for females. The median follow-up was 69 months for males and 81 months for females. Significant differences were identified for tumor location, hormone receptor status, molecular subtypes and hormone therapy between the two groups. Monofactorial analysis demonstrated that tumor size, lymph node state, American Joint Committee on Cancer stage, molecular subtypes and adjuvant chemotherapy treatment were prognostic factors in male breast cancer patients. The 5- and 10-year disease-free survival rates were 65.6 and 40.1% for males, and 74.9 and 51.5% for females, respectively. The 5- and 10-year overall survival rates were 72.9 and 53.9% for males, and 83.2 and 68.5% for females, respectively. There was significantly difference in disease-free survival and overall survival between the two matched groups (P = 0.002). CONCLUSIONS Male breast cancer patients had inferior outcome despite of equal stage in comparison with matched female breast cancer patients, which demonstrates that biological differences may contribute to the worse prognosis.
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Affiliation(s)
- Xingyu Chen
- *Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China.
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245
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Ninkovic S, Azanjac G, Knezevic M, Radovanovic D, Canovic D, Nedovic J, Mitrovic S. Lobular Breast Cancer in a Male Patient with a Previous History of Irradiation Due to Hodgkin's Disease. ACTA ACUST UNITED AC 2013; 7:315-8. [PMID: 23904835 DOI: 10.1159/000341391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Male breast cancer is rare and represents less than 1% of all breast cancers. Considering the fact that the male breast most often does not consist of lobules and acini, lobular carcinoma of the male breast is exceptionally rare. CASE REPORT In this paper we present a unique case of alveolar variant of lobular male breast cancer in a 56-year-old patient. CONCLUSION According to our knowledge this is the first presentation of an alveolar variant of lobular male breast cancer that appeared 14 years after chemo- and radiotherapy for the treatment of Hodgkin's disease.
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Affiliation(s)
- Srdjan Ninkovic
- Faculty of Medicine, University of Kragujevac, Serbia ; Clinical Centre Kragujevac, Serbia
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246
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Portal Hypertension, Nodular Regenerative Hyperplasia of the Liver, and Obstructive Portal Venopathy due to Metastatic Breast Cancer. Case Rep Pathol 2013; 2013:826284. [PMID: 23984149 PMCID: PMC3747434 DOI: 10.1155/2013/826284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/09/2013] [Indexed: 11/17/2022] Open
Abstract
Nodular regenerative hyperplasia (NRH) of the liver is associated with noncirrhotic portal hypertension, rheumatologic and hematologic disorders, administration of certain drugs, and other underlying conditions. This report describes a 64-year-old man with clinically presumed cirrhosis who presented to our institution with coffee-ground emesis, esophageal varices, ascites, and encephalopathy. Eleven years earlier he had been treated for breast cancer with mastectomy and chemo-radiotherapy. He died suddenly, and the autopsy showed no evidence of cirrhosis but instead demonstrated NRH with extensive emboli of recurrent breast carcinoma within the portal vein and its intrahepatic branches. Neoplastic occlusion of the portal vein as a cause of presinusoidal noncirrhotic portal hypertension has not previously been reported for metastatic breast carcinoma. This case highlights the importance of obstructive portal venopathy in the pathogenesis of NRH as well as the diagnostic difficulties that may be encountered in determining the cause of portal hypertension.
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247
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Meaney-Delman D, Bellcross CA. Hereditary breast/ovarian cancer syndrome: a primer for obstetricians/gynecologists. Obstet Gynecol Clin North Am 2013; 40:475-512. [PMID: 24021253 DOI: 10.1016/j.ogc.2013.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An understanding of the diagnosis and clinical management of hereditary breast and ovarian cancer syndrome (HBOC) is essential for obstetricians/gynecologists. This article provides practical information regarding collecting a family history, cancer risk assessment and genetic testing, BRCA-associated cancer prognosis and treatment, screening recommendations, and prevention strategies. Through appropriate cancer risk assessment, women with BRCA1/2 mutations can be identified, and screening and prevention strategies can be used before a diagnosis of cancer occurs. Women's health providers with a strong working knowledge of HBOC are able to improve the quality of care for women and families impacted by BRCA1/2 mutations.
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Affiliation(s)
- Dana Meaney-Delman
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303, USA.
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248
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Hashimoto N, Kudo Y, Kurushima M, Suzuki Y, Yachi T, Tokura T, Umehara Y, Nishikawa S, Takahashi K, Morita T, Narita F. Computed tomographic lymphography for sentinel lymph node biopsy in male breast cancer: report of two cases. SPRINGERPLUS 2013; 2:351. [PMID: 23961415 PMCID: PMC3733075 DOI: 10.1186/2193-1801-2-351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022]
Abstract
Male breast cancer is rare, accounting for less than 1% of breast cancers. Because of its rarity evidence of the usefulness sentinel lymph node biopsy (SLNB) for male breast cancer has not been established. Moreover, a navigation system which can easily determine the incision site of SLNB is needed because a second incision for SLNB is necessary in most cases. We report successful computed tomographic lymphography (CTLG)-guided SLNB in two male breast cancer cases: the first patient was a 79-year-old man and the second was a 64-year-old man. Both had presented with a lump behind the nipple. Clinical diagnoses were early breast carcinoma in both cases. The second patient took tamoxifen 20 mg daily as neoadjuvant endocrine therapy. SLNs were clearly visualized by CTLG, allowing mastectomies with SLNB to be performed. Both SLNB were negative, such that axillary lymph node dissection was not needed. Preoperative CTLG is useful for visualizing lymph flow and detecting SLN in male breast cancer.
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Affiliation(s)
- Naoki Hashimoto
- Department of Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
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249
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Patten DK, Sharifi LK, Fazel M. New approaches in the management of male breast cancer. Clin Breast Cancer 2013; 13:309-14. [PMID: 23845572 DOI: 10.1016/j.clbc.2013.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/12/2013] [Accepted: 04/16/2013] [Indexed: 11/15/2022]
Abstract
Male breast cancer (MBC) is a rare condition that accounts for 0.1% of all male cancers. Our current evidence base for treatment is derived from female breast cancer (FBC) patients. Risk factors for MBC include age, genetic predisposition, race, sex hormone exposure, and environmental factors. Most patients present later and with more advanced disease than comparable FBC patients. Tumors are likely to be estrogen receptor and progesterone receptor positive, with the most common histologic type being invasive ductal carcinoma. Triple assessment remains the criterion standard for diagnosis. Primary MBC is mostly managed initially by simple mastectomy, with the option of breast conserving surgery, which carries an increased risk of recurrence. Sentinel node biopsy is recommended as the initial procedure for staging the axilla. Reconstructive surgery focuses on achieving primary skin closure, and radiotherapy largely follows treatment protocols validated in FBC. We recommend chemotherapy for men with more advanced disease, in particular, those with estrogen receptor negative histology. MBC responds well to endocrine therapy, although it is associated with significant adverse effects. Third-generation aromatase inhibitors are promising but raise concerns due to their failure to prevent estrogen synthesis in the testes. Fulvestrant remains unproven as a therapy, and data on trastuzumab is equivocal with HER2 receptor expression and functionality unclear in MBC. In metastatic disease, drug-based hormonal manipulation remains a first-line therapy, followed by systemic chemotherapy for hormone-refractory disease. Prognosis for MBC has improved over the past 30 years, with survival affected by disease staging, histologic classification, and comorbidity.
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Affiliation(s)
- Darren K Patten
- Department of Biosurgery and Surgical Oncology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Breast and General Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK.
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A case of male inflammatory breast cancer. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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