Male breast cancer following repeated fluoroscopy

Breast Cancer, Secondary Breast Cancers in Childhood Cancer Male Survivors-Characteristics and Risks

PURPOSE

Male breast cancer (MBC) is uncommon, accounting for less than 1% of all breast cancers. Secondary breast cancers among childhood cancer survivors have been well described in the literature, but less is known about MBC.

METHODS AND MATERIALS

We carried out an analysis in a cohort of 7019 five-year survivors of a solid childhood (aged ≤20 years) cancer treated in France before 2001 and followed for an average of 20 years and compared breast cancers occurring in both men and women.

RESULTS

Among the 7019 survivors, 4 out of 3893 male survivors developed breast cancer, compared with 99 out of 3126 female survivors. All of the men had a history of radiation therapy. The 4 men with MBC had estrogen receptors and 3 had progesterone receptors.

CONCLUSIONS

MBC is a rare second malignancy among childhood cancer survivors. Receipt of radiation therapy is a recognized risk factor, but more data about eventual genetic mutations are necessary. Regular screening based only on a history of radiation therapy is not recommended; however, attention must be given in the case of suspicious symptoms.

Male breast cancer: a review of clinical management

AIMS

Male breast cancer incidence is 1% of all breast cancers and is increasing. We aim to present an overview of male breast cancer with particular emphasis on clinical management.

METHODS

Studies were identified by an online search of literature in the MEDLINE database till June 2006 followed by an extensive review of bibliographies.

RESULTS

Increased risk factors include genetic predisposition as in BRCA2 families; testicular dysfunction due to chromosomal abnormality such as Klinefelter's syndrome or environmental factors such as chronic heat exposure and radiation. Clinical assessment with biopsy is the hallmark of diagnosis. Earlier presentations are becoming commoner but there are wide geographical differences. Surgical treatment involves simple or modified radical mastectomy along with surgical assessment of the axilla, either via sentinel node biopsy in clinically node-negative disease or axillary sampling/clearance in node-positive disease. Reconstructions for restoring body image have been recently reported. Indications for adjuvant therapies are similar to that in women. For metastatic disease, tamoxifen is still the mainstay for oestrogen receptor positive disease. For oestrogen receptor negative disease, doxorubicin based chemotherapy regimens are used. In addition, the oft neglected psychological aspects of men having a "cancer of women" are increasingly being recognised.

CONCLUSIONS

There is, thus, need for further increasing awareness among men to reduce stigma associated with presentation of symptoms related to breast. This should be in addition to stressing to clinicians the ways of earlier detection and tailor-made "gender oriented" treatment of breast cancer in men.

Ductal carcinoma in situ of the breast in men: a review

Breast carcinoma in men is rare and comprises approximately 1% of all breast cancer cases. In contrast to the increase in the detection rate of ductal carcinoma in situ (DCIS) in women resulting from the wide use of screening mammography programs, the rate of male DCIS is still small and represents approximately 5% of all male breast cancers. Considerable debate exists concerning the nature of this entity, including the clinical course, pathologic findings, treatment, and prognosis. In this review, the relevant literature dealing with male DCIS is summarized in an attempt to more precisely define the features of this disease.

Epidemiology of Male Breast Cancer

Breast cancer in men is a rare disease, accounting for ∼1% of all breast cancer cases. Although the epidemiologic literature regarding female breast cancer is extensive, relatively little is known about the etiology of male breast cancer (MBC). This review is intended to summarize the existing body of evidence on genetic and epidemiologic risk factors for breast cancer in men. Overall, the epidemiology of MBC presents similarities with the epidemiology of female breast cancer. Major genetic factors associated with an increased risk of breast cancer for men include BRCA2 mutations, which are believed to account for the majority of inherited breast cancer in men, Klinefelter syndrome, and a positive family history. Suspected genetic factors include AR gene mutations, CYP17 polymorphism, Cowden syndrome, and CHEK2. Epidemiologic risk factors for MBC include disorders relating to hormonal imbalances, such as obesity, testicular disorders (e.g., cryptorchidism, mumps orchitis, and orchiectomy), and radiation exposure. Suspected epidemiologic risk factors include prostate cancer,prostate cancer treatment, gynecomastia, occupational exposures (e.g., electromagnetic fields, polycyclic aromatic hydrocarbons, and high temperatures), dietary factors (e.g., meat intake and fruit and vegetable consumption), and alcohol intake.

Prevalence of BRCA1 and BRCA2 mutations in male breast cancer patients in Canada

Men who inherit a mutation in the BRCA2 gene carry a 6% risk of developing breast cancer by the age of 70. The proportion of male breast cancers attributable to BRCA mutations has not yet been determined with accuracy. We studied a series of 14 male breast cancer patients, unselected for family history or ethnicity, who were treated at a single regional cancer center in Canada. Family histories were obtained, and the men were tested for germ-line mutations of BRCA1 and BRCA2. Seven of these patients had a significant family history of breast cancer (i.e., at least one first- or second-degree relative with breast cancer diagnosed before age 70). Two of the men carried BRCA2 mutations, but no BRCA1 mutations were found. Both mutation carriers reported a positive family history and a personal history of cancer that preceded their diagnosis of breast cancer. Our results support the recommendation that male breast cancer patients who have a significant family history of breast or ovarian cancer should be offered genetic counseling and testing.

Male breast cancer: a review of the literature

Although breast cancer is uncommon in men, it can cause significant morbidity and mortality. The current review was undertaken to determine whether strategies applied for the evaluation and treatment of breast cancer in females are appropriate in male breast cancer. Male breast cancer has biological differences compared with female breast cancer, including a high prevalence in certain parts of Africa, a higher incidence of oestrogen receptor positivity and more aggressive clinical behaviour. It responds to hormonal manipulation and chemotherapy, but optimal treatment regimens in males are unknown. Male breast cancer remains an uncommon disease. Most of our current knowledge regarding its biology, natural history and treatment strategies has been extrapolated from its female counterpart. Much research is needed to further characterise the molecular biological properties of male breast tumours and their prognostic significance, and to devise treatment strategies, including optimal chemotherapy regimens.

Carcinoma of the male breast: update 1994

In many ways, male and female breast cancers are similar, but do have some notable differences. Although the underlying etiology of male breast cancer may be partially due to hormonal or environmental changes, this disease is rare compared to female breast cancer. Most often, it presents as a painless lump, with estrogen receptor-positive infiltrating ductal carcinoma being the most common pathologic type. The main component of local therapy is either a radical or a modified radical mastectomy, with adjuvant chemotherapy proving useful. Estrogen receptor-positive tumors respond well to hormonal therapy. More research is needed in order to: (1) further characterize the molecular biological properties of male breast cancer tumors, (2) further investigate the role of adjuvant chemotherapy, and define successful regimens, and (3) determine optimal chemotherapy regimens in the treatment of metastatic disease. As this disease is a relatively rare condition, whenever possible, all patients should be allowed to participate in national cooperative group studies.

Ionizing radiation and breast cancer in men (United States)

The purposes of this study were to determine whether exposure of the vestigial male breast to ionizing radiation is associated with an increase in risk of breast cancer and, if so, to determine whether the apparent effects on risk in men are similar to those reported for women. A population-based case-control study of breast cancer in men was conducted in 10 geographic areas of the United States. Information on possible prior exposure to ionizing radiation, and on other potential risk factors for breast cancer, was obtained from personal interviews of 227 cases and 300 controls who were recruited from October 1983 to September 1986. Evidence from this study that ionizing radiation can cause breast cancer in men includes: a modest trend of increasing risk with frequency of chest X-rays; an increase in risk in men with three or more radiographic examinations, especially if received prior to 1963; and an increase in risk in men who received X-ray treatments to the chest and adjacent body areas. Risk was increased only from 20 to 35 years after initial exposure from either radiographic examinations or X-ray treatments, and declined after three to four decades since last exposure, suggesting a wave of increased risk of finite duration following exposure. The doses of radiation received could not be estimated precisely, but those from diagnostic procedures were likely similar to those received by prepubertal females in prior studies, and the results of those and the present investigation are compatible. The carcinogenic effects of ionizing radiation may be similar in the male and prepubertal female breast.

Cancer of the male breast: the Turkish experience

Twenty-six patients with male breast cancer who were admitted to the Center of Oncology and Nuclear Medicine, Istanbul, Turkey, between 1980 and 1988, were analyzed retrospectively. Median age was 60 years. Most lesions were infiltrating ductal carcinomas (92%). Of 26 lesions, 9 were staged as stage II (35%), 14 as stage III (54%), and 3 as stage IV (11%). All but five patients underwent unilateral mastectomy (81%). Postoperative treatment consisted of radiation therapy combined with chemotherapy in 11 patients (42%), chemotherapy with or without hormonal therapy in 4 (15%), radiation therapy alone in 10 (38%). Radiation therapy was delivered for a mean total radiation dose of 52 +/- 2 Gy (range 30-60 Gy). Chemotherapy consisted of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in most patients (60%). FAC regimen (5-fluorouracil, Adriamycin, and cyclophosphamide) was given to 6 patients (40%). Six patients were known to have died of breast cancer during follow-up (23%). Fourteen patients were NED (no evidence of disease) at last follow-up (54%). Overall actuarial 5-year survival was calculated to be 37%, and median actuarial survival was 46.6 months. Actuarial 5-year disease-free survival was 27%, and median actuarial disease-free survival was 47.1 months. Only one patient had a local recurrence, and eight patients had 13 distant metastases (31%). Age (P = 0.023), tumor stage (P = 0.055) and nodal status (P = 0.013) were the most significant prognostic factors correlated with the overall survival.

Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiological factors

Male breast cancer is a rare tumour in all parts of the world. About 1% of all breast cancers occur in men, but the male/female ratio is higher among black than among white populations. This effect can be seen in US cancer registries and even more markedly in African data. A positive correlation exists on a population scale between male breast cancer and prostate cancer. Seven case-control studies of male breast cancer are available, and a pooled analysis was conducted of the most commonly suspected risk factors. Male breast cancer appears to be associated with marital status: Mantel-Haenszel exposure odds ratio (EOR) for never married = 1.6; 95% confidence limits (CL) = 1.1, 2.3, religion (EOR for being Jewish = 2.1; 95% CL = 1.4, 3.2), previous breast pathology (EOR for positive history of benign breast disease = 2.7; 95% CL = 1.7, 4.2), gynaecomastia (EOR for positive history = 6.2, 95% CL = 3.4, 11.4), previous testicular pathology (EOR for positive history = 2.2; 95% CL = 1.5, 3.3), previous liver diseases (EOR for positive history = 1.6; 95% CL = 1.0, 2.4) and family history of breast cancer (EOR for first-degree relative with breast cancer = 2.5; 95% CL = 1.7, 3.7). No association is found with smoking history. Other potential risk factors such as reproductive history, education, occupation, anthropometric variables, association with various diseases, and specific exposures such as drug use, were not systematically evaluated in all studies and provide sometimes contradictory results, possibly due to small numbers of exposed subjects. Overall, the analytical epidemiology of male breast cancer presents similarities with the epidemiology of female breast cancer, with a potential role of factors related to hormonal status, relative hyperoestrogeny in men being potentially linked to increased risk of disease. Genetics may also play a role, with high risk linked to a familial history of breast cancer, and with a major risk in patients with Klinefelter's syndrome.

Male breast cancer

Breast cancer in the male is an uncommon disease, occurring less than 1% as often as in females. Because of its rarity, this disease has not been as extensively studied as its female counterpart. Male breast cancer is evaluated and managed in a fashion very similar to that for female breast cancer. Primary management in early stage disease is usually a modified radical mastectomy. First line hormonal therapy for metastatic disease, in our institution, is tamoxifen for patients with positive estrogen receptors. Second line therapy consists of progestins or antiandrogens/LHRH analogs. No firm recommendations can be made concerning adjuvant systemic therapy. However, it is likely that studies from female patients are adaptable. Unfortunately, carcinoma of the male breast is such an infrequently encountered tumor that unfamiliarity with the disease can lead to delays in diagnosis and treatment. An increased awareness of the disease may be expected to result in earlier detection and institution of therapy at a stage when cure may be possible.