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Sahin SI, Balci S, Guler G, Altundag K. Clinicopathological analysis of 38 male patients diagnosed with breast cancer. Breast Dis 2024; 43:1-8. [PMID: 38363600 PMCID: PMC10894578 DOI: 10.3233/bd-230050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Male breast cancer (MBC) accounts for one percent of all breast cancers. Due to the lack of awareness and routine screening programs, most patients present with systemic disease at the time of diagnosis with low overall survival. OBJECTIVES This study aims to investigate the prognostic factors of male breast cancer and its correlation with established prognostic parameters and patient outcomes. METHODS Thirty-eight male breast cancer patients are identified from the MKA Breast Cancer Clinic database, and their corresponding clinical and pathological characteristics are obtained. Cut-off values of 1% and 10% are applied to further classify ER and PR results. RESULTS Older men are more likely to develop MBC than younger men and are more likely to have spread to axillary lymph nodes. Invasive ductal carcinoma is a more common histologic type in MBC. All the tested patients have ER and PR positivity. Distant metastasis developed in 17/38 (44.7%) patients. Bone metastasis is seen commonly in metastatic MBC. CONCLUSIONS According to our cohort, MBC is seen in older males, presents in later stages, and shows hormone receptor positivity and a tendency to bone involvement. MBC is a heterogenous but distinct biological entity requiring a specific clinical and pathological approach.
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Affiliation(s)
- Seniha Irem Sahin
- Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Serdar Balci
- Memorial Hospital Group, Pathology Laboratory, Istanbul, Turkey
| | - Gulnur Guler
- Bilen Pathology, Sakir Baki Sokak, Ankara, Turkey
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2
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Dogan I, Aydin E, Ak N, Ozkurt S, Ibıs K, Sükrüoglu O, Erciyas SK, Küçücük S, Yazici H, Aydiner A, Saip P. Clinicopathologic characteristics and prognostic factors in patients with male breast cancer: A single tertiary center experience. J Cancer Res Ther 2023; 19:1887-1892. [PMID: 38376293 DOI: 10.4103/jcrt.jcrt_243_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 02/21/2024]
Abstract
BACKGROUND The goal of this study was to assess the clinicopathologic characteristics and prognostic variables in men with breast cancer (BC). METHODS Clinical features, pathological characteristics, stage at diagnosis, and therapy data were noted. Survival analysis was performed using the log-rank technique and Cox regression model. RESULTS Eighty patients were included in the study. In 31% of the individuals, BRCA (BReast CAncer genes 1 and 2) mutations were identified. The estrogen receptor (ER) positivity ratio was 93.6%, whereas the progesterone receptor (PR) positivity ratio was 74.4%. In 16.9% of the cases, HER2 overexpression was found. The median survival time was 120.9 months (70.3-171.5), and the five-year overall survival (OS) ratio was 74.9%. In univariate analysis, BRCA mutation status had no effect on OS (P = 0.50). CA15-3 levels (P = 0.03) at diagnosis and history of smoking (P = 0.03) were significantly linked with OS. However, the multivariate analysis could not confirm these results. CONCLUSIONS We found that BRCA mutation, body mass index, a history of smoking, and alcohol consumption did not affect the OS in this research.
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Affiliation(s)
- Izzet Dogan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Esra Aydin
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Naziye Ak
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Selnur Ozkurt
- Department of Radiation Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Kamuran Ibıs
- Department of Radiation Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Ozge Sükrüoglu
- Department of Cancer Genetics, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Seda Kılıc Erciyas
- Department of Cancer Genetics, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Seden Küçücük
- Department of Radiation Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Hulya Yazici
- Department of Cancer Genetics, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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Merlino L, D’Ovidio G, Matys V, Piccioni MG, Porpora MG, Senatori R, Viscardi MF, Vitale A, Della Rocca C. Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) in Breast Cancer Survivors: A Systematic Review and Update. Pharmaceuticals (Basel) 2023; 16:ph16040550. [PMID: 37111307 PMCID: PMC10142093 DOI: 10.3390/ph16040550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
(1) Background: Genitourinary syndrome of menopause (GSM) is a medical condition that can affect breast cancer survivors (BCS). This is a complication that often can occur as a result of breast cancer treatment, causing symptoms such as vaginal dryness, itching, burning, dyspareunia, dysuria, pain, discomfort, and impairment of sexual function. BCS who experience these symptoms negatively impact multiple aspects of their quality of life to the point that some of them fail to complete adjuvant hormonal treatment; (2) Methods: In this systematic review of the literature, we have analyzed possible pharmacological and non-pharmacological treatments for GSM in BCS. We reviewed systemic hormone therapy, local hormone treatment with estrogens and androgens, the use of vaginal moisturizers and lubricants, ospemifene, and physical therapies such as radiofrequency, electroporation, and vaginal laser; (3) Results: The data available to date demonstrate that the aforementioned treatments are effective for the therapy of GSM and, in particular, vulvovaginal atrophy in BCS. Where possible, combination therapy often appears more useful than using a single line of treatment; (4) Conclusions: We analyzed the efficacy and safety data of each of these options for the treatment of GSM in BCS, emphasizing how often larger clinical trials with longer follow-ups are needed.
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Affiliation(s)
- Lucia Merlino
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giulia D’Ovidio
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Viviana Matys
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Grazia Piccioni
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Roberto Senatori
- Italian Society of Colposcopy and Cervicovaginal Pathology (SICPCV), 00186 Rome, Italy
| | - Maria Federica Viscardi
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Antonio Vitale
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Cattolica del Sacro Cuore University, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Carlo Della Rocca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
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Zheng G, Leone JP. Male Breast Cancer: An Updated Review of Epidemiology, Clinicopathology, and Treatment. JOURNAL OF ONCOLOGY 2022; 2022:1734049. [PMID: 35656339 PMCID: PMC9155932 DOI: 10.1155/2022/1734049] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/23/2022] [Accepted: 05/05/2022] [Indexed: 12/11/2022]
Abstract
Male breast cancer (MaBC) is a rare clinical entity, which makes up approximately 1% of all breast cancers. However, the incidence of MaBC has been steadily increasing over the past few decades. The risk factors for MaBC include age, black race, family history of breast cancer, genetic mutations, liver cirrhosis, and testicular abnormalities. The majority of patients with MaBC present with painless lumps, and about half of the patients have at least one lymph node involved at the time of diagnosis. The treatment of MaBC models that of female breast cancer (FeBC), but this is mainly due to lack of prospective studies for MaBC patients. The treatment modality includes surgery, adjuvant radiation, endocrine therapy, and chemotherapy. However, there are some distinct features of MaBC, both clinically and molecularly, that may warrant a different clinical approach. Ongoing multinational effort is required, to conduct clinical trials for MaBC, or the inclusion of MaBC patients in FeBC trials, to help clinicians improve care for MaBC patients.
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Affiliation(s)
- Guoliang Zheng
- Department of Medicine, St Elizabeth Medical Center, A Teaching Hospital of Boston University, 736 Cambridge Street, Boston, MA, USA
| | - Jose Pablo Leone
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA
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ESMER AC, DAĞ A, BERKEŞOĞLU M, TAZEOĞLU D. Male Breast Cancer: A Single-Center Experience. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.927704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Vasiliou SK, Diamandis EP. Androgen receptor: A promising therapeutic target in breast cancer. Crit Rev Clin Lab Sci 2019; 56:200-223. [PMID: 30821186 DOI: 10.1080/10408363.2019.1575643] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer (BCa) is the second most common cancer worldwide and the most prevalent cancer in women. The majority of BCa cases are positive (+) for the estrogen receptor (ER+, 80%) and progesterone receptor (PR+, 65%). Estrogen and progesterone hormones are known to be involved in cancer progression, and thus hormonal deprivation is used as an effective treatment for ER+PR+ BCa subtypes. However, some ER+PR+ BCa patients develop resistance to such therapies. Meanwhile, chemotherapy is the only available treatment for ER-PR- BCa tumors. Another hormone receptor known as the androgen receptor (AR) has also been found to be widely expressed in human breast carcinomas. However, the mechanisms of AR and its endogenous androgen ligands is not well-understood in BCa and its biological role in this hormone-related disease remains unclear. In this review, we aim to address the importance of the AR in BCa diagnosis and prognosis, current AR-targeting approaches in BCa, and the potential for AR-downstream molecules to serve as therapeutic targets.
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Affiliation(s)
- Stella K Vasiliou
- a Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada.,b Department of Pathology and Laboratory Medicine , Mount Sinai Hospital , Toronto , Canada
| | - Eleftherios P Diamandis
- a Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada.,b Department of Pathology and Laboratory Medicine , Mount Sinai Hospital , Toronto , Canada.,c Department of Clinical Biochemistry , University Health Network , Toronto , Canada
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Kang E, Lakshmanan A. Narcissism and Self- Versus Recipient-Oriented Imagery in Charitable Giving. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2018; 44:1214-1227. [DOI: 10.1177/0146167218764658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prior research documents extensively that high-narcissism individuals largely tend to be self-centered and often lack empathy. This research outlines the charitable appeal types that can activate empathic responses and other-centered behaviors from high-narcissism individuals. Across four studies, we show that donors who are higher in narcissism exhibit greater charitable intentions when appealed to via imagine-self charitable appeals (as opposed to imagine-recipient types of appeals). Imagine-self appeals enable high-narcissism donors to project themselves into the recipient’s situation and, in doing so, elicit greater empathy and, consequently, greater charity. This effect dissipates when projecting oneself is very difficult or impossible—such as with animal recipients or the other gender suffering a gender-specific ailment. We also explicate the underlying process role of self-focused imagination and empathy in heightening charitable outcomes from high-narcissism individuals.
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Uslukaya Ö, Gümüş M, Gümüş H, Bozdağ Z, Türkoğlu A. The Management and Outcomes of Male Breast Cancer. THE JOURNAL OF BREAST HEALTH 2016; 12:165-170. [PMID: 28331756 DOI: 10.5152/tjbh.2016.3073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Due to a lack of sufficient data, the treatment protocols for male breast cancer are usually the same as those used for female breast cancer. The aim of the current study was to present our clinical experience with male breast cancer. MATERIALS AND METHODS The records of 37 patients who were treated for male breast cancer in our hospital between 2004 and 2014 were reviewed retrospectively. The data of patients were recorded and analyzed. RESULTS The mean age of the patients was 63.03±12.36 years. Thirty-three patients (89.2%) had invasive ductal carcinoma, two (5.4%) had ductal carcinoma in situ, and two had invasive lobular carcinoma (5.4%). The most common molecular subtype was luminal A (17 cases, 45.9%). Twenty-nine patients with male breast cancer underwent mastectomy and two underwent breast conserving surgery. Axillary lymph node dissection was performed in 25 patients. The most common surgical procedure was modified radical mastectomy. Distant metastases were present in 17 (45.9%) patients. Overall, the 5-year survival was 60%. The 5-year survival was 100% for those with stage 0-I disease, 87% for stage II, and 42% for stage III. The 3-year survival was 14% for stage IV. CONCLUSION Patients with male breast cancer presented at an older age, a later stage, and with earlier metastasis. Early metastasis and death increases with increasing stage. Poor prognosis correlates with late admission. Data from different centers should be compiled and reviewed in order to determine a specific treatment protocol for male breast cancer; each paper published reveals new data.
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Affiliation(s)
- Ömer Uslukaya
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Metehan Gümüş
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Hatice Gümüş
- Department of Radiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Zübeyir Bozdağ
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Ahmet Türkoğlu
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Hejazi SH, Ahangari G, Pornour M, Deezagi A, Aminzadeh S, Ahmadkhaniha HR, Akbari ME. Evaluation of gene expression changes of serotonin receptors, 5-HT3AR and 5-HT2AR as main stress factors in breast cancer patients. Asian Pac J Cancer Prev 2015; 15:4455-8. [PMID: 24969868 DOI: 10.7314/apjcp.2014.15.11.4455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is a serious and potentially lethal multi-factor disease among 40-50 aged women in both developed and developing countries. Also, various studies have pointed to roles of neurotransmitters like serotonin in development of cancers, through action on various types of receptors. This study was conducted to evaluate serotonin receptor (5HT2AR and 5HT3AR) genes expression in peripheral blood mononuclear cells (PBMCs) of breast cancer patients in comparison with the healthy people and in the MCF7 cell line. Peripheral blood samples were obtained from 30 patients and 30 healthy individuals. Total RNA was extracted from PBMCs and MCF-7 cells. and 5HT2AR and 5HT3AR were detected by RT-PCR techniques. Finally, serotonin receptor gene expression variation in breast cancer patients and MCF-7 cells were determined by real time-PCR. This latter indicated significant promotion in expression of 5HT3AR and 5HT2AR in PBMCs in breast cancer patients but expression of 5HT2AR in the MCF-7 cell line was significantly decreased. In conclusion, after performing complimentary tests, determine of gene expression changes in serotonin receptors (5HT2AR and 5HT3AR) may be useful as a new approach in treatment of breast cancer based on use of antagonists.
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Affiliation(s)
- Seyed Hesam Hejazi
- Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran E-mail :
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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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Tariq KB, Al-Saffar F, Ibrahim S, Pham D, Farhangi A, Rana F, Zaiden R. Male Breast Cancer and Hyperestrogenemia: A Thirteen-Year Review. World J Oncol 2014; 5:55-61. [PMID: 29147378 PMCID: PMC5649874 DOI: 10.14740/wjon803w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2014] [Indexed: 11/11/2022] Open
Abstract
Background Male breast cancer (MBC) is a very rare malignancy and accounts for 0.1% of all male cancers. MBC has not been studied as extensively as its female counterpart. Certain clinical and pathological risk factors like smoking history, age at onset, family history of cancer, obesity, ethnicity, estrogen/progesterone receptor status and BRCA gene mutation status have all been studied well in the female breast cancer (FBC) patients and the clinical trial evidence from these studies is then extrapolated to treat and manage patients with MBC. One such area of interest is high levels of estrogen and its relationship with MBC. In our retrospect research study we aim to find an association between MBC and high levels of circulating estrogen at the time of diagnosis. Methods A 13-year retrospective review of the male breast cases at University of Florida College of Medicine's Tumor Registry was conducted. Data regarding certain clinic-pathological risk factors and MBC were collected and reviewed. Main surrogate indicators for elevated estrogen were examined, namely, low HDL (< 40 mg/dL), low albumin (< 4 g/dL) and high BMI (> 25). Presence of any one of these surrogates was seen as an indirect marker for high estrogen level. For cancer staging, the American Joint Committee on Cancer (AJCC) staging system was used. Stages 0-2 were grouped together as they are less extensive compared to stages 3-4 (also grouped together) which represent extensive disease. Univariate analysis was conducted using STATA 13 to do Fischer's exact test as cross-tables showed cell counts of five or less. The main comparison was that between extensive MBC (stages 3-4) and non-extensive breast cancer (stages 0-2). Results Between January 2000 and November 2013, we found a total of 2,129 cases of breast cancer patients at our institute. Out of these 2,113 (99.24%) were female and 16 (0.75%) were men. Four MBC patients were excluded because their complete charts could not be found in the medical records department. Six (50%) patients had one indicator, four (33%) patients had two indicators and one (8.3%) patient had all three. Eleven (91.6%) patients had precursors suggestive of hyperestrogenemia. Only one (8.33%) patient did not have any surrogate marker indicator of high estrogen levels. Two (16%) were black and 10 (83.33%) were white. Mean age was 61.75. Five (41%) had a first degree relative with a malignancy. Laterality was nine (75%) in the left breast, three (35%) in right breast. Eight (66.6%) found a mass on physical exam. Five (41.6%) had a positive smoking history. One patient had no data in the chart. Remaining all 11 (91.6%) had non-TNBC. One patient did not have complete documentation. Five (41.6%) had mastectomy, six (50%) received RT, four (33.3%) received chemotherapy and another four received hormone therapy. In terms of stage, four (33.3%) had stage 4, two (16.6%) stage 3B, two (16.6%) stage 2B, two (16.6%) stage 2A, one (8.33%) had stage 1C and one had stage 0. HDL data were available in seven (58.3%) with mean of 37, albumin in 10 (83.3%) with mean of 3.61, BMI in 11 (91.66%) patients with a mean of 33.30. Within subgroups, two patients were black and 10 white. Both black patients had LE disease (stage 0-2). Of the white patients, four (40%) had limited disease while six (60%) had extensive breast cancer. Family history assumed a similar distribution as three (60%) of patients with negative family history for cancer had limited disease and two (40%) had extensive one, same numbers applied for family-history-positive population. Three (60%) of patients with limited disease smoker and two (40%) did not. As for laterality, a total of nine patients had left-sided breast cancer, of whom five had had limited disease and four fell into the extensive disease category. The hormonal status for most patients were HER/NEU negative (seven out of 10 patients, two patients did not have this information on file), ER positive (11 out of 12) and PR positive (8 out of 12). Estrogen status: Low HDL was seen in three out of seven patients, low albumin in four out of 10 and obese BMI in nine out of 11. Finally, 11 out of 12 patients had at least one indicator of high estrogen. No significant change in prevalence of these markers was seen when comparing patients with limited and extensive disease. Conclusion None of the aforementioned variables assumed statistical significance between the two subgroups. Results, however, show that as a whole, 11 out of the 12 patients had at least one indicator of high estrogen. Our results point in the direction that elevated estrogen is probably associated with MBC. Further meta-analysis of similar studies can be helpful to explain the dynamics of this association. Our statistical analysis was limited due to the small sample size, which is due to the extreme rarity of the disease.
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Affiliation(s)
- Khurram Bilal Tariq
- Department of Internal Medicine, University of Florida, College of Medicine, 653 West 8th Street, Box L 18, Jacksonville, FL 32209, USA
| | - Farah Al-Saffar
- Division of Hematology and Medical Oncology, University of Florida, Jacksonville, FL, USA
| | - Saif Ibrahim
- Department of Internal Medicine, University of Florida, College of Medicine, 653 West 8th Street, Box L 18, Jacksonville, FL 32209, USA
| | - Dat Pham
- Division of Hematology and Medical Oncology, University of Florida, Jacksonville, FL, USA
| | - Arezo Farhangi
- Division of Hematology and Medical Oncology, University of Florida, Jacksonville, FL, USA
| | - Fauzia Rana
- Division of Hematology and Medical Oncology, University of Florida, Jacksonville, FL, USA
| | - Robert Zaiden
- Division of Hematology and Medical Oncology, University of Florida, Jacksonville, FL, USA
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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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Yang G, Nowsheen S, Aziz K, Georgakilas AG. Toxicity and adverse effects of Tamoxifen and other anti-estrogen drugs. Pharmacol Ther 2013; 139:392-404. [PMID: 23711794 DOI: 10.1016/j.pharmthera.2013.05.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/13/2013] [Indexed: 01/20/2023]
Abstract
Breast cancer is a heterogeneous disease affecting thousands of people every year. Multiple factors are responsible in causing breast cancer while a number of treatment options are also available for the disease. Tamoxifen is the most widely used anti-estrogen for the treatment of hormone-dependent breast cancer. The specific drug is used as a hormonal therapy for patients who exhibit estrogen receptor positive breast cancer. The pharmacological activity of Tamoxifen is dependent on its conversion to its active metabolite, endoxifen, by CYP2D6. Tamoxifen reduces the risk of recurrence and death from breast cancer when given as adjuvant therapy and provides effective palliation for patients with metastatic breast cancer. In this review we focus on the role of Tamoxifen in breast cancer treatment including mechanisms and side-effects. Finally, we discuss in detail the exciting prospects that lie ahead.
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Affiliation(s)
- Geniey Yang
- Department of Biology, Thomas Harriot College of Arts and Sciences, East Carolina University, Greenville, NC 27858, USA
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Hur SM, Cho DH, Lee SK, Choi MY, Bae SY, Koo MY, Kim S, Nam SJ, Lee JE, Yang JH. Occult breast cancers manifesting as axillary lymph node metastasis in men: a two-case report. J Breast Cancer 2012; 15:359-63. [PMID: 23091551 PMCID: PMC3468792 DOI: 10.4048/jbc.2012.15.3.359] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/20/2012] [Indexed: 11/30/2022] Open
Abstract
Occult breast cancer is a type of breast cancer without any symptoms on the breasts or any abnormalities upon radiologic examination such as mammography. In males, there are few cases of breast cancer, the rate of diagnosis of occult breast cancer is very low, and little is known about this disease. We experienced two cases of occult breast cancers manifesting as axillary lymph node metastasis in men. They had a palpable lesion on axillary area several years ago and had not seen a doctor about it. As such there was no abnormality on evaluations for cancer except for axillary lymph node showing signs of carcinoma (primary or metastatic) on biopsy and estrogen receptor-positive and progesterone receptor-positive on immunohistochemistry. The patients were diagnosed with occult breast cancer, and treatments were performed. Herein, we report the rare cases of occult breast cancers in men.
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Affiliation(s)
- Sung Mo Hur
- Department of Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
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Sandhu NP, Bride MBM, Dilaveri CA, Neal L, Farley DR, Loprinzi CL, Wahner-Roedler DL, Ghosh K. Male breast cancer. JOURNAL OF MEN'S HEALTH 2012. [DOI: 10.1016/j.jomh.2012.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Meattini I, Livi L, Franceschini D, Saieva C, Scotti V, Casella D, Criscenti V, Zanna I, Meacci F, Gerlain E, Agresti B, Mangoni M, Paiar F, Simontacchi G, Greto D, Nori J, Bianchi S, Cataliotti L, Biti G. Treatment of invasive male breast cancer: a 40-year single-institution experience. Radiol Med 2012; 118:476-86. [PMID: 22872459 DOI: 10.1007/s11547-012-0867-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 12/04/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE We conducted a retrospective analysis to evaluate the management and outcome of invasive male breast cancer treated in a single-institution over a period of 40 years. MATERIALS AND METHODS We reviewed the clinical and pathological features of 60 male patients affected by breast carcinoma treated at our Radiotherapy Unit between 1971 and 2011. Tumours were classified according to histological type and the updated 2010 TNM classification of malignant tumours. RESULTS At a median follow-up of 8.9 [range, 0.6-20; standard deviation (SD), 4.98] years, 32 patients (53.3%) were alive and 16 patients died (26.7%) due to disease progression and 12 (20%) due to other causes. At univariate analysis for overall survival, pathological tumour size (p=0.031), histological subtype (p=0.013) and nodal status (p=0.006) emerged as significant predictors of death. At multivariate analysis, independent death predictors were advanced pathological tumour size (p=0.016), positive nodal status (p=0.003) and invasive cribriform histological type (p=0.0003). CONCLUSIONS In consideration of the rarity of the disease, many issues are still being debated, and future collaborative studies are required. However, our experience confirms the prognostic role of greater pathological tumour size and positive nodal status as unfavourable features for survival in male breast cancer.
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Affiliation(s)
- Icro Meattini
- Radiotherapy Unit, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
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18
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Cutuli B, Le-Nir CCS, Serin D, Kirova Y, Gaci Z, Lemanski C, De Lafontan B, Zoubir M, Maingon P, Mignotte H, Lara CTD, Edeline J, Penault-Llorca F, Romestaing P, Delva C, Comet B, Belkacemi Y. Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases. Crit Rev Oncol Hematol 2010; 73:246-54. [DOI: 10.1016/j.critrevonc.2009.04.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 03/18/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022] Open
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Abstract
BACKGROUND A 49-year-old patient with high-risk prostate cancer presented to a specialist. He was treated with neoadjuvant hormonal therapy for 6 months, followed by conformal radiotherapy. Three years later, he had a biochemical recurrence and commenced continuous luteinizing hormone-releasing hormone analog and antiandrogen therapy as part of a clinical trial. Aside from notable gynecomastia, he remained asymptomatic. He has a strong family history of breast cancer with multiple sisters affected. INVESTIGATIONS At 58 years of age, the patient underwent BRCA2 germline testing and was found to be a mutation carrier. Following post-test counseling, he was offered clinical breast examination, which was unremarkable except for gynecomastia. Baseline screening mammography identified a 4 mm cluster of microcalcifications and ductal carcinoma in situ (DCIS) was confirmed by stereotactic biopsy. DIAGNOSIS DCIS in a male BRCA2 mutation carrier undergoing androgen deprivation therapy for prostate cancer. MANAGEMENT The patient was treated with bilateral mastectomy and no additional systemic therapy was recommended. This case report illustrates the importance of implementing screening mammography in male BRCA mutation carriers, particularly in those with a BRCA2 mutation.
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20
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Abstract
Male breast cancer is an uncommon condition. It often occurs in settings in which there is an imbalance between androgens and oestrogens. Genetics plays an important role, as many cases are associated with mutations in BRCA2 or other genes. Male breast cancer occurs at an older age than female breast cancer and is frequently diagnosed at a later stage. Tumors are predominantly oestrogen and progesterone positive. Prognosis is approximately equivalent to that of breast cancer in females when matched for age, stage and hormonal receptors. The recommended treatment for male breast cancer is similar to that for breast cancer in postmenopausal females. However, the presence of androgens in males has a strong effect on the hormonal milieu and the ability of male patients to respond to hormonal agents. When pharmacologic treatment is required, tamoxifen is effective for first-line therapy. Other hormonal approaches such as orchiectomy, aromatase inhibitors and androgen ablation may be useful in later lines of therapy.
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Affiliation(s)
- Teresa G Hayes
- Hematology Oncology Section, Department of Veterans' Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA.
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21
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Saudade André, Isabel Fonseca, Antó. Male Breast Cancer? A Reappraisal of Clinical and Biologic Indicators of Prognosis. Acta Oncol 2009. [DOI: 10.1080/02841860118880] [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]
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22
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Ottini L, Palli D, Rizzo S, Federico M, Bazan V, Russo A. Male breast cancer. Crit Rev Oncol Hematol 2009; 73:141-55. [PMID: 19427229 DOI: 10.1016/j.critrevonc.2009.04.003] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 03/20/2009] [Accepted: 04/01/2009] [Indexed: 12/19/2022] Open
Abstract
Male breast cancer (MaleBC) is a rare disease, accounting for <1% of all male tumors. During the last few years, there has been an increase in the incidence of this disease, along with the increase in female breast cancer (FBC). Little is known about the etiology of MaleBC: hormonal, environmental and genetic factors have been reported to be involved in its pathogenesis. Major risk factors include clinical disorders carrying hormonal imbalances, radiation exposure and, in particular, a positive family history (FH) for BC, the latter suggestive of genetic susceptibility. Rare mutations in high-penetrance genes (BRCA1 and BRCA2) confer a high risk of BC development; low-penetrance gene mutations (i.e. CHEK-2) are more common but involve a lower risk increase. About 90% of all male breast tumors have proved to be invasive ductal carcinomas, expressing high levels of hormone receptors with evident therapeutic returns. The most common clinical sign of BC onset in men is a painless palpable retroareolar lump, which should be evaluated by means of mammography, ultrasonography and core biopsy or fine needle aspiration (FNA). To date, there are no published data from prospective randomized trials supporting a specific therapeutic approach in MaleBC. Tumor size together with the number of axillary nodes involved are the main prognostic factors and should guide the treatment choice. Locoregional approaches include surgery and radiotherapy (RT), depending upon the initial clinical presentation. When systemic treatment (adjuvant, neoadjuvant and metastatic) is delivered, the choice between hormonal and or chemotherapy (CT) should depend upon the clinical and biological features, according to the FBC management guidelines. However great caution is required because of high rates of age-related comorbidities.
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Affiliation(s)
- Laura Ottini
- Department of Experimental Medicine, University of Rome "La Sapienza", Italy
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23
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Besic N, Cernivc B, de Grève J, Lokar K, Krajc M, Novakovic S, Zgajnar J, Teugels E. BRCA2 gene mutations in Slovenian male breast cancer patients. ACTA ACUST UNITED AC 2008; 12:203-9. [PMID: 18439106 DOI: 10.1089/gte.2007.0071] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Male breast cancer (MBC) is a rare disease, comprising less than 1% of breast cancer patients in Slovenia. Some inherited cases are due to the mutations of BRCA1 or BRCA2 genes. There is no information available about the frequency of BRCA gene mutations in Slovenian MBC population. The purpose of this study was to characterize BRCA germline mutations in Slovenian MBC patients. Forty-one patients who were diagnosed with breast cancer at the Institute of Oncology Ljubljana between 1970 and 2006 were proposed to take part in this study. Of them, 27 agreed to follow a genetic counseling session and 25 patients agreed to provide a blood sample for genetic testing. The BRCA1 and BRCA2 genes from the MBC patients were screened for four highly recurrent mutations in the Slovenian population. When an additional breast cancer case or an ovarian cancer was present in the family, a more extended analysis was performed. No BRCA1 mutations were found. A BRCA2 gene mutation was identified in four MBC patients. Three of them carried the Slovenian founder mutation IVS16-2A>G. All four mutations were confined to the patients with a family history of breast cancer. Among the MBC patients with a family history of breast cancer in the first- or second-degree relatives, the frequency of BRCA2 gene mutation was 50%. The median age of the patients with a BRCA2 gene mutation was 60 years, not significantly different from those without a mutation. The BRCA2 mutations were diagnosed in 16% of our MBC patients.
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Affiliation(s)
- Nikola Besic
- Institute of Oncology Ljubljana, Ljubljana, Slovenia.
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24
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Shome D, Jayadev C, Gadgil D, Natarajan S, Jain V. Systemic chemotherapy and tamoxifen induced regression of choroidal metastasis from a breast carcinoma in a male. Indian J Ophthalmol 2007; 55:475-7. [PMID: 17951913 PMCID: PMC2635995 DOI: 10.4103/0301-4738.36491] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We report a case of a 55-year-old male patient with breast carcinoma, who developed choroidal metastasis. The patient had undergone mastectomy for carcinoma of right breast, five years ago. The patient was advised close follow-up for the left eye, as he was already on tamoxifen therapy (started a month ago) for spinal metastasis. On last follow-up, a year later, the choroidal lesion had completely scarred, with no recurrences. Systemic hormonal therapy like tamoxifen given for the breast primary and other systemic metastases may cause regression of the choroidal metastasis, thereby avoiding ocular radiotherapy. Medline search revealed only one published case of regression of choroidal metastasis from a male breast primary, on tamoxifen therapy.
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Affiliation(s)
- Debraj Shome
- Department of Ophthalmic and Facial Plastic Surgery, Orbital Diseases and Ocular Oncology, Aditya Jyot Eye Hospital Pvt Ltd, Mumbai, India.
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25
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26
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Beyrouti MI, Beyrouti R, Beyrouti R, Ben Amar M, Affes N, Frikha F, Abid M, Mnif H, Ayadi L, Ghorbel A. [Breast cancer in men]. Presse Med 2007; 36:1919-24. [PMID: 17448628 DOI: 10.1016/j.lpm.2007.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Indexed: 11/16/2022] Open
Abstract
Breast cancer in men is rare and most often occurs at or after the age of 60 years. Prognosis is poor when it is discovered at a late stage, as it often is in men, although it should be easier to detect because men have so little breast tissue. The causal mechanism appears to depend on hormone metabolism abnormalities related to elevated estrogen or prolactin levels. A family history of breast cancer is found in 5-10% of cases. Infiltrating ductal carcinoma accounts for most cases (70-90%) of male breast cancers. In situ but not invasive carcinoma is exclusively ductal and accounts for 7% of cases. Spread to lymph nodes is observed in 50-75% of cases. Immunohistochemical analysis shows that tumors are positive for progesterone and estrogen receptors more frequently in men than women. Diagnosis is based on clinical examination, ultrasonography, and mammography. Aspiration cytology often makes it possible to confirm the malignancy. Excisional biopsy with an immediate intraoperative pathology examination confirms malignancy and makes wider excision possible during the same procedure. A modified radical mastectomy with removal of some lymph nodes (Patey's mastectomy) is the standard basic treatment. Locoregional radiotherapy is very often indicated. Hormone therapy is also a first-line treatment. Chemotherapy is reserved for young men with substantial lymph node invasion and negative for hormonal receptors. The prognosis of breast cancer in men remains uncertain because of the frequently late diagnosis, unpredictable course, and high potential for metastasis.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Biopsy
- Breast/pathology
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/diagnostic imaging
- Breast Neoplasms, Male/drug therapy
- Breast Neoplasms, Male/epidemiology
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Child
- Female
- Humans
- Incidence
- Male
- Mammography
- Mastectomy, Modified Radical
- Middle Aged
- Prognosis
- Ultrasonography, Mammary
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27
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Abstract
Male breast cancer is rare. Median age at diagnosis is approximately 65 years, and > 35% of male breast cancers occur in elderly men. Retroareolar lump is the most frequent symptom, and 25-30% of tumours are T(4) lesions. Infiltrating ductal carcinoma represents almost 90% of the cases, and 10% are ductal carcinoma in situ. Axillary nodal involvement is present in 50-60% of the cases. Estrogen and progesterone receptors are positive in 75-92% and 54-77% of the cases. Mastectomy with axillary dissection remains the standard treatment. Sentinel lymph node biopsy could be proposed in small tumours (< or = 2 cm). Locoregional radiotherapy is very often indicated. Tamoxifen is the standard adjuvant treatment, but chemotherapy is proposed in young men with axillary nodal involvement and/or negative hormone receptors. Tumour size and, more particularly, histopathological axillary involvement are the strongest predictive factors for both locoregional recurrence and metastasis. Globally, the prognosis is similar to that in women (at identical stage), but the intercurrent death rate is higher due to the important impact of comorbidities and second neoplasm.
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Affiliation(s)
- Bruno Cutuli
- Radiation Oncology Department, Polyclinique de Courlancy, 38 rue de Courlancy, 51100 Reims, France.
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28
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Avisar E, McParland E, Dicostanzo D, Axelrod D. Prognostic factors in node-negative male breast cancer. Clin Breast Cancer 2007; 7:331-5. [PMID: 17092401 DOI: 10.3816/cbc.2006.n.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Male breast cancer has traditionally been compared with female breast cancer, using the same staging system and prognostic indicators. A variety of histochemical and pathologic factors commonly used in node-negative female breast cancer were applied to 18 node-negative male breast cancers to assess their relevance to survival. PATIENTS AND METHODS A slide review was performed for nuclear grade, lymphocytic infiltration, and lymphatic and vascular invasion. Flow cytometry was available on all the specimens. Immunohistochemistry was used to assess p53, estrogen receptors (ERs), cathepsin D, Ki-67, and c-erbB-2 (HER2/neu). A clinical correlation was performed based on chart reviews and phone interviews, recording demographics, treatment, and long-term survival. RESULTS The average age at diagnosis was 64 years (range, 34-85 years). There were 15 T1 lesions, 2 T2 lesions, and 1 T3 lesion. All patients had a modified radical mastectomy. None received radiation therapy. The mean follow-up was 73 months. Three patients died of their disease (17.6%), 2 patients died from unrelated reasons, 1 patient was lost to follow-up, and the other 12 patients are alive with no evidence of disease. The actuarial 5-year survival was 83%. Estrogen receptor and HER2/neu overexpression were significantly more predominant in male breast cancer than in female breast cancer. Estrogen receptor positivity was present in 17 of 18 patients and HER2/neu overexpression in 10 of 18. A positive ER status and overexpression of cathepsin or p53 were correlated with a better survival, but only ER (P = 0.026) and p53 (P = 0.023) reached statistical significance. CONCLUSION In this study, ER status was the only commonly used prognostic marker for female breast cancer found to be applicable in node-negative male breast cancer.
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Affiliation(s)
- Eli Avisar
- Miller School of Medicine, University of Miami, 1475 NW 12th Avenue, Miami, FL 33136, USA.
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29
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Nahleh Z, Girnius S. Male breast cancer: a gender issue. ACTA ACUST UNITED AC 2006; 3:428-37. [PMID: 16894388 DOI: 10.1038/ncponc0564] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 04/28/2006] [Indexed: 11/09/2022]
Abstract
The incidence of male breast cancer (MBC) is rising; however, mortality due to MBC has not changed, unlike female breast cancer. This lack of change is mostly attributable to a lack of major progress in the understanding and treatment of the disease. The treatment of MBC has been extrapolated from the knowledge of female breast cancer, despite the multiple differences in the pathogenesis, biology and genetics of these two disease entities, especially the differences with regard to the role of male hormones as well as estrogens in MBC compared with female disease. Although major advances in hormonal manipulation for the treatment of breast cancer are being developed, an improved understanding of the potential differences between male and female breast cancer is essential, as this would provide new opportunities for therapeutic intervention and probable improved outcome for MBC. This review aims at highlighting the major differences between male and female breast cancer with an emphasis on hormonal therapy, and discusses some of the recent advances in MBC.
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Affiliation(s)
- Zeina Nahleh
- Breast Oncology Program, Division of Hematology-Oncology, University of Cincinnati, Cincinnati, OH 45267, USA.
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30
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Burga AM, Fadare O, Lininger RA, Tavassoli FA. Invasive carcinomas of the male breast: a morphologic study of the distribution of histologic subtypes and metastatic patterns in 778 cases. Virchows Arch 2006; 449:507-12. [PMID: 17058095 PMCID: PMC1888721 DOI: 10.1007/s00428-006-0305-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 08/24/2006] [Indexed: 11/22/2022]
Abstract
The current investigation was conducted to evaluate the proportional distribution of the various histologic subtypes (including newly recognized variants) of male breast carcinomas, to determine whether any histologic subtypes occur with a frequency that is markedly discordant with the expected frequencies from published data on parallel female breast tumors. We also aimed to document the distribution of malignancies metastatic to the breast. Seven hundred fifty-nine archived cases of primary invasive carcinoma involving the male breast were retrieved and subcategorized into histologic subtypes according to contemporary criteria. Six hundred forty-three (84.7%) tumors were pure infiltrating ductal carcinoma (IDC) not otherwise specified. The most common of the remainder included papillary carcinoma with invasion in the form of IDC (n = 34), mixed IDC and mucinous carcinoma (n = 26), and pure mucinous carcinoma (n = 21). In 19 cases, metastases from other sites involved the breast, most commonly (58%) cutaneous melanoma. Invasive carcinoma of the male breast appears to display a morphologic spectrum and distribution of histologic subtypes that is comparable to those of the female breast, with some expected variation. Compared with published experience on their female counterparts, there is a two-fold increase in the frequency of invasive papillary carcinoma in the male breast. Finally, the most common tumor metastatic to the male breast in this series was cutaneous melanoma.
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Affiliation(s)
- Ana M. Burga
- Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC USA
- Department of Pathology, Englewood Hospital, Englewood, NJ USA
| | - Oluwole Fadare
- Department of Pathology, Yale University School of Medicine, New Haven, CT USA
- Department of Pathology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX USA
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
- Department of Pathology, Wilford Hall Medical Center, 2200 Bergquist Dr., Ste 1, Lackland AFB, TX 78236 USA
| | - Ruth A. Lininger
- Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC USA
- Department of Pathology, University of North Carolina, Chapel Hill, NC USA
| | - Fattaneh A. Tavassoli
- Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC USA
- Department of Pathology, Yale University School of Medicine, New Haven, CT USA
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31
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Agrawal A, Ayantunde AA, Rampaul R, Robertson JFR. Male breast cancer: a review of clinical management. Breast Cancer Res Treat 2006; 103:11-21. [PMID: 17033919 DOI: 10.1007/s10549-006-9356-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/24/2006] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- A Agrawal
- Professorial Unit of Surgery, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK.
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32
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Abstract
Skin involvement as a symptom, or even the presenting sign, of this breast cancer in men is not well known by dermatologists. In fact, a review of the English-language literature reveals few references about this subject. We report a case of breast carcinoma in a 58-year-old man with rapidly progressive cutaneous metastases that did not respond to any treatment schedules.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms, Male/drug therapy
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/radiotherapy
- Breast Neoplasms, Male/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Disease Progression
- Doxorubicin/administration & dosage
- Epirubicin/administration & dosage
- Fatal Outcome
- Fluorouracil/administration & dosage
- Humans
- Lung Neoplasms/secondary
- Lymph Node Excision
- Lymphatic Metastasis
- Male
- Mastectomy, Radical
- Megestrol Acetate/therapeutic use
- Middle Aged
- Paclitaxel/administration & dosage
- Palliative Care
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/radiotherapy
- Skin Neoplasms/secondary
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Affiliation(s)
- Ali Karakuzu
- Department of Dermatology, Medical Faculty, Atatürk University, Erzurum, Turkey.
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33
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Fonseca RR, Tomás AR, André S, Soares J. Evaluation of ERBB2 Gene Status and Chromosome 17 Anomalies in Male Breast Cancer. Am J Surg Pathol 2006; 30:1292-8. [PMID: 17001161 DOI: 10.1097/01.pas.0000213354.72638.bd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Male breast cancer (MBC) is an uncommon neoplasm that shares several biologic characteristics with its female counterpart. In the latter, abnormalities in the expression and/or copy number of the ERBB2 gene are present in 10% to 30% of invasive carcinoma and behave as poor prognostic markers. ERBB2 abnormalities have also been reported in MBC, yet at lower frequency, but their prognostic significance remains controversial. Furthermore, no study has addressed the impact of chromosome 17 abnormalities in MBC survival. In this study, the ERBB2-gene status (overexpression and amplification) and chromosome 17 numerical abnormalities were investigated in a series of 50 archival cases of MBC. The results, together with patient's age, histologic grade, pathologic stage, and estrogen receptor status were correlated with overall survival. ERBB2-protein overexpression was present in 7 cases (14%), ERBB2-gene amplification in 4 (8%), and aneuploidy of chromosome 17 in 12 cases (33.3%). The pathologic stage, ERBB2 overexpression and ERBB2 amplification were significantly correlated with overall survival (P=0.002, 0.016, and 0.009, respectively). No correlation was observed between chromosome 17 aneuploidy and overall survival. Therefore, despite their low incidence in MBC, expression abnormalities of ERBB2 behave, together with the pathologic stage of the tumor, as predictors of overall survival, akin to what has been reported for its female counterpart.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/metabolism
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adult
- Aged
- Aged, 80 and over
- Aneuploidy
- Biomarkers, Tumor/metabolism
- Breast Neoplasms, Male/genetics
- Breast Neoplasms, Male/metabolism
- Breast Neoplasms, Male/mortality
- Breast Neoplasms, Male/pathology
- Chromosomes, Human, Pair 17
- DNA, Neoplasm/analysis
- Gene Dosage
- Genes, erbB-2
- Humans
- In Situ Hybridization, Fluorescence
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Survival Rate
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Affiliation(s)
- Ricardo R Fonseca
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa de Francisco Gentil EPE, Lisboa, Portugal.
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34
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Nahleh ZA. Hormonal therapy for male breast cancer: A different approach for a different disease. Cancer Treat Rev 2006; 32:101-5. [PMID: 16472925 DOI: 10.1016/j.ctrv.2005.12.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 12/20/2005] [Indexed: 11/28/2022]
Abstract
Male breast cancer (MBC) is on the rise in the United States [Surveillance, Epidemiology, and End Results (SEER) Program () SEER Stat Database: Incidence-SEER 9 Regs Public-Use; November 2004 submission (1973-2002), National Cancer Institute, DCPPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005, based on the November 2004 submission]; however mortality due to MBC has not changed unlike in its female counterpart [American Cancer Society: Cancer facts and figures 2005. Atlanta (GA): American Cancer Society; 2005]. The rarity of MBC has precluded major progress in the understanding and treatment of this disease. Treatment has often been extrapolated from female breast cancer (FBC) despite distinct clinicopathologic features between the two entities, especially with regards to the role of male hormones and estrogens in this disease. Also, it is uncertain if hormone receptor positive tumors carry the same prognostic implication in MBC as in the female disease. Hormonal therapy has been the mainstay of treatment in MBC with tamoxifen the front-line drug. The role of the newer generation aromatase inhibitors has not been well defined but they are being used in clinical practice for the treatment of MBC, based on accepted data for women with the disease. This commentary focuses on the major hormonal differences between male and female breast cancer that would suggest the need to explore different treatment strategies if significant advances are to be made in the understanding and treatment of this distinct disease.
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Affiliation(s)
- Zeina A Nahleh
- Department of Internal Medicine, Division of Hematology-Oncology, The Barrett Cancer Center, University of Cincinnati, 234 Goodman Avenue, ML 0501, Cincinnati, OH 45267, USA.
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Franceschini G, D'Alba P, Costantini M, Magistrelli A, Belli P, Mulè A, Coco C, Picciocchi A. Synchronous bilateral breast carcinoma in a 50-year-old man with 45,X/46,XY mosaic karyotype: report of a case. Surg Today 2005; 36:71-5. [PMID: 16378198 DOI: 10.1007/s00595-005-3076-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 03/15/2005] [Indexed: 11/26/2022]
Abstract
We report a case of synchronous bilateral breast cancer in a patient with ambiguous external genitalia attributed to a 45,X/46,XY mosaicism. To our knowledge, this represents the first such case ever to be reported. Mammography, ultrasonography, computed tomography, and magnetic resonance imaging all showed bilateral suspicious breast masses with microcalcifications. There were no radiological findings of muscle invasion or axillary lymphadenopathy. The patient was successfully treated by bilateral radical modified mastectomy followed by external irradiation and adjuvant endocrine therapy. Histological examination revealed a bilateral ductal carcinoma in situ, with a cribriform and papillary pattern and microfoci of infiltrating ductal carcinoma. The hormonal profile revealed high levels of follicle-stimulating hormone and luteinizing hormone, and low levels of testosterone. Testicular sonography revealed small hypoechoic testicles with bilateral microlithiasis. This case shows that 45,X/46,XY men may have an increased risk of breast cancer and must be followed up carefully.
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MESH Headings
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/etiology
- Breast Neoplasms, Male/genetics
- Breast Neoplasms, Male/surgery
- Carcinoma in Situ
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/surgery
- Humans
- Karyotyping
- Male
- Mastectomy, Modified Radical
- Middle Aged
- Mosaicism
- Noonan Syndrome/complications
- Noonan Syndrome/genetics
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Affiliation(s)
- Gianluca Franceschini
- Department of Surgery, Catholic University School of Medicine, Policlinico Agostino Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy
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36
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de Bree E, Tsagkatakis T, Kafousi M, Tsiftsis DD. Breast enlargement in young men not always gynaecomastia: breast cancer in a 22-year-old man. ANZ J Surg 2005; 75:914-6. [PMID: 16176240 DOI: 10.1111/j.1445-2197.2005.03572.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Adult
- Biopsy, Needle
- Bone Neoplasms/secondary
- Breast/pathology
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/diagnostic imaging
- Breast Neoplasms, Male/mortality
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Diagnosis, Differential
- Gynecomastia/diagnosis
- Humans
- Lung Neoplasms/secondary
- Male
- Mammography
- Mastectomy, Modified Radical
- Time Factors
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, University Hospital - Medical School of Crete, Herakleion, Greece.
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37
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Alenda C, Aranda FI, Seguí FJ, Laforga J. Secretory carcinoma of the male breast: correlation of aspiration cytology and pathology. Diagn Cytopathol 2005; 32:47-50. [PMID: 15584046 DOI: 10.1002/dc.20157] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Secretory carcinoma (SC) is a rare variant of breast carcinoma, which was first described in children and adolescents but it can occur at all ages. Very few cases have been reported in male patients. We describe the cytological and histopathological features of SC in a 79-yr-old man. Cytological findings demonstrated cohesive sheets of monotonous cells with round nuclei and small nucleoli. Most cells contained intracytoplasmic vacuoles, which are the key feature of an accurate diagnosis. Differential diagnosis with other tumors is discussed briefly.
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Affiliation(s)
- Cristina Alenda
- Department of Pathology, Hospital General Universitario de Alicante, Alicante, Spain.
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38
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Frangou EM, Lawson J, Kanthan R. Angiogenesis in male breast cancer. World J Surg Oncol 2005; 3:16. [PMID: 15743520 PMCID: PMC555542 DOI: 10.1186/1477-7819-3-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 03/02/2005] [Indexed: 12/30/2022] Open
Abstract
Background Male breast cancer is a rare but aggressive and devastating disease. This disease presents at a later stage and in a more advanced fashion than its female counterpart. The immunophenotype also appears to be distinct when compared to female breast cancer. Angiogenesis plays a permissive role in the development of a solid tumor and provides an avenue for nutrient exchange and waste removal. Recent scrutiny of angiogenesis in female breast cancer has shown it to be of significant prognostic value. It was hypothesized that this holds true in invasive ductal carcinoma of the male breast. In the context of male breast cancer, we investigated the relationship of survival and other clinico-pathological variables to the microvascular density of the tumor tissue. Methods Seventy-five cases of primary male breast cancer were identified using the records of the Saskatchewan Cancer Agency over a period of 26 years. Forty-seven cases of invasive ductal carcinoma of the male breast had formalin-fixed paraffin-embedded tissue blocks that were suitable for this study. All cases were reviewed. Immunohistochemical staining was performed for the angiogenic markers (cluster designations 31 (CD31), 34 (CD34) and 105 (CD105), von Willebrand factor (VWF), and vascular endothelial growth factor (VEGF)). Microvascular density (MVD) was determined using average, centre, and highest microvessel counts (AMC, CMC, and HMC, respectively). Statistical analyses compared differences in the distribution of survival times and times to relapse between levels of MVD, tumor size, node status and age at diagnosis. In addition, MVD values were compared within each marker, between each marker, and were also compared to clinico-pathological data. Results Advanced age and tumor size were related to shorter survival times. There were no statistically significant differences in distributions of survival times and times to relapse between levels of MVD variables. There was no significant difference in MVD between levels of the different clinico-pathological variables. MVD was strongly and significantly correlated between AMC, CMC and HMC for CD31, CD34, and CD105 (p < 0.01) and remained moderate to weak for VWF and VEGF. Conclusion Microvascular density does not appear to be an independent prognostic factor in male breast cancer. However, the likelihood of death for men with breast cancer is increased in the presence of increased age at diagnosis and advanced tumor size. This is perhaps linked to inherent tumor vasculature, which is strongly related throughout a tumor section.
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Affiliation(s)
- Evan M Frangou
- Department of Pathology, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Canada
| | - Joshua Lawson
- Institute of Agricultural Rural Environmental Health, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Canada
| | - Rani Kanthan
- Department of Pathology, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Canada
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39
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Abstract
Abstract
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.
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Affiliation(s)
- Joli R. Weiss
- 1Department of Epidemiology, Roswell Park Cancer Institute, Buffalo, New York and
| | - Kirsten B. Moysich
- 1Department of Epidemiology, Roswell Park Cancer Institute, Buffalo, New York and
| | - Helen Swede
- 2Connecticut Tumor Registry, Hartford, Connecticut
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40
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Zakaria HM, Al-Mulhim AMA, Abdel Hadi MS, Al Tamimi DM. Male breast carcinoma: experience from a university hospital in Saudi Arabia. Breast J 2004; 10:466-8. [PMID: 15327509 DOI: 10.1111/j.1075-122x.2004.21408.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
MESH Headings
- Adult
- Breast Neoplasms, Male/epidemiology
- Breast Neoplasms, Male/etiology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Hospitals, University
- Humans
- Male
- Medical Records
- Middle Aged
- Retrospective Studies
- Saudi Arabia/epidemiology
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41
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Kidwai N, Gong Y, Sun X, Deshpande CG, Yeldandi AV, Rao MS, Badve S. Expression of androgen receptor and prostate-specific antigen in male breast carcinoma. Breast Cancer Res 2003; 6:R18-23. [PMID: 14680496 PMCID: PMC314449 DOI: 10.1186/bcr733] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Revised: 10/02/2003] [Accepted: 10/09/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The androgen-regulated proteins prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) are present in high concentrations in normal prostate and prostatic cancer and are considered to be tissue-specific to prostate. These markers are commonly used to diagnose metastatic prostate carcinoma at various sites including the male breast. However, expression of these two proteins in tumors arising in tissues regulated by androgens such as male breast carcinoma has not been thoroughly evaluated. METHODS In this study we analyzed the expression of PSA, PSAP and androgen receptor (AR) by immunohistochemistry in 26 cases of male breast carcinomas and correlated these with the expression of other prognostic markers. RESULTS AR, PSA and PSAP expression was observed in 81%, 23% and 0% of carcinomas, respectively. Combined expression of AR and PSA was observed in only four tumors. CONCLUSION Although the biological significance of PSA expression in male breast carcinomas is not clear, caution should be exercised when it is used as a diagnostic marker of metastatic prostate carcinoma.
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Affiliation(s)
- Noman Kidwai
- Northwestern University Medical School, Chicago, IL, USA
| | - Yun Gong
- Northwestern University Medical School, Chicago, IL, USA
| | - Xiaoping Sun
- Northwestern University Medical School, Chicago, IL, USA
| | | | | | | | - Sunil Badve
- Northwestern University Medical School, Chicago, IL, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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42
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Karadaglić D, Milobratović D. [Dermatologic diseases of the breast]. VOJNOSANIT PREGL 2002; 59:531-8. [PMID: 12451734 DOI: 10.2298/vsp0205531k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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43
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de Bree E, Askoxylakis J, Giannikaki E, Chroniaris N, Sanidas E, Tsiftsis DD. Secretory carcinoma of the male breast. Ann Surg Oncol 2002; 9:663-7. [PMID: 12167580 DOI: 10.1007/bf02574482] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Secretory carcinoma is a distinctive and rare variant of breast carcinoma with a favorable prognosis because these tumors usually behave in an indolent manner. The occurrence of this type of breast cancer in males was studied. METHODS An extensive literature survey concerning secretory breast cancer in males was performed. Data of one case treated in our institute were added. RESULTS A total of 14 cases were identified, and our case was added to this series. The median age was 17 years. The duration of symptoms varied from 1 month to 21 years, and the tumor size was 1.2 to 4 cm. Surgical treatment varied from local excision only to modified radical mastectomy. Three patients received adjuvant treatment. Lymph nodes were involved in 3 of the 10 cases undergoing axillary lymph node dissection. The primary tumor was only 1.5 cm in diameter in two of those cases. None of the patients presented with systemic metastases. Only one male was reported to develop recurrence and consequently died of systemic disease. CONCLUSIONS Secretory breast cancer is very rare in males and seems to occur at a younger age in males than in females. A sufficient number of female cases have been reported with recurrence after local excision. Although in females lymph node metastases are rarely observed in secretory breast carcinoma smaller than 2 cm, in male patients nodal metastases might occur more frequently in smaller tumors. Therefore, mastectomy with sentinel lymph node biopsy or axillary lymph node dissection is recommended in any male case. Biological behavior seems to be similarly favorable in either sex.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, University Hospital, Medical School of Crete, 711 10 Herakleion, Greece.
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44
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Emmert S, Bertsch HP, Zutt M, Haenssle H, Hallermann C, Kretschmer L, Neumann C. [Bizarrely patterned erythema and papules in a 39-year-old man. Lymphangiosis carcinomatosa as the chief symptom of disseminated metastatic breast carcinoma in a man]. DER HAUTARZT 2002; 53:495-8. [PMID: 12356011 DOI: 10.1007/s00105-002-0371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S Emmert
- Abteilung Dermatologie und Venerologie, Georg-August-Universität Göttingen, Germany.
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45
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Smolin Y, Massie MJ. Male breast cancer: a review of the literature and a case report. PSYCHOSOMATICS 2002; 43:326-30. [PMID: 12189259 DOI: 10.1176/appi.psy.43.4.326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Yvette Smolin
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
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46
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Abstract
Breast cancer in males is uncommon, occurring at approxiamtely 1% of the rate of female breast cancer. Male breast carcinomas tend to be highly positive for hormone receptors, including oestrogen, progesterone and androgen receptors. Owing to this, hormone therapy is recommended as the primary treatment modality. Adjuvant therapy is recommended for male breast cancers with large size or positive axillary nodes. For metastatic disease, options for therapy include tamoxifen, orchiectomy, anti-androgens with or without luteinising hormone releasing hormone analogues or combination chemotherapy. The newer hormonal treatments, such as the selective aromatase inhibitors or novel antioestrogens, have not yet been well studied in male breast cancer but have potential for efficacy in this disease.
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Affiliation(s)
- Teresa Hayes
- Baylor College of Medicine, Houston, Texas, USA.
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47
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Meijer-van Gelder ME, Look MP, Bolt-de Vries J, Peters HA, Klijn JG, Foekens JA. Clinical relevance of biologic factors in male breast cancer. Breast Cancer Res Treat 2001; 68:249-60. [PMID: 11727961 DOI: 10.1023/a:1012221921416] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There is ample information on the clinical role of biologic factors in female breast cancer: urokinase-type plasminogen activator (uPA), its receptor uPAR, its inhibitors PAI-1 and PAI-2, cathepsin D and pS2-protein. However such reports are missing or very rare for male breast cancer. We determined the cytosolic levels of oestrogen receptor (ER), progesterone receptor (PgR), cathepsin D, pS2-protein, uPA, uPAR, PAI-1 and PAI-2 of the primary tumour tissues from 40 male breast cancer patients. The tumour levels were compared with those of 180 matched females and 4114 historic females with breast cancer. In male breast tumours the level of PgR was higher, those of uPA, PAI-1, PAI-2 and cathepsin D lower. The tumour level of ER in men was similar to those in the matched and postmenopausal women, but much higher than those in the historic women. Male breast cancer seems to be biologically different from female breast cancer. Correlation of the eight cell biologic factors with disease outcome showed that PAI-1 (p = 0.03) was the only independent predictive factor for poor prognosis in male breast cancer.
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Affiliation(s)
- M E Meijer-van Gelder
- Department of Medical Oncology, Rotterdam Cancer Institute (Daniel den Hoed Kliniek), University Hospital, The Netherlands.
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48
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Affiliation(s)
- J C English
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA.
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49
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Whitaker-Worth DL, Carlone V, Susser WS, Phelan N, Grant-Kels JM. Dermatologic diseases of the breast and nipple. J Am Acad Dermatol 2000; 43:733-51; quiz 752-4. [PMID: 11050577 DOI: 10.1067/mjd.2000.109303] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Breast and nipple skin is commonly affected by various inflammatory and neoplastic processes. Despite this fact, many physicians are unaware of the spectrum of diseases that can involve this area. Because breast and nipple skin represents a cosmetically, sexually, and functionally important entity to most patients, awareness of these disease entities is invaluable. This article reviews the normal anatomy of the breast, cutaneous manifestations of neoplastic processes that can present in these areas, and common inflammatory diseases of the breast and nipple skin.
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Affiliation(s)
- D L Whitaker-Worth
- University of Connecticut School of Medicine, Department of Dermatology, Farmington, USA.
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50
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Clark JL, Nguyen PL, Jaszcz WB, Jatoi A, Niehans GA. Prognostic Variables in Male Breast Cancer. Am Surg 2000. [DOI: 10.1177/000313480006600515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The prognostic role of ploidy status, S phase fraction, estrogen and progesterone receptor status, and the expression of p53 and erbB-2 protein in male breast carcinoma (MBC) remains controversial. The primary objective of this study was to determine which of the common prognostic factors for female breast cancer predict prognosis in MBC. A secondary objective was to assess the impact of comorbid illnesses on survival. A retrospective review of demographic data, surgical treatment, pathological staging, adjuvant treatment and follow-up was completed for 16 patients with MBC (1 intraductal and 15 invasive). Formalin-fixed, paraffin-embedded tissue was processed for ploidy, S phase fraction, and immunohistochemical detection of estrogen and progesterone receptors plus expression of p53 and erbB-2 protein. Six of 15 patients with infiltrating ductal carcinoma are currently alive without evidence of disease and a median survival of 61 months. Nine patients died after a median survival of 52 months, with 6 patients having no evidence of recurrent breast cancer. Two of 3 deaths secondary to advanced breast cancer occurred in patients who initially presented with T4 lesions and were staged IIIB. Two of 15 tumors were erbB-2 positive, whereas only 1 tested weakly positive for p53 protein. We observed that MBCs express erbB-2 and p53 proteins infrequently. Neither ploidy status, S phase fraction, nor erbB-2/ p53 status provided any apparent improvement in establishing prognosis beyond routine pathological staging. Advanced TNM stage was associated with diminished survival. The majority of MBCs express estrogen and progesterone receptors. Survivals in MBC were reduced in association with comorbid medical conditions.
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Affiliation(s)
- John L. Clark
- Surgical Service, Minneapolis Veterans Affairs Medical Center, Minneapolis
- Department of Surgery, University of Minnesota, Minneapolis
| | - Phuong L. Nguyen
- Pathology and Laboratory Service, Minneapolis Veterans Affairs Medical Center, Minneapolis
- Division of Hematopathology, University of Minnesota, Mayo Clinic
| | - Waclaw B. Jaszcz
- Pathology and Laboratory Service, Minneapolis Veterans Affairs Medical Center, Minneapolis
- Department of Laboratory Medicine and Pathology, University of Minnesota, Mayo Clinic
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Oncology, Mayo Clinic
| | - Gloria A. Niehans
- Pathology and Laboratory Service, Minneapolis Veterans Affairs Medical Center, Minneapolis
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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