Survival of Male Breast Cancer Patients: A Population-Based Study in Osaka, Japan

Prognostic Factors in Male Breast Cancer: A Retrospective Nationwide Study in South Korea by the Study of SMARTSHIP Group

This study evaluated the incidence, the survival outcomes and its prognostic factors for male breast cancer (MBC) in Korea. Using the National Health Insurance Service database of Korea, we identified MBC patients who had the new claim code of C50. Medical records including type of surgeries and radiotherapy within one year of the first claim and death records were reviewed. Between 2005 and 2016, 838 newly diagnosed MBC patients were included (median follow-up, 1,769 days). The 70–74-year age group had the highest incidence of MBC. The 5-year survival rate was 73.7%. Age > 65 years, low income, no surgical intervention, no tamoxifen use, and > 2 comorbidities correlated with a worse outcome. MBC incidence has increased over time, and its peak is noted at age > 70 years. Age > 65 years, > 2 comorbidities, no surgical intervention, and no tamoxifen use correlate to poor prognosis.

Male breast cancer: A closer look at patient and tumor characteristics and factors associated with survival

Background

The prognostic effect of molecular subtypes on male breast cancer (MBC) remains unclear. The aim of this study was to evaluate the clinicopathological and prognostic factors of MBC patients.

Methods

From 1 January 1990 to 31 December 2014, the data of 152 MBC and 304 female breast cancer (FBC) patients were identified and extensively compared.

Results

Compared with the FBC group, MBC patients were found to have a higher rate of cancer family history (30.9% vs. 18.4%, P = 0.001), mass around the areola area (37.5% vs. 5.6%, P = 0.000), lymph node invasion (44.1% vs. 34.2%, P = 0.006) and hormonal receptor positivity (66.4% vs. 49.3%, P = 0.027). Luminal A was the most common subtype accounting for 69.8%, whereas HER2‐positive (12.7%) and TNBC (1.6%) subtypes were rare in the MBC group. However, it was significantly lower for MBC than for FBC who received endocrine therapy (38.8% vs. 49.3%, P = 0.041). MBC showed the worse overall survival (OS) and disease‐free survival (DFS) than those of FBC patients. However, 10‐year OS and DFS were similar between MBC and FBC patients in the subgroups of nonluminal subtype (P < 0.001), but worse in MBC patients than those in FBC patients in the subgroups of luminal A (P = 0.004 for OS; P = 0.002 for DFS) and luminal B (P = 0.006 for OS; P = 0.003 for DFS). Multivariate analysis indicated tumor size, radical mastectomy and endocrine therapy as independent risk factors for OS and DFS of MBC patients.

Conclusions

Our study determined that MBC patients possessed a worse prognosis, usually with lymph node invasion, and were estrogen receptor (ER), progesterone receptor (PR)‐positive and human epidermal growth factor receptor (HER2)‐negative. Molecular subtypes based on FBC did not provide the same prognostic information in MBC, even in the luminal groups.

Comparing the Characteristics and Outcomes of Male and Female Breast Cancer Patients in Korea: Korea Central Cancer Registry

PURPOSE

This study aimed to determine the incidence of male breast cancer (MBC) and its survival outcomes in Korea, and to compare these results to those for female breast cancer (FBC).

Materials and Methods

We searched the Korea Central Cancer Registry and identified 227,122 breast cancer cases that were diagnosed between 1999 and 2016. Demographic and clinical characteristics and overall survival (OS) rates were estimated according to sex, age, histological type, and cancer stage.

RESULTS

The 227,122 patients included 1,094 MBC cases and 226,028 FBC cases. Based on the age-standardized rate, the male: female ratio was 0.0055:1. The most common ages at diagnosis were 60-69 years for MBC and 40-49 years for FBC (p < 0.001). Male patients were less likely than female patients to receive adjuvant radiotherapy (7.5% vs. 21.8%, p < 0.001) or adjuvant chemotherapy (40.1% vs. 55.4%, p < 0.001). The 5-year OS rates after diagnosis were 88.8% for all patients, although it was significantly lower for MBC than for FBC (76.2% vs. 88.9%, p < 0.001). In both groups, older age (≥ 60 years) was associated with shorter survival. The 5-year OS rates for the invasive histological types were 75.8% for men and 89.0% for women. The 5-year OS rates in both groups decreased with increasing cancer stage.

CONCLUSION

MBC was diagnosed at older ages than FBC, and male patients were less likely to receive radiotherapy and chemotherapy. The survival outcomes were worse for MBC than for FBC, with even poorer outcomes related to older age, the inflammatory histological types, and advanced stage. It is important that clinicians recognize the differences between FBC and MBC when treating these patients.

Clinical Features of Male Breast Cancer: Experiences from Seven Institutions Over 20 Years

Purpose

Breast cancer treatment has progressed significantly over the past 20 years. However, knowledge regarding male breast cancer (MBC) is sparse because of its rarity. This study is an investigation of the clinicopathologic features, treatments, and clinical outcomes of MBC.

Materials and Methods

Clinical records of 59 MBC patients diagnosed during 1995-2014 from seven institutions in Korea were reviewed retrospectively.

Results

Over a 20-year period, MBC patients accounted for 0.98% among total breast cancer patients, and increased every 5 years. The median age of MBC patientswas 66 years (range, 24 to 87 years). Forty-three patients (73%) complained of a palpable breast mass initially. The median symptom duration was 5 months (range, 1 to 36 months). Mastectomy was performed in 96% of the patients. The most frequent histology was infiltrating ductal carcinoma (75%). Ninety-one percent of tumors (38/43) were estrogen receptor–positive, and 28% (11/40) showed epidermal growth factor receptor 2 (HER-2) overexpression. After curative surgery, 42% of patients (19/45) received adjuvant chemotherapy; 77% (27/35) received hormone therapy. Five out of ten patients with HER-2 overexpressing tumors did not receive adjuvant anti–HER-2 therapy, while two out of four patients with HER-2 overexpressing tumors received palliative trastuzumab for recurrent and metastatic disease. Letrozole was used for one patient in the palliative setting. The median overall survival durations were 7.2 years (range, 0.6 to 17.0 years) in patients with localized disease and 2.9 years (range, 0.6 to 4.3 years) in those with recurrent or metastatic disease.

Conclusion

Anti–HER-2 and hormonal therapy, except tamoxifen, have been underutilized in Korean MBC patients compared to female breast cancer patients. With the development of precision medicine, active treatment with targeted agents should be applied. Further investigation of the unique pathobiology of MBC is clinically warranted.

Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship

BACKGROUND

The causes, optimal treatments, and medical/psychosocial sequelae of breast cancer in men are poorly understood.

DESIGN

A systematic review of the English language literature was conducted to identify studies relevant to male breast cancer between 1987 and 2012 and including at least 20 patients. Searches were carried out on PubMed using the title terms 'male breast cancer' or 'male breast carcinoma'.

RESULTS

Relevant published data regarding risk factors, biological characteristics, presentation and prognosis, appropriate evaluation and treatment, and survivorship issues in male breast cancer patients are presented. BRCA2 mutations, age, conditions that alter the estrogen/androgen ratio, and radiation are proven risk factors. Disease biology is distinct in men, but diagnostic approaches and treatments for men are generally extrapolated from those in women due to inadequate research in men. Survivorship issues in men may include sexual and hormonal side-effects of endocrine therapies as well as unique psychosocial impacts of the disease.

CONCLUSION

Further research is needed to address gaps in knowledge pertaining to care of male breast cancer patients and survivors.

Male breast cancer: 10-year experience at mansoura university hospital in egypt

Objective

Male breast cancer (MBC) is a rare disease representing less than 1% of all malignancies. The objective of the study is to report clinicopathological characteristics, treatment patterns, and outcomes of MBC in Mansoura University Hospital, Egypt.

Methods

This retrospective study focused on male breast cancer patients during 10 years (2000-2009). The studied variables were data regarding general characteristics of patients, treatment modalities and survival.

Results

The series included 37 patients (0.8% of all breast cancer). The median age was 57.7 years (range: 26-86 years). The main clinical complaint was a mass beneath the areola in 94.5% of the cases. Most patients had a locally advanced disease. 94.5% of tumors were invasive duct carcinomas. The treatment was essentially surgery in 91.8%, followed by adjuvant radiotherapy (in 89.2%), hormonal therapy (in 56.7%) and chemotherapy (in 91.8%). Follow-up period ranged from 6-115 months. Local recurrence occurred in 4 cases and metastasis in 11 cases. The 2-year and 5-year overall survival (OS) rates were 81.6% and 60.5%, respectively. The 2-year and 5-year disease-free survival (DFS) rates were 68.4%, and 52.6%, respectively. OS was not significantly affected by any of the studied parameters. Factors influencing DFS were: T stage (P=0.05), positive lymph nodes (P=0.043), metastasis (P=0.004), and chemotherapy (P=0.046).

Conclusions

MBC is a rare disease and often diagnosed at a locally advanced stage. The management of male and female breast carcinoma is identical. Future research for better understanding of this disease is needed to improve the management and prognosis of male breast cancer patients.

Finasteride and Male Breast Cancer: Does the MHRA Report Show a Link?

Finasteride is an important drug for the management of androgenetic alopecia. However, there are concerns about the possible side effects of the drug such as impotence. Recently stray reports have appeared about the occurrence of male breast carcinoma in patients who received the drug. These have been looked in to by Medicines and Health care products Regulatory Agency (MHRA). This article summarizes the MHRA report.

Survival of male breast cancer in fars, South of iran

BACKGROUND

Although breast cancer in men is uncommon, its incidence rate has an increasing trend. Due to its low incidence, there are few studies in this subject and limited information is available. The purpose of this study was to investigate clinicopathological characteristics and survival of male breast cancer (MBC) in Fars Province, south of Iran.

METHODS

The data for this study were obtained from the population based cancer registry of Vice-Chancellor for Health Affairs of Shiraz University of Medical Sciences and Shiraz hospitals between January 1, 1989 and January 1, 2008, including 64 patients with MBC. Demographic, clinical and pathological aspects were investigated. The Kaplan-Meier method was used for the determination of survival rate and Log Rank test for the comparison. The Cox proportional hazards model was used for the multiple analysis.

RESULTS

The patients' mean age at the time of diagnosis was 60.3 years (SD=12.7). The most frequent age group (26.6%) was 51-60 years. The most common symptom (96.8%) was a palpable mass. The majority of patients (44.4%) had a symptom duration of less than or equal to 6 months. 56.3% of the patients had a tumor size of 2-4.9 cm. Forty six percent of the cases had axillary lymph node involvement. The median survival time was 10.0 years [95% confidence interval (CI): 6.0-14.0]. The 5 year overall survival rate was 66.0% (95% CI=51.0-81.0%). The median survival time of patients with axillary lymph node involvement was 8.2 years (95% CI=6.7-9.6) and for the cases without involvement was 12.0 years (95% CI=8.4-15.2). In addition to axillary lymph node involvement, positive family history in contrast to negative family history and left tumors in compari-son with right tumors were poorer prognostic factors in univariate analysis respectively (p=0.006, p=0.031). In multiple analysis, axillary lymph node involvement was an independent predictor of poorer survival (Hazard ratio=1.6, 95% CI=1.1-6.4, p=0.030) and the other variables did not have a significant effect.

CONCLUSION

The mean age of MBC in this series is lower than that in western countries. It is compatible to the mean age of female breast cancer which is approximately one decade less than that in developed countries. The survival rate of MBC is relatively lower than that in western countries. Axillary lymph node involvement is an important prognostic factor in the survival of MBC. Multicenter population based studies with greater number of patients are required for better estimation of different aspects of MBC in Iran.

Clinicopathological characteristics of male breast cancer

PURPOSE

To investigate clinicopathological characteristics and outcomes of male breast cancer (MBC).

PATIENTS AND METHODS

We retrospectively analyzed the data of 20 MBC patients in comparison with female ductal carcinoma treated at Yonsei University Severance Hospital from July 1985 to May 2007. Clinicopathological features, treatment patterns, and survival were investigated.

RESULTS

MBC consists of 0.38% of all breast cancers. The median age was 56 years. The median symptom duration was 10 months. The median tumor size was 1.7 cm, 27.8% showed node metastasis, and 71.4% were estrogen receptor positive. All 20 cancers were arisen from ductal cells. No lobular carcinoma was found. The incidence of stages 0, I, II, and III in patients were 2, 10, 4, and 3, respectively. All patients underwent mastectomy. One with invasive cancer did not receive axillary node dissection and stage was not exactly evaluated. Adjuvant treatments were determined by pathologic parameters and stage. Clinicopathological parameters and survival rates of MBC were comparable to those of female ductal carcinoma.

CONCLUSION

The onset age of MBC was 10 years older and symptom duration was longer than in female patients. No difference in outcomes between MBC and female ductal carcinoma suggests that the biology of MBC is not different from that of females. Therefore, education, an appropriate system for early detection, and adequate treatment are necessary for improving outcomes.

Prolactin receptor expression in gynaecomastia and male breast carcinoma

AIMS

Despite the well-established function of prolactin (PRL) in normal breast development, its role in breast cancer pathogenesis is still controversial. PRL activity is dependent on the activation of a transmembrane protein, the PRL receptor (PRLR). The aim was to evaluate and compare PRLR expression in gynaecomastia and male breast carcinoma (MBC).

METHODS AND RESULTS

PRLR expression was detected immunohistochemically in 30 cases of gynaecomastia and 30 cases of MBC. The whole series was also assessed for oestrogen receptors (ER), progesterone receptors (PR) and androgen receptors (AR). A cut-off of 10% was used as the criterion for positivity. Histological type and tumour differentiation were evaluated. Pathological stage was assessed [Tumour Node Metastasis (TNM)-International Union Against Cancer system]. Statistical analysis was performed with Fisher's exact test. PRLR positivity was seen in 20% of gynaecomastia cases and in 60% of MBC cases (P = 0.003). In gynaecomastia immunoreactivity was predominantly observed in luminal cell borders, whereas in MBC the reactivity was heterogeneous and mainly cytoplasmic. There was no statistically significant correlation between PRLR expression and ER, PR, AR, pTNM, or histological grade.

CONCLUSIONS

PRLR is significantly more expressed in MBC than in gynaecomastia, and with different patterns of reactivity, suggesting a role for PRL in male breast carcinogenesis.