1
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Anazco D, Acosta A, Cathcart-Rake EJ, D'Andre SD, Hurtado MD. Weight-centric prevention of cancer. OBESITY PILLARS 2024; 10:100106. [PMID: 38495815 PMCID: PMC10943063 DOI: 10.1016/j.obpill.2024.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Background The link between excess adiposity and carcinogenesis has been well established for multiple malignancies, and cancer is one of the main contributors to obesity-related mortality. The potential role of different weight-loss interventions on cancer risk modification has been assessed, however, its clinical implications remain to be determined. In this clinical review, we present the data assessing the effect of weight loss interventions on cancer risk. Methods In this clinical review, we conducted a comprehensive search of relevant literature using MEDLINE, Embase, Web of Science, and Google Scholar databases for relevant studies from inception to January 20, 2024. In this clinical review, we present systematic reviews and meta-analysis, randomized clinical trials, and prospective and retrospective observational studies that address the effect of different treatment modalities for obesity in cancer risk. In addition, we incorporate the opinions from experts in the field of obesity medicine and oncology regarding the potential of weight loss as a preventative intervention for cancer. Results Intentional weight loss achieved through different modalities has been associated with a reduced cancer incidence. To date, the effect of weight loss on the postmenopausal women population has been more widely studied, with multiple reports indicating a protective effect of weight loss on hormone-dependent malignancies. The effect of bariatric interventions as a protective intervention for cancer has been studied extensively, showing a significant reduction in cancer incidence and mortality, however, data for the effect of bariatric surgery on certain specific types of cancer is conflicting or limited. Conclusion Medical nutrition therapy, exercise, antiobesity medication, and bariatric interventions, might lead to a reduction in cancer risk through weight loss-dependent and independent factors. Further evidence is needed to better determine which population might benefit the most, and the amount of weight loss required to provide a clinically significant preventative effect.
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Affiliation(s)
- Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Maria D. Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
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2
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Thomas M, Al Kashroom H, Reddy S, Zaccarini D, Willer K. Male Breast Cancer: Imaging Considerations for Diagnosis and Surveillance. J Clin Med Res 2024; 16:197-207. [PMID: 38855781 PMCID: PMC11161189 DOI: 10.14740/jocmr5169] [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] [Received: 04/05/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Male breast cancer accounts for less than 1% of all breast cancer cases. The important risk factors for the development of male breast cancer are family history, genetic mutations, obesity, liver disease, alcoholism, exogenous estrogen administration, and radiation exposure to the chest area. Despite its rarity, numerous studies have investigated the data on imaging considerations (mammogram, ultrasound, and magnetic resonance imaging (MRI)), but have addressed only certain aspects of male breast cancer. A comprehensive approach on the imaging characteristics, timing of imaging, prognostication based on imaging characteristics, and follow-up strategies in male breast cancer are still lacking. The purpose of this review article was to provide a comprehensive overview of the imaging findings, optimal timing to obtain imaging, and the appropriate follow-up strategies in male breast cancer survivors. This article also describes how imaging modalities can aid in determining prognosis. By addressing this knowledge gap, the article provides valuable insights for clinicians managing this uncommon yet clinically significant disease.
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Affiliation(s)
- Mathew Thomas
- Department of Internal Medicine, State University of New York (SUNY) Upstate, Syracuse, NY, USA
| | - Hatem Al Kashroom
- Department of Radiology, State University of New York (SUNY) Upstate, Syracuse, NY, USA
| | - Shilpa Reddy
- Department of Pathology, State University of New York (SUNY) Upstate, Syracuse, NY, USA
| | - Daniel Zaccarini
- Department of Pathology, State University of New York (SUNY) Upstate, Syracuse, NY, USA
| | - Katherine Willer
- Department of Radiology, State University of New York (SUNY) Upstate, Syracuse, NY, USA
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3
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Grubstein A, Dahan M, Jomar W, Friehmann T, Tamir S, Shochat T, Atar E, Allweis TM. Screening Mammography for Males With Elevated Breast Cancer Risk, Mutation Carriers, and Gynecomastia. Clin Breast Cancer 2024:S1526-8209(24)00100-9. [PMID: 38670861 DOI: 10.1016/j.clbc.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/24/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION The recommendations for annual mammography for male carriers with gynecomastia are controversial. This study investigated the potential link between gynecomastia and breast cancer in male carriers. PATIENTS AND METHODS The database of a tertiary medical center was retrospectively searched for all male patients who underwent at least 1 digital mammography study from 2016 to 2023. Known carriers of a pathogenic variant in a high-risk breast-cancer gene were identified. Patients were stratified by carrier status, diagnosis of breast cancer, and diagnosis of gynecomastia. Data on demographics, hormone profile, and pathology results were compared. RESULTS The cohort included 446 men of whom 82 were known carriers. Gynecomastia was diagnosed by mammography in 251 patients: 239/364 noncarriers (66%) and 12/82 carriers (15%) (P < .0001). Breast cancer was found in 21/364 noncarriers (6%) and 6/82 carriers (7%) (P < .6), and in 10/251 patients with gynecomastia (4%) and 17/193 (9%) without gynecomastia (P < .05). Among patients without gynecomastia, the number of breast cancer cases was similar in carriers and noncarriers (P = .3). Among patients with gynecomastia, the rate of breast cancer was higher in carriers (P < .08). On logistic regression analysis, the effect of gynecomastia on carriers was significant (P = .02). The odds ratio for a breast cancer diagnosis was 5.8 in the presence of gynecomastia (95% CI, 1.1-31, P < .04) and 0.52 in the absence of gynecomastia (95% CI, 0.2-1.7, P < .3). CONCLUSION Gynecomastia may be associated with an increased risk of breast cancer in carriers. Larger studies are needed to determine whether and when to screen male carriers.
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Affiliation(s)
- Ahuva Grubstein
- Department of Radiology, Breast Imaging Division, Beilinson Medical Center, affiliated to the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel.
| | - Marva Dahan
- Department of Radiology, Breast Imaging Division, Beilinson Medical Center, affiliated to the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Wael Jomar
- Department of Radiology, Breast Imaging Division, Beilinson Medical Center, affiliated to the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Tal Friehmann
- Department of Radiology, Breast Imaging Division, Beilinson Medical Center, affiliated to the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Tamir
- Department of Radiology, Breast Imaging Division, Beilinson Medical Center, affiliated to the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Department, Rabin Medical Center, Beilinson, Petah Tikva affiliated with the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Eli Atar
- Department of Radiology, Breast Imaging Division, Beilinson Medical Center, affiliated to the Sackler Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Tanir M Allweis
- Surgery Department, Hadassah Medical Center, affiliated to Hadassah Medical School, The Hebrew University, Jerusalem, Israel
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4
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Pleasant V. A Public Health Emergency: Breast Cancer Among Black Communities in the United States. Obstet Gynecol Clin North Am 2024; 51:69-103. [PMID: 38267132 DOI: 10.1016/j.ogc.2023.11.001] [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: 01/26/2024]
Abstract
While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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5
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Rogges E, Corati T, Amato M, Campagna D, Farro J, De Toffol S, Fortunato L, Costarelli L. Pleomorphic/solid lobular carcinoma of male breast with PALB2 germline mutation: case report and literature review. Pathologica 2024; 116:62-68. [PMID: 38482676 PMCID: PMC10938273 DOI: 10.32074/1591-951x-936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/15/2023] [Indexed: 03/17/2024] Open
Abstract
Male breast cancer (MBC) accounts for approximately 1% of all breast cancers and among these infiltrating lobular carcinomas (ILC) represents only 1-2% of all MBC cases. Pleomorphic invasive lobular carcinoma (PILC) is an aggressive variant of ILC with only eight cases reported until now in males. Up to 10% of MBC cases have a germline pathogenic variant in a predisposing gene such as BRCA1 and BRCA2 genes. Mutations in PALB2 (partner and localizer of BRCA2) have been reported in men with breast cancer, with a frequency that ranges from 0.8 to 6.4%, but it has never been reported in male ILC. Here, we report a rare and interesting case of an invasive pleomorphic/solid lobular carcinoma, which carries a pathogenic variant in PALB2 gene, and a family history of breast cancer without other well defined risk factors for developing this type of neoplasia. In addition, we review the current literature.
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Affiliation(s)
- Evelina Rogges
- Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Tiberio Corati
- Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Michelina Amato
- Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Domenico Campagna
- Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Juliette Farro
- Department of Genetics, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Simona De Toffol
- Laboratory of Medical Genetics, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio VA, Italy
| | - Lucio Fortunato
- Breast Center, Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy
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Valentini V, Bucalo A, Conti G, Celli L, Porzio V, Capalbo C, Silvestri V, Ottini L. Gender-Specific Genetic Predisposition to Breast Cancer: BRCA Genes and Beyond. Cancers (Basel) 2024; 16:579. [PMID: 38339330 PMCID: PMC10854694 DOI: 10.3390/cancers16030579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Among neoplastic diseases, breast cancer (BC) is one of the most influenced by gender. Despite common misconceptions associating BC as a women-only disease, BC can also occur in men. Additionally, transgender individuals may also experience BC. Genetic risk factors play a relevant role in BC predisposition, with important implications in precision prevention and treatment. The genetic architecture of BC susceptibility is similar in women and men, with high-, moderate-, and low-penetrance risk variants; however, some sex-specific features have emerged. Inherited high-penetrance pathogenic variants (PVs) in BRCA1 and BRCA2 genes are the strongest BC genetic risk factor. BRCA1 and BRCA2 PVs are more commonly associated with increased risk of female and male BC, respectively. Notably, BRCA-associated BCs are characterized by sex-specific pathologic features. Recently, next-generation sequencing technologies have helped to provide more insights on the role of moderate-penetrance BC risk variants, particularly in PALB2, CHEK2, and ATM genes, while international collaborative genome-wide association studies have contributed evidence on common low-penetrance BC risk variants, on their combined effect in polygenic models, and on their role as risk modulators in BRCA1/2 PV carriers. Overall, all these studies suggested that the genetic basis of male BC, although similar, may differ from female BC. Evaluating the genetic component of male BC as a distinct entity from female BC is the first step to improve both personalized risk assessment and therapeutic choices of patients of both sexes in order to reach gender equality in BC care. In this review, we summarize the latest research in the field of BC genetic predisposition with a particular focus on similarities and differences in male and female BC, and we also discuss the implications, challenges, and open issues that surround the establishment of a gender-oriented clinical management for BC.
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Affiliation(s)
- Virginia Valentini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Agostino Bucalo
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Giulia Conti
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Ludovica Celli
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Virginia Porzio
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Carlo Capalbo
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
- Medical Oncology Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Valentina Silvestri
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
| | - Laura Ottini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.V.); (A.B.); (G.C.); (L.C.); (V.P.); (C.C.); (V.S.)
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7
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Bhardwaj PV, Gupta S, Elyash A, Teplinsky E. Male Breast Cancer: a Review on Diagnosis, Treatment, and Survivorship. Curr Oncol Rep 2024; 26:34-45. [PMID: 38224426 DOI: 10.1007/s11912-023-01489-z] [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] [Accepted: 12/11/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Male breast cancer is a relatively uncommon and rare disease that is often managed based on evidence adopted from trials pertaining to female breast cancer due to low accrual rates or exclusion of males. This is despite the known differences in the biology and epidemiology of this condition. This review provides an update regarding the management and surveillance of male breast cancer. RECENT FINDINGS Men with breast cancer tend to undergo more extensive surgery in the breast and axilla. The outcomes of male breast cancer compared to a similar subtype of female breast cancer appear worse when matched for stage. Systemic therapies remain predominantly based on recommendations for female breast cancer, although tamoxifen is the more optimal endocrine therapy for men than women. Surveillance with mammograms is recommended for patients harboring a breast cancer susceptibility gene but is otherwise not advised for men who have undergone a mastectomy. Notably, the role of other imaging modalities, including ultrasound and magnetic resonance imaging, is minimal. Although the focus on survivorship care among men is low, it is abundantly clear that this is a stigmatizing diagnosis for men, and they suffer from long-term physical and psychological sequelae following a diagnosis and treatment of breast cancer. In summary, providing more gender-inclusive care and advocating for increased representation of men in prospective breast cancer studies and clinical trials may help improve outcomes and provide enhanced support for this population.
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Affiliation(s)
- Prarthna V Bhardwaj
- Division of Hematology-Oncology, University of Massachusetts Chan School of Medicine, Baystate, MA, USA
| | - Shilpi Gupta
- Division of Medical Oncology, Atlantic Health System, Morristown Medical Center, Morristown, NJ, USA
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8
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Pan K, Bazzano LA, Betha K, Charlton BM, Chavarro JE, Cordero C, Gunderson EP, Haggerty CL, Hart JE, Jukic AM, Ley SH, Mishra GD, Mumford SL, Schisterman EF, Schliep K, Shaffer JG, Sotres-Alvarez D, Stanford JB, Wilcox AJ, Wise LA, Yeung E, Harville EW. Large-Scale Data Harmonization Across Prospective Studies. Am J Epidemiol 2023; 192:2033-2049. [PMID: 37403415 PMCID: PMC10988223 DOI: 10.1093/aje/kwad153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/11/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
The Preconception Period Analysis of Risks and Exposures Influencing Health and Development (PrePARED) Consortium creates a novel resource for addressing preconception health by merging data from numerous cohort studies. In this paper, we describe our data harmonization methods and results. Individual-level data from 12 prospective studies were pooled. The crosswalk-cataloging-harmonization procedure was used. The index pregnancy was defined as the first postbaseline pregnancy lasting more than 20 weeks. We assessed heterogeneity across studies by comparing preconception characteristics in different types of studies. The pooled data set included 114,762 women, and 25,531 (22%) reported at least 1 pregnancy of more than 20 weeks' gestation during the study period. Babies from the index pregnancies were delivered between 1976 and 2021 (median, 2008), at a mean maternal age of 29.7 (standard deviation, 4.6) years. Before the index pregnancy, 60% of women were nulligravid, 58% had a college degree or more, and 37% were overweight or obese. Other harmonized variables included race/ethnicity, household income, substance use, chronic conditions, and perinatal outcomes. Participants from pregnancy-planning studies had more education and were healthier. The prevalence of preexisting medical conditions did not vary substantially based on whether studies relied on self-reported data. Use of harmonized data presents opportunities to study uncommon preconception risk factors and pregnancy-related events. This harmonization effort laid the groundwork for future analyses and additional data harmonization.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emily W Harville
- Correspondence to Dr. Emily W. Harville, Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112 (e-mail: )
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9
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Almanza-Aguilera E, Cano A, Gil-Lespinard M, Burguera N, Zamora-Ros R, Agudo A, Farràs M. Mediterranean diet and olive oil, microbiota, and obesity-related cancers. From mechanisms to prevention. Semin Cancer Biol 2023; 95:103-119. [PMID: 37543179 DOI: 10.1016/j.semcancer.2023.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 07/02/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Abstract
Olive oil (OO) is the main source of added fat in the Mediterranean diet (MD). It is a mix of bioactive compounds, including monounsaturated fatty acids, phytosterols, simple phenols, secoiridoids, flavonoids, and terpenoids. There is a growing body of evidence that MD and OO improve obesity-related factors. In addition, obesity has been associated with an increased risk for several cancers: endometrial, oesophageal adenocarcinoma, renal, pancreatic, hepatocellular, gastric cardia, meningioma, multiple myeloma, colorectal, postmenopausal breast, ovarian, gallbladder, and thyroid cancer. However, the epidemiological evidence linking MD and OO with these obesity-related cancers, and their potential mechanisms of action, especially those involving the gut microbiota, are not clearly described or understood. The goals of this review are 1) to update the current epidemiological knowledge on the associations between MD and OO consumption and obesity-related cancers, 2) to identify the gut microbiota mechanisms involved in obesity-related cancers, and 3) to report the effects of MD and OO on these mechanisms.
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Affiliation(s)
- Enrique Almanza-Aguilera
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Spain
| | - Ainara Cano
- Food Research, AZTI, Basque Research and Technology Alliance (BRTA), Parque Tecnológico de Bizkaia, Astondo Bidea, Edificio 609, 48160, Derio, Spain
| | - Mercedes Gil-Lespinard
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Spain
| | - Nerea Burguera
- Food Research, AZTI, Basque Research and Technology Alliance (BRTA), Parque Tecnológico de Bizkaia, Astondo Bidea, Edificio 609, 48160, Derio, Spain
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Spain; Department of Nutrition, Food Sciences, and Gastronomy, Food Innovation Network (XIA), Institute for Research on Nutrition and Food Safety (INSA), Faculty of Pharmacy and Food Sciences University of Barcelona, Barcelona, Spain.
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Spain
| | - Marta Farràs
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Spain.
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10
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Al Saati A, Vande Perre P, Plenecassagnes J, Gilhodes J, Monselet N, Cabarrou B, Lignon N, Filleron T, Telly D, Perello-Lestrade E, Feillel V, Staub A, Martinez M, Chipoulet E, Collet G, Thomas F, Gladieff L, Toulas C. Multigene Panel Sequencing Identifies a Novel Germline Mutation Profile in Male Breast Cancer Patients. Int J Mol Sci 2023; 24:14348. [PMID: 37762649 PMCID: PMC10531866 DOI: 10.3390/ijms241814348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Even though male breast cancer (MBC) risk encompasses both genetic and environmental aetiologies, the primary risk factor is a germline pathogenic variant (PV) or likely pathogenic variant (LPV) in BRCA2, BRCA1 and/or PALB2 genes. To identify new potential MBC-specific predisposition genes, we sequenced a panel of 585 carcinogenesis genes in an MBC cohort without BRCA1/BRCA2/PALB2 PV/LPV. We identified 14 genes carrying rare PVs/LPVs in the MBC population versus noncancer non-Finnish European men, predominantly coding for DNA repair and maintenance of genomic stability proteins. We identified for the first time PVs/LPVs in PRCC (pre-mRNA processing), HOXA9 (transcription regulation), RECQL4 and WRN (maintenance of genomic stability) as well as in genes involved in other cellular processes. To study the specificity of this MBC PV/LPV profile, we examined whether variants in the same genes could be detected in a female breast cancer (FBC) cohort without BRCA1/BRCA2/PALB2 PV/LPV. Only 5/109 women (4.6%) carried a PV/LPV versus 18/85 men (21.2%) on these genes. FBC did not carry any PV/LPV on 11 of these genes. Although 5.9% of the MBC cohort carried PVs/LPVs in PALLD and ERCC2, neither of these genes were altered in our FBC cohort. Our data suggest that in addition to BRCA1/BRCA2/PALB2, other genes involved in DNA repair/maintenance or genomic stability as well as cell adhesion may form a specific MBC PV/LPV signature.
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Affiliation(s)
- Ayman Al Saati
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
- Université de Toulouse, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Pierre Vande Perre
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
| | - Julien Plenecassagnes
- Bioinformatics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France;
| | - Julia Gilhodes
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Nils Monselet
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Bastien Cabarrou
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Norbert Lignon
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Thomas Filleron
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Dominique Telly
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
| | - Emilie Perello-Lestrade
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
| | - Viviane Feillel
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Anne Staub
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | | | - Edith Chipoulet
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Gaëlle Collet
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Fabienne Thomas
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
- Université de Toulouse, Université Toulouse III-Paul Sabatier, Toulouse, France
- Pharmacology Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Laurence Gladieff
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Christine Toulas
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
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11
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Kim H, Wisniewska K, Regner MJ, Thennavan A, Spanheimer PM, Franco HL. Single-Cell Transcriptional and Epigenetic Profiles of Male Breast Cancer Nominate Salient Cancer-Specific Enhancers. Int J Mol Sci 2023; 24:13053. [PMID: 37685859 PMCID: PMC10487538 DOI: 10.3390/ijms241713053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Male breast cancer represents about 1% of all breast cancer diagnoses and, although there are some similarities between male and female breast cancer, the paucity of data available on male breast cancer makes it difficult to establish targeted therapies. To date, most male breast cancers (MBCs) are treated according to protocols established for female breast cancer (FBC). Thus, defining the transcriptional and epigenetic landscape of MBC with improved resolution is critical for developing better avenues for therapeutic intervention. In this study, we present matched transcriptional (scRNA-seq) and epigenetic (scATAC-seq) profiles at single-cell resolution of two treatment naïve MBC tumors processed immediately after surgical resection. These data enable the detection of differentially expressed genes between male and female breast tumors across immune, stromal, and malignant cell types, to highlight several genes that may have therapeutic implications. Notably, MYC target genes and mTORC1 signaling genes were significantly upregulated in the malignant cells of MBC compared to the female counterparts. To understand how the regulatory landscape of MBC gives rise to these male-specific gene expression patterns, we leveraged the scATAC-seq data to systematically link changes in chromatin accessibility to changes in gene expression within each cell type. We observed cancer-specific rewiring of several salient enhancers and posit that these enhancers have a higher regulatory load than lineage-specific enhancers. We highlight two examples of previously unannotated cancer-cell-specific enhancers of ANXA2 and PRDX4 gene expression and show evidence for super-enhancer regulation of LAMB3 and CD47 in male breast cancer cells. Overall, this dataset annotates clinically relevant regulatory networks in male breast tumors, providing a useful resource that expands our current understanding of the gene expression programs that underlie the biology of MBC.
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Affiliation(s)
- Hyunsoo Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kamila Wisniewska
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Matthew J. Regner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Bioinformatics and Computational Biology Graduate Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aatish Thennavan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Oral and Craniofacial Biomedicine Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Philip M. Spanheimer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hector L. Franco
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Bioinformatics and Computational Biology Graduate Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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12
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Lee-Rueckert M, Canyelles M, Tondo M, Rotllan N, Kovanen PT, Llorente-Cortes V, Escolà-Gil JC. Obesity-induced changes in cancer cells and their microenvironment: Mechanisms and therapeutic perspectives to manage dysregulated lipid metabolism. Semin Cancer Biol 2023; 93:36-51. [PMID: 37156344 DOI: 10.1016/j.semcancer.2023.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
Obesity has been closely related to cancer progression, recurrence, metastasis, and treatment resistance. We aim to review recent progress in the knowledge on the obese macroenvironment and the generated adipose tumor microenvironment (TME) inducing lipid metabolic dysregulation and their influence on carcinogenic processes. Visceral white adipose tissue expansion during obesity exerts systemic or macroenvironmental effects on tumor initiation, growth, and invasion by promoting inflammation, hyperinsulinemia, growth-factor release, and dyslipidemia. The dynamic relationship between cancer and stromal cells of the obese adipose TME is critical for cancer cell survival and proliferation as well. Experimental evidence shows that secreted paracrine signals from cancer cells can induce lipolysis in cancer-associated adipocytes, causing them to release free fatty acids and acquire a fibroblast-like phenotype. Such adipocyte delipidation and phenotypic change is accompanied by an increased secretion of cytokines by cancer-associated adipocytes and tumor-associated macrophages in the TME. Mechanistically, the availability of adipose TME free fatty acids and tumorigenic cytokines concomitant with the activation of angiogenic processes creates an environment that favors a shift in the cancer cells toward an aggressive phenotype associated with increased invasiveness. We conclude that restoring the aberrant metabolic alterations in the host macroenvironment and in adipose TME of obese subjects would be a therapeutic option to prevent cancer development. Several dietary, lipid-based, and oral antidiabetic pharmacological therapies could potentially prevent tumorigenic processes associated with the dysregulated lipid metabolism closely linked to obesity.
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Affiliation(s)
| | - Marina Canyelles
- Institut d'Investigacions Biomèdiques (IIB) Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Mireia Tondo
- Institut d'Investigacions Biomèdiques (IIB) Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Noemi Rotllan
- Institut d'Investigacions Biomèdiques (IIB) Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | | | - Vicenta Llorente-Cortes
- Wihuri Research Institute, Helsinki, Finland; Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), Barcelona, Spain; CIBERCV, Institute of Health Carlos III, 28029 Madrid, Spain.
| | - Joan Carles Escolà-Gil
- Institut d'Investigacions Biomèdiques (IIB) Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
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13
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Kuziel G, Moore BN, Arendt LM. Obesity and Fibrosis: Setting the Stage for Breast Cancer. Cancers (Basel) 2023; 15:cancers15112929. [PMID: 37296891 DOI: 10.3390/cancers15112929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a rising health concern and is linked to a worsened breast cancer prognosis. Tumor desmoplasia, which is characterized by elevated numbers of cancer-associated fibroblasts and the deposition of fibrillar collagens within the stroma, may contribute to the aggressive clinical behavior of breast cancer in obesity. A major component of the breast is adipose tissue, and fibrotic changes in adipose tissue due to obesity may contribute to breast cancer development and the biology of the resulting tumors. Adipose tissue fibrosis is a consequence of obesity that has multiple sources. Adipocytes and adipose-derived stromal cells secrete extracellular matrix composed of collagen family members and matricellular proteins that are altered by obesity. Adipose tissue also becomes a site of chronic, macrophage-driven inflammation. Macrophages exist as a diverse population within obese adipose tissue and mediate the development of fibrosis through the secretion of growth factors and matricellular proteins and interactions with other stromal cells. While weight loss is recommended to resolve obesity, the long-term effects of weight loss on adipose tissue fibrosis and inflammation within breast tissue are less clear. Increased fibrosis within breast tissue may increase the risk for tumor development as well as promote characteristics associated with tumor aggressiveness.
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Affiliation(s)
- Genevra Kuziel
- Cancer Biology Graduate Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
| | - Brittney N Moore
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Lisa M Arendt
- Cancer Biology Graduate Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
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14
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Preuss C, Wunderle M, Hack CC, Beckmann MW, Wenkel E, Jud S, Heindl F. [Breast cancer in men]. Dtsch Med Wochenschr 2023; 148:301-306. [PMID: 36878228 DOI: 10.1055/a-1924-3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Male breast cancer is an unknown field for many practitioners. Patients often see different doctors before the correct diagnosis is made - often too late. This article is intended to point out risk factors, initiation of diagnostics and therapy. In the dawning age of molecular medicine, we will also take a look at genetics.
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15
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Scagliotti MF, Boietti BR, Knoblovits P. Prevalence of men's health history in male breast cancer patients. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2022:S2530-0180(22)00242-6. [PMID: 36509663 DOI: 10.1016/j.endien.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Male breast carcinoma (MBC) is an uncommon disease, accounting for less than 0.5% of cancer diagnoses in men. Data on the prevalence thereof in Argentina are unknown. PRIMARY OBJECTIVE To estimate the prevalence of a men's health history associated with MBC as well as the anthropometric and clinical characteristics of the study population. METHODS This cross-sectional study included all men according to original biological sex over 18 years of age with a history of breast cancer who sought care at the Hospital Italiano de Buenos Aires [Italian Hospital of Buenos Aires] between January 2010 and December 2018. RESULTS We included 57 men with breast cancer. Their median age was 71 years. Of them, 53.06% had obesity and 24.53% had diabetes. With respect to men's health history, 5.56% (2/36) had infertility, 29.17% (14/48) had gynaecomastia and 60.71% (17/28) had sexual dysfunction. Some 63% (7/11) had androgen deficiency based on laboratory diagnosis; of them, 45.45% (5/11) had high gonadotropins. CONCLUSION We identified similarities with the literature as to the prevalence of obesity, diabetes and infertility in patients with MBC. The prevalence of testosterone deficiency was higher than reported for men of the same age. Many of these factors support the need to examine the role of endogenous hormones. Further research is required to help physicians care for and counsel men at higher risk of this disease.
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Affiliation(s)
- Maria Florencia Scagliotti
- Servicio de Endocrinología y Metabolismo, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Bruno Rafael Boietti
- Área de Investigación Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Pablo Knoblovits
- Servicio de Endocrinología y Metabolismo, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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16
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Zhou Q, Zhang Q, Zhao S, Zhang Y, Wang Q, Li J. A Novel Nomogram for Predicting Breast Cancer-specific Survival in Male Patients. Am J Clin Oncol 2022; 45:427-437. [PMID: 36106711 DOI: 10.1097/coc.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To compare breast cancer-specific survival (BCSS) of nonmetastatic invasive breast cancer between male (MBC) and female (FBC) patients, define clinicopathologic variables related to BCSS in nonmetastatic invasive MBC patients, and establish a nomogram for individual risk prediction. MATERIALS AND METHODS On the basis of Surveillance, Epidemiology, and End Results database, 2094 MBC and 48,104 FBC cases underwent propensity score matching (PSM). We compared the prognosis of patients before and after PSM and developed a nomogram for BCSS of nonmetastatic invasive MBC patients. Internal validation was performed using the consistency index, calibration curves, and receiver operating characteristic curves. Simultaneously, data from 49 nonmetastatic invasive MBC patients diagnosed between January 2012 and May 2016 were collected for external validation. RESULTS Before PSM, overall survival and BCSS were significantly shorter in MBC than those in FBC patients. After PSM, MBC patients continued to have a shorter overall survival, but not BCSS, than FBC patients. Marital status, age, histologic grade, estrogen/progesterone receptor status, Tumor Lymph Node stage, and surgery were included in the prediction model. CONCLUSIONS The nomogram developed in this study seems to be more accurate than conventional Tumor-nodal-metastasis staging staging to predict BCSS and may serve as an effective tool for assessing the prognosis of nonmetastatic invasive MBC.
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Affiliation(s)
- Qianmei Zhou
- Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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17
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Bharathidasan K, Curl J, Babu VK, Felton S, Nugent K. An Approach to Gynecomastia in Primary Care Clinics. South Med J 2022; 115:597-602. [PMID: 35922045 DOI: 10.14423/smj.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily overlooked, appropriate investigation and management often are missed. The workup of gynecomastia is highly individualized, based on the patient's presentation and related factors. It should be guided by thorough history taking and physical examination. Unless the patient has associated symptoms, or there is suspicion for an underlying clinical disorder causing the gynecomastia, the patient need not be investigated further. A breast ultrasound is not routinely recommended. Gynecomastia is a benign finding that will spontaneously regress in most patients; however, patients who are concerned with their physical appearance can be treated either medically or surgically. Patients who have had gynecomastia for more than 1 year tend to have fibrosis, which may be more difficult to treat. Management of gynecomastia is highly patient centered, following a detailed discussion about treatment goals and should be started early. Gynecomastia is not considered a premalignant condition; routine screening is not cost-effective, and imaging studies should be pursued only if physical examination findings suggest malignancy.
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Affiliation(s)
- Kavya Bharathidasan
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Jordan Curl
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Vedesh Kumar Babu
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Shaili Felton
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Kenneth Nugent
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
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18
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McClurg DP, Urquhart G, McGoldrick T, Chatterji S, Miedzybrodzka Z, Speirs V, Elsberger B. Analysis of the Clinical Advancements for BRCA-Related Malignancies Highlights the Lack of Treatment Evidence for BRCA-Positive Male Breast Cancer. Cancers (Basel) 2022; 14:3175. [PMID: 35804947 PMCID: PMC9264767 DOI: 10.3390/cancers14133175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
Male breast cancer (MBC) is a rare disease that accounts for less than 1% of all breast cancers and male malignancies. Despite recognised clinico-pathological and molecular differences to female breast cancer (FBC), the clinical management of MBC follows established FBC treatment strategies. Loss of function mutations in the DNA damage response genes BRCA1 and BRCA2, have been strongly implicated in the pathogenesis of MBC. While there have been extensive clinical advancements in other BRCA-related malignancies, including FBC, improvements in MBC remain stagnant. Here we present a review that highlights the lack of treatment evidence for BRCA-related MBC and the required national and global collaborative effort to address this unmet need. In doing so, we summarise the transformative clinical advancements with poly(ADP-ribose) polymerase (PARP) inhibitors in other BRCA-related cancers namely, FBC and prostate cancer.
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Affiliation(s)
- Dylan P. McClurg
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Gordan Urquhart
- Aberdeen Royal Infirmary, Department of Oncology, Foresterhill Road, Aberdeen AB25 2ZN, UK; (G.U.); (T.M.)
| | - Trevor McGoldrick
- Aberdeen Royal Infirmary, Department of Oncology, Foresterhill Road, Aberdeen AB25 2ZN, UK; (G.U.); (T.M.)
| | - Subarnarekha Chatterji
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Zosia Miedzybrodzka
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Valerie Speirs
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
| | - Beatrix Elsberger
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK; (D.P.M.); (S.C.); (Z.M.)
- Aberdeen Royal Infirmary, Breast Unit, Foresterhill Road, Aberdeen AB25 2ZN, UK
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19
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Rutherford CL, Goodman D, Lannigan A. A systematic literature review of the management, oncological outcomes and psychosocial implications of male breast cancer. Eur J Surg Oncol 2022; 48:2104-2111. [PMID: 35725681 DOI: 10.1016/j.ejso.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancers, it has significant oncological, survival and psychosocial implications for patients. The aim of this study is to assess the latest literature in the diagnosis, management, oncological outcomes, and psychosocial impact of MBC. METHODS A systematic literature review was conducted using the PRISMA guidelines (Moher et al., 2009) [1] to explore the management of MBC, with particular focus on investigative imaging, surgical management, oncological outcomes, survival, genetic screening and psychosocial effects. Electronic databases were searched for randomised control trials, cohort studies and case series involving more than 10 patients. Imaging and surgical techniques, local and distant disease recurrence, survival, genetic screening and psychosocial implications in the setting of MBC were assessed. RESULTS The search criteria identified 199 articles, of which 59 met the inclusion criteria. This included 39,529 patients, with a mean age of 64.5 years (55-71), and a mean follow-up of 66.3 months (26.2-115). Mastectomy remains the most frequently used surgical technique, with an average of 89.6%. Loco-regional and distant recurrence rate was 10.1% and 21.4% respectively. Disease-free survival (DFS) at 5 and 10 years was 66.8% and 54.5% respectively. Disease-specific survival (DSS) at 5 and 10 years was 87.1% and 67.1% respectively. Overall survival (OS) at 5 and 10 years was 72.7% and 50.7% respectively. Genetic screening was conducted in 38.6% of patients of which 4.8% and 15.8% were found to be BRCA1 and BRCA2 carriers respectively. Psychosocial studies were conducted mainly using questionnaire and interview-based methodology focusing primarily on awareness of breast cancer in men, support available and impact on gender identity. CONCLUSIONS This review demonstrates that men present with later stage disease with subsequent impact on survival outcomes. There remains a paucity of high-level evidence and prospective studies are required. There is a need for increasing awareness amongst the public and health care professionals in order to improve outcomes and reduce stigma associated with MBC.
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Affiliation(s)
| | - D Goodman
- National University of Ireland Galway, Ireland
| | - A Lannigan
- University Hospital Wishaw, United Kingdom
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20
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Scagliotti MF, Boietti BR, Knoblovits P. Prevalencia de antecedentes andrológicos en pacientes con cáncer de mama masculino. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Swerdlow AJ, Bruce C, Cooke R, Coulson P, Jones ME. Infertility and risk of breast cancer in men: a national case–control study in England and Wales. Breast Cancer Res 2022; 24:29. [PMID: 35578306 PMCID: PMC9112475 DOI: 10.1186/s13058-022-01517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Breast cancer is uncommon in men and its aetiology is largely unknown, reflecting the limited size of studies thus far conducted. In general, number of children fathered has been found a risk factor inconsistently, and infertility not. We therefore investigated in a case–control study, the relation of risk of breast cancer in men to infertility and number of children. Patients and methods We conducted a national case–control study in England and Wales, interviewing 1998 cases incident 2005–17 and 1597 male controls, which included questions on infertility and offspring. Results Risk of breast cancer was statistically significantly associated with male-origin infertility (OR = 2.03 (95% confidence interval (CI) 1.18–3.49)) but not if a couple’s infertility had been diagnosed as of origin from the female partner (OR = 0.86 (0.51–1.45)). Risk was statistically significantly raised for men who had not fathered any children (OR = 1.50 (95% CI 1.21–1.86)) compared with men who were fathers. These associations were statistically significantly present for invasive tumours but not statistically significant for in situ tumours. Conclusion Our data give strong evidence that risk of breast cancer is increased for men who are infertile. The reason is not clear and needs investigation.
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22
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Incidental Pathologic Findings in Young Men with Gynecomastia. Plast Reconstr Surg 2022; 149:608-613. [PMID: 35196673 DOI: 10.1097/prs.0000000000008815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pathologic examination of young adult gynecomastia tissue is controversial given the low incidence of breast carcinoma in this population. The authors examined the pathologic findings in a large cohort of adolescents with gynecomastia to evaluate the need for routine tissue analysis in this population. METHODS A retrospective review of men who underwent unilateral or bilateral mastectomy for gynecomastia at a single institution between February of 2007 and November of 2019 identified demographics, medical history, surgical characteristics, and pathologic findings. Descriptive statistics were performed. RESULTS A total of 268 male patients were included. Mean age was 16.6 years. Mean body mass index was 27.8 kg/m2, and 42.5 percent of the sample was obese. The majority (83.2 percent) underwent bilateral subcutaneous mastectomy. There were no abnormal histopathologic findings in 95.1 percent. Among the 13 patients with abnormalities, eight (3 percent) had nonproliferative changes, two (0.8 percent) had proliferative changes without atypia, two (0.8 percent) had atypical ductal hyperplasia, and one (0.4 percent) had both bilateral atypical ductal hyperplasia and unilateral ductal carcinoma in situ. No patients had invasive carcinoma. The three patients with atypical ductal hyperplasia and/or ductal carcinoma in situ were obese but had no other breast cancer or gynecomastia risk factors. CONCLUSIONS Findings conferring potentially increased risk of developing breast cancer were identified in three male adolescents (1.2 percent). Incidence of these findings is similar between male adolescents and similarly aged female adolescents undergoing breast reduction surgery. Although worrisome pathology results are rare, too little is known about the natural history of atypical proliferation and ductal carcinoma in situ in young men to recommend against routine analysis. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
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23
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Cui X. The Prevalence and Death Risk of Male Breast Cancer: A Study Based on the Surveillance, Epidemiology, and End Results Database. Am J Mens Health 2022; 16:15579883221074818. [PMID: 35094596 PMCID: PMC8808035 DOI: 10.1177/15579883221074818] [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] [Indexed: 11/16/2022] Open
Abstract
This study was to investigate the prevalence and death risk of male breast cancer (MBC) patients. The prevalence trend was based on the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017. A competitive risk analysis was performed to analyze the death risk of MBC patients. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated. The results indicated that the prevalence of MBC after the standardization of the total population increased in 1975–2017 and its annual percentage change (APC) was 0.536% (95% CI = [0.362%, 0.713%]). The prevalence of MBC was rapidly increased in patients aged ≥70 years (APC = 0.780%; 95% CI = [0.491%, 1.076%]) and Grade Ⅱ tumors (APC = 1.462%; 95% CI = [1.260%, 1.686%]). The 1-, 3-, and 5-year cumulative mortality of MBC patients who died of MBC was 2.23% (95% CI = [1.61%, 2.85%]), 7.56% (95% CI = [6.33%, 8.78%]), and 13.10% (95% CI = [11.10%, 11.32%]), respectively. Competitive risk analysis demonstrated that Blacks (HR = 1.76; 95% CI = [1.12, 2.77]), Grade 3 (HR = 2.56; 95% CI = [1.03, 6.35]), AJCC (American Joint Committee on Cancer) Stage Ⅲ (HR = 3.04; 95% CI = [1.76, 5.26]), and AJCC Stage Ⅳ (HR = 7.27; 95% CI = [1.36, 38.83]) were associated with an increased MBC-specific death risk, whereas married status (HR = 0.40; 95% CI = [0.25, 0.64]), surgery (HR = 0.25; 95% CI = [0.12, 0.50]), Luminal A subtype (HR = 0.20; 95% CI = [0.07, 0.53]), and Luminal B subtype (HR = 0.29; 95% CI = [0.10, 0.87]) were related to a reduced MBC-specific death risk. In addition, similar results can be observed in patients with surgery recommended and done (p < .05). This study may provide evidence for the prevalence trend, cumulative mortality, and death risk of MBC patients.
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Affiliation(s)
- Xiaofei Cui
- Department of Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China.,Molecular Oncology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
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24
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Swerdlow AJ, Bruce C, Cooke R, Coulson P, Schoemaker MJ, Jones ME. Risk of breast cancer in men in relation to weight change: a national case‐control study in England and Wales. Int J Cancer 2022; 150:1804-1811. [PMID: 35049043 PMCID: PMC9303449 DOI: 10.1002/ijc.33938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
Breast cancer is uncommon in men and knowledge about its causation limited. Obesity is a risk factor but there has been no investigation of whether weight change is an independent risk factor, as it is in women. In a national case‐control study, 1998 men with breast cancer incident in England and Wales during 2005 to 2017 and 1597 male controls were interviewed about risk factors for breast cancer including anthropometric factors at several ages. Relative risks of breast cancer in relation to changes in body mass index (BMI) and waist/height ratios at these ages were obtained by logistic regression modelling. There were significant trends of increasing breast cancer risk with increase in BMI from age 20 to 40 (odds ratio [OR] 1.11 [95% confidence interval (CI) 1.05‐1.17] per 2 kg/m2 increase in BMI; P < .001), and from age 40 to 60 (OR 1.12 [1.04‐1.20]; P = .003), and with increase in self‐reported adiposity compared to peers at age 11 to BMI compared with peers at age 20 (OR 1.19 [1.09‐1.30]; P < .001). Increase in waist/height ratio from age 20 to 5 years before diagnosis was also highly significantly associated with risk (OR 1.13 [1.08‐1.19]; P < .001). The associations with increases in BMI and waist/height ratio were significant independently of each other and of BMI or waist/height ratio at the start of the period of change analysed, and effects were similar for invasive and in situ tumours separately. Increases in BMI and abdominal obesity are each risk factors for breast cancer in men, independently of obesity per se. These associations might relate to increasing oestrogen levels with weight gain, but this needs investigation.
What's new?
Although obesity is an established risk factor for breast cancer in men, there have been no investigations of whether weight change is an independent risk factor, as it is in women. In an interview case‐control study including 1998 cases and 1597 controls, authors found that increase in body mass index and in abdominal obesity are each significant risk factors for breast cancer in men, independent of obesity per se.
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Affiliation(s)
- Anthony J Swerdlow
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Division of Breast Cancer Research The Institute of Cancer Research London UK
| | - Cydney Bruce
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham Nottingham UK
| | - Rosie Cooke
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Penny Coulson
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Michael E Jones
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
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25
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Kwok HT, Van M, Fan KS, Chan J. Top 100 cited articles in male breast cancer: A bibliometric analysis. Breast Dis 2022; 41:15-20. [PMID: 34219705 DOI: 10.3233/bd-201024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Male breast cancer is a considerably rare condition and only accounts for 1% of all breast cancer cases. Due to limited public awareness, the condition is likely to present late, leading to late diagnosis and treatment worsening morbidity and mortality. This article aims to identify the focus and most influential research on male breast cancer. Objective Identify the most influential papers in male breast cancer. METHODS Search on Web of Science using the search terms 'Male', 'Breast Cancer' and "Male breast cancer" to identify all full manuscripts in English language and were ranked by the total number of citations. The top 100 articles were then further analysed according to subject, author, journal, year and country of publications. RESULTS The mean number of citations per paper was 96. Most cited paper was by Thorlacius, S et al. evaluating the relationship between BRCA2 and female breast cancer, prostate cancer, pancreatic cancer and ovarian cancer. Cancer is the journal with the most published papers and received most citations in the male breast cancer research field. The USA contributed 49 of the manuscripts in the top 100. The most studied topic was risk factors for male breast cancer, with 20 articles. CONCLUSIONS The most cited papers identified in this study described the advance in the knowledge of genetics and epidemiology in male breast cancer and has led to improvements in the 4 management of the disease. Most of the highly cited articles in this field were published in high impact journals and had accumulated at least 100 citations to date, reflecting their quality and impact. By collating the most influential publications in this field, this analysis can serve to identify knowledge gaps in male breast cancer research as well as to help identify what makes a paper impactful and citable.
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Affiliation(s)
| | - Minh Van
- St. George's Medical School, London, UK
| | | | - Jeremy Chan
- Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
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26
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Liu FC, Veierød MB, Kjærheim K, Robsahm TE, Ghiasvand R, Babigumira R, Shala NK, Berge LAM, Ursin G, Grimsrud TK, Stenehjem JS. Excess risk of male breast cancer in the Norwegian Offshore Petroleum Workers (NOPW) cohort: a possible link to extreme night shift work? Breast Cancer Res 2021; 23:106. [PMID: 34794511 PMCID: PMC8600808 DOI: 10.1186/s13058-021-01485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fei-Chih Liu
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway. .,Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Marit B Veierød
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kristina Kjærheim
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway
| | - Trude E Robsahm
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway
| | - Reza Ghiasvand
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Ronnie Babigumira
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway.,Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Nita K Shala
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway.,Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Leon A M Berge
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway.,Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway
| | - Jo S Stenehjem
- Department of Research, Cancer Registry of Norway, Majorstuen, P.O. Box 5313, 0304, Oslo, Norway
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27
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Swerdlow AJ, Bruce C, Cooke R, Coulson P, Griffin J, Butlin A, Smith B, Swerdlow MJ, Jones ME. Obesity and Breast Cancer Risk in Men: A National Case-Control Study in England and Wales. JNCI Cancer Spectr 2021; 5:pkab078. [PMID: 34738071 PMCID: PMC8562705 DOI: 10.1093/jncics/pkab078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/09/2021] [Accepted: 08/26/2021] [Indexed: 11/14/2022] Open
Abstract
Background Breast cancer is rare in men, and information on its causes is very limited from studies that have generally been small. Adult obesity has been shown as a risk factor, but more detailed anthropometric relations have not been investigated. Methods We conducted an interview population-based case-control study of breast cancer in men in England and Wales including 1998 cases incident during 2005-2017 at ages younger than 80 years and 1597 male controls, with questions asked about a range of anthropometric variables at several ages. All tests of statistical significance were 2-sided. Results Risk of breast cancer statistically significantly increased with increasing body mass index (BMI) at ages 20 (odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.02 to 1.12 per 2-unit change in BMI), 40 (OR = 1.11, 95% CI = 1.07 to 1.16), and 60 (OR = 1.14, 95% CI = 1.09 to 1.19) years, but there was also an indication of raised risk for the lowest BMIs. Large waist circumference 5 years before interview was more strongly associated than was BMI with risk, and each showed independent associations. Associations were similar for invasive and in situ tumors separately and stronger for HER2-positive than HER2-negative tumors. Of the tumors, 99% were estrogen receptor positive. Conclusions Obesity at all adult ages, particularly recent abdominal obesity, is associated with raised risk of breast cancer in men, probably because of the conversion of testosterone to estrogen by aromatase in adipose tissue. The association is particularly strong for HER2-expressing tumors.
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Affiliation(s)
- Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Cydney Bruce
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rosie Cooke
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Department of Oncology, University of Oxford, Oxford, UK
| | - Penny Coulson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - James Griffin
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alison Butlin
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Beverley Smith
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - M Jill Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
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28
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Pizzato M, Carioli G, Bertuccio P, Malvezzi M, Levi F, Boffetta P, Negri E, La Vecchia C. Trends in male breast cancer mortality: a global overview. Eur J Cancer Prev 2021; 30:472-479. [PMID: 33470692 DOI: 10.1097/cej.0000000000000651] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent trends in male breast cancer have been inadequately studied. We updated mortality trends in selected countries and regions worldwide using most recent available data and we predicted figures for 2020. METHODS We extracted official death certification data for male breast cancer and population estimates from the WHO and the Pan American Health Organization databases, from 2000 to 2017. We computed age-standardized (world population) death rates for selected countries and regions worldwide. We used joinpoint regression analysis to identify significant changes in trends and to predict death numbers and rates for 2020. RESULTS In 2015-2017, Central-Eastern Europe had a rate of 2.85/1 000 000, and Russia of 2.22, ranking among the highest. North-Western and Southern Europe, the European Union as a whole and the USA showed rates ranging between 1.5 and 2.0. Lower rates were observed in most Latin American countries, with values below 1.35/1 000 000, in Australia, 1.22, and Japan, 0.58. Between 2000-2004 and 2015-2017, age-adjusted death rates decreased between 10 and 40% in North-Western Europe, Russia, and the USA, and between 1.5 and 25% in the other areas under study, except Latin America (+0.8%). Except for Central-Eastern Europe, predicted rates for 2020 were favourable. CONCLUSION Advancements in management are likely the main drivers of the favourable trends in male breast cancer death rates over the last decades. Delayed diagnosis and limited access to effective care explain the higher mortality in some areas.
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Affiliation(s)
| | - Greta Carioli
- Department of Clinical Sciences and Community Health
| | - Paola Bertuccio
- Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy
| | | | - Fabio Levi
- Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - Eva Negri
- Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy
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29
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Zeinomar N, Bandera EV, Qin B. Toward Understanding the Etiology of Male Breast Cancer: An Ongoing Research Challenge. JNCI Cancer Spectr 2021; 5:pkab079. [PMID: 34703984 PMCID: PMC8536819 DOI: 10.1093/jncics/pkab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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30
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AYGİN D, YAMAN Ö. Breast cancer in men: Risk factors, treatment options, quality of life? Systematic review. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.910209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Avau F, Chintinne M, Baudry S, Buxant F. Literature review and case report of bilateral intracystic papillary carcinoma associated with an invasive ductal carcinoma in a male breast. Breast Dis 2021; 41:5-13. [PMID: 34219706 DOI: 10.3233/bd-210001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intracystic papillary carcinoma (IPC) is a rare tumor with good prognosis that occurs in only 5% to 7.5% of male breast cancer. We report a case of a 46-year-old man who presented a brown nipple discharge a few months ago. He had a bilateral IPC and an invasive ductal carcinoma on the right breast. A double mastectomy was then performed with a bilateral sentinel lymph node biopsy, and he received chemotherapy, radiotherapy, and hormonotherapy. Two years after the diagnosis, the patient recovered and was free of recurrence. Considering the scarcity of this tumor type, we conducted a systematic literature review on the PubMed of all the cases of IPC in men. The clinical presentation, imaging, and treatment of the 43 case reports from the 41 articles selected were described. Furthermore, no clear guidelines for IPC management are available. Conservative surgery should also be preferred, and a sentinel lymph node biopsy should be performed systematically. Moreover, radiotherapy should be proposed in the case of conservative surgery, and hormone therapy could be proposed in the case of invasive IPC or IPC associated with a ductal carcinoma in situ.
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Affiliation(s)
- Fiona Avau
- Obstetrics and Gynecology, Hôpitaux Iris Sud HIS, Brussels, Belgium
| | | | - Sarah Baudry
- Radiology, Hôpitaux Iris Sud HIS, Brussels, Belgium
| | - Frédéric Buxant
- Obstetrics and Gynecology, Hôpitaux Iris Sud HIS, Brussels, Belgium
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32
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Radiotherapy for prevention or management of gynecomastia recurrence: Future role for general gynecomastia patients in plastic surgery given current role in management of high-risk prostate cancer patients on anti-androgenic therapy. J Plast Reconstr Aesthet Surg 2021; 74:3128-3140. [PMID: 34001449 DOI: 10.1016/j.bjps.2021.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/09/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Several technologies and innovative approaches continue to emerge for the optimal management of gynecomastia by plastic surgeons; the present study investigates the role of radiation therapy in this context. METHODS A systematic review was performed to evaluate the utility of radiotherapy for the prevention and treatment of gynecomastia incidence or recurrence by plastic surgeons. RESULTS Fifteen articles met the inclusion criteria for review. The mean incidence of gynecomastia was 70% in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. Radiotherapy was shown to significantly reduce the incidence to a median of 23%, with all six randomized control studies assessed demonstrating a statistically significant decrease in incidence following radiotherapy prophylaxis. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. Complications following radiotherapy were minor and self-limiting in all cases, restricted to minor skin reactions, and associated with larger radiotherapy doses delivered in fewer fractions. The median complication rate was 12.4% with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. While the efficacy of radiation therapy as a treatment modality for gynecomastia was also established, it was shown to be less effective than other available options. CONCLUSIONS Low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients; further studies are indicated within the common gynecomastia population managed by plastic surgeons to assess the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients.
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33
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Olimpiadi YB, Brownson KE, Kahn JA, Kim B, Han H, Khemichian S, Fong TL, Kang I, Terando A, Lang JE. Treatment and Outcomes of Early Stage Breast Cancer in Patients with Hepatic Dysfunction. J Surg Res 2020; 256:212-219. [PMID: 32711178 PMCID: PMC7854813 DOI: 10.1016/j.jss.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND There exists a dogma of surgical nihilism for patients with cirrhosis and breast cancer causing de-escalation of surgery and impacting survival. We hypothesized that breast cancer surgery would not result in a significant change in the Model for End-Stage Liver Disease-Sodium (MELD-Na) scores before and after surgery. METHODS We performed a single institutional retrospective review of medical records between January 2013 and July 2019 of patients with concurrent cirrhosis and breast cancer. We used the nonparametric Friedman test to compare differences in MELD-Na scores. RESULTS Eight patients with both cirrhosis and breast cancer were identified. Median follow-up was 30.5 mo. Half of the patients had Child-Pugh class A cirrhosis and half had Child-Pugh class B cirrhosis. Six (75%) patients underwent lumpectomy and two (25%) underwent mastectomy. There was no statistically significant difference (P = 0.66) in median MELD-Na score before surgery (16) and after surgery (18). Two (25%) patients experienced postoperative complications. Three patients were listed for liver transplantation. Of three listed patients, two (25%) patients underwent successful liver transplantation after breast surgery. One (12.5%) patient died without transplant. Three (37.5%) patients were alive for more than 5 y after breast cancer diagnosis without evidence of cancer recurrence. The eighth patient has remained breast cancer free for more than 6 mo since her surgery. CONCLUSIONS Surgery for patients with Child-Pugh class A and B cirrhosis and early stage breast cancer did not result in a significant change in MELD-Na score before and after surgery, suggesting that selected patients may benefit from breast cancer surgery with curative intent.
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Affiliation(s)
- Yuliya B Olimpiadi
- Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Kirstyn E Brownson
- Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Jeffrey A Kahn
- Liver Transplant Program, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California
| | - Brian Kim
- Liver Transplant Program, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California
| | - Hyosun Han
- Liver Transplant Program, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California
| | - Saro Khemichian
- Liver Transplant Program, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California
| | - Tse-Ling Fong
- Liver Transplant Program, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California
| | - Irene Kang
- Division of Medical Oncology, Department of Medicine, University of Southern California, Los Angeles, California
| | - Alicia Terando
- Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Julie E Lang
- Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
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34
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Abstract
Despite decades of laboratory, epidemiological and clinical research, breast cancer incidence continues to rise. Breast cancer remains the leading cancer-related cause of disease burden for women, affecting one in 20 globally and as many as one in eight in high-income countries. Reducing breast cancer incidence will likely require both a population-based approach of reducing exposure to modifiable risk factors and a precision-prevention approach of identifying women at increased risk and targeting them for specific interventions, such as risk-reducing medication. We already have the capacity to estimate an individual woman's breast cancer risk using validated risk assessment models, and the accuracy of these models is likely to continue to improve over time, particularly with inclusion of newer risk factors, such as polygenic risk and mammographic density. Evidence-based risk-reducing medications are cheap, widely available and recommended by professional health bodies; however, widespread implementation of these has proven challenging. The barriers to uptake of, and adherence to, current medications will need to be considered as we deepen our understanding of breast cancer initiation and begin developing and testing novel preventives.
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Affiliation(s)
- Kara L Britt
- Breast Cancer Risk and Prevention Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kelly-Anne Phillips
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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35
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Zheng A, Zhang L, Ji Z, Fan L, Jin F. Oncotype DX for Comprehensive Treatment in Male Breast Cancer: A Case Report and Literature Review. Am J Mens Health 2020; 13:1557988319847856. [PMID: 31068065 PMCID: PMC6509981 DOI: 10.1177/1557988319847856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Male breast cancer (MBC) is uncommon in clinical practice. Using the 21-gene assay to facilitate decision-making on comprehensive treatment of MBC is rarely reported. This study reports the case of a 53-year-old man with left breast cancer. Modified radical mastectomy was performed. Endocrine treatment was chosen for the patient according to the result of the 21-gene assay, a recommended genomic test of breast cancer. The patient remained in good health without evidence of recurrence at 18-month follow-up. This case provides a reference mode for the comprehensive management of early-stage, estrogen receptor–expressing and lymph node–negative MBC patients.
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Affiliation(s)
- Ang Zheng
- 1 Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lin Zhang
- 2 NingBo Huamei Hospital, University of Chinese Academy of Sciences, People's Republic of China
| | - Ziyao Ji
- 3 Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lijuan Fan
- 1 Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Feng Jin
- 1 Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
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36
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Munteanu R, Onaciu A, Moldovan C, Zimta AA, Gulei D, Paradiso AV, Lazar V, Berindan-Neagoe I. Adipocyte-Based Cell Therapy in Oncology: The Role of Cancer-Associated Adipocytes and Their Reinterpretation as Delivery Platforms. Pharmaceutics 2020; 12:pharmaceutics12050402. [PMID: 32354024 PMCID: PMC7284545 DOI: 10.3390/pharmaceutics12050402] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022] Open
Abstract
Cancer-associated adipocytes have functional roles in tumor development through secreted adipocyte-derived factors and exosomes and also through metabolic symbiosis, where the malignant cells take up the lactate, fatty acids and glutamine produced by the neighboring adipocytes. Recent research has demonstrated the value of adipocytes as cell-based delivery platforms for drugs (or prodrugs), nucleic acids or loaded nanoparticles for cancer therapy. This strategy takes advantage of the biocompatibility of the delivery system, its ability to locate the tumor site and also the predisposition of cancer cells to come in functional contact with the adipocytes from the tumor microenvironment for metabolic sustenance. Also, their exosomal content can be used in the context of cancer stem cell reprogramming or as a delivery vehicle for different cargos, like non-coding nucleic acids. Moreover, the process of adipocytes isolation, processing and charging is quite straightforward, with minimal economical expenses. The present review comprehensively presents the role of adipocytes in cancer (in the context of obese and non-obese individuals), the main methods for isolation and characterization and also the current therapeutic applications of these cells as delivery platforms in the oncology sector.
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Affiliation(s)
- Raluca Munteanu
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Anca Onaciu
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Cristian Moldovan
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Alina-Andreea Zimta
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Diana Gulei
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Angelo V. Paradiso
- Oncologia Sperimentale, Istituto Tumori G Paolo II, IRCCS, 70125 Bari, Italy
| | - Vladimir Lazar
- Worldwide Innovative Network for Personalized Cancer Therapy, 94800 Villejuif, France
| | - Ioana Berindan-Neagoe
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute “Prof. Dr. Ion Chiricuta”, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
- Correspondence:
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Trabert B, Sherman ME, Kannan N, Stanczyk FZ. Progesterone and Breast Cancer. Endocr Rev 2020; 41:5568276. [PMID: 31512725 PMCID: PMC7156851 DOI: 10.1210/endrev/bnz001] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/06/2019] [Indexed: 12/31/2022]
Abstract
Synthetic progestogens (progestins) have been linked to increased breast cancer risk; however, the role of endogenous progesterone in breast physiology and carcinogenesis is less clearly defined. Mechanistic studies using cell culture, tissue culture, and preclinical models implicate progesterone in breast carcinogenesis. In contrast, limited epidemiologic data generally do not show an association of circulating progesterone levels with risk, and it is unclear whether this reflects methodologic limitations or a truly null relationship. Challenges related to defining the role of progesterone in breast physiology and neoplasia include: complex interactions with estrogens and other hormones (eg, androgens, prolactin, etc.), accounting for timing of blood collections for hormone measurements among cycling women, and limitations of assays to measure progesterone metabolites in blood and progesterone receptor isotypes (PRs) in tissues. Separating the individual effects of estrogens and progesterone is further complicated by the partial dependence of PR transcription on estrogen receptor (ER)α-mediated transcriptional events; indeed, interpreting the integrated interaction of the hormones may be more essential than isolating independent effects. Further, many of the actions of both estrogens and progesterone, particularly in "normal" breast tissues, are driven by paracrine mechanisms in which ligand binding to receptor-positive cells evokes secretion of factors that influence cell division of neighboring receptor-negative cells. Accordingly, blood and tissue levels may differ, and the latter are challenging to measure. Given conflicting data related to the potential role of progesterone in breast cancer etiology and interest in blocking progesterone action to prevent or treat breast cancer, we provide a review of the evidence that links progesterone to breast cancer risk and suggest future directions for filling current gaps in our knowledge.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Mark E Sherman
- Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Nagarajan Kannan
- Laboratory of Stem Cell and Cancer Biology, Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Frank Z Stanczyk
- Departments of Obstetrics and Gynecology, and Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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Woods RW, Salkowski LR, Elezaby M, Burnside ES, Strigel RM, Fowler AM. Image-based screening for men at high risk for breast cancer: Benefits and drawbacks. Clin Imaging 2020; 60:84-89. [PMID: 31864206 PMCID: PMC7242122 DOI: 10.1016/j.clinimag.2019.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
Male breast cancer is a rare malignancy. Due to low prevalence and limited data to support male breast cancer screening, there are currently no recommendations for image-based screening in asymptomatic men and few recommendations for men at high risk for breast cancer. However, symptomatically diagnosed cancers in men are typically advanced, suggesting that earlier detection may improve outcomes. In this article we briefly review the risk factors for male breast cancer, and discuss the potential benefits and possible drawbacks of routine image-based screening for men at high risk for breast cancer.
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Affiliation(s)
- Ryan W Woods
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Lonie R Salkowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Mai Elezaby
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elizabeth S Burnside
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; University of Wisconsin Carbone Cancer Center, 600 Highland Avenue, Madison, WI 53792, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; University of Wisconsin Carbone Cancer Center, 600 Highland Avenue, Madison, WI 53792, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, USA
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Kjaerulff TM, Ersbøll AK, Pukkala E, Bolin K, Green A, Emneus M, Brasso K, Iversen P, Thygesen LC. Characteristics of finasteride users in comparison with nonusers: A Nordic nationwide study based on individual-level data from Denmark, Finland, and Sweden. Pharmacoepidemiol Drug Saf 2020; 29:453-460. [PMID: 32048414 DOI: 10.1002/pds.4947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Published epidemiological studies on the association between finasteride use and the risk of male breast cancer have been inconclusive due to methodological limitations including a few male breast cancer cases included. Determinants of male breast cancer have been studied, but it remains unexplored whether these are also related to finasteride use and thereby constitute potential confounders. This study aimed to assess whether there are differences between finasteride users and nonusers with regard to numerous potential confounders. METHODS In total, 246 508 finasteride users (≥35 years) were identified in the prescription registries of Denmark (1995-2014), Finland (1997-2013), and Sweden (2005-2014). An equal number of nonusers were sampled. The directed acyclic graph (DAG) methodology was used to identify potential confounders for the association between finasteride and male breast cancer. A logistic regression model compared finasteride users and nonusers with regard to potential confounders that were measurable in registries and population surveys. RESULTS Finasteride users had higher odds of testicular abnormalities (odds ratio [OR] 1.40; 95% confidence interval [CI] 1.36-1.44), obesity (1.31; 1.23-1.39), exogenous testosterone (1.61; 1.48-1.74), radiation exposure (1.22; 1.18-1.27), and diabetes (1.07; 1.04-1.10) and lower odds of occupational exposure in perfume industry or in high temperature environments (0.93; 0.87-0.99), living alone (0.89; 0.88-0.91), living in urban/suburban areas (0.97; 0.95-0.99), and physical inactivity (0.70; 0.50-0.99) compared to nonusers. CONCLUSIONS Systematic differences between finasteride users and nonusers were found emphasizing the importance of confounder adjustment of associations between finasteride and male breast cancer.
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Affiliation(s)
| | - Annette Kjaer Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Eero Pukkala
- Cancer Society of Finland, Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Kristian Bolin
- Centre for Health Economics and Department of Economics, University of Gothenburg, Gothenburg, Sweden
| | - Anders Green
- Open Patientdata Explorative Network (OPEN), Odense University Hospital and University of Southern Denmark, Odense, Denmark.,Institute of Applied Economics and Health Research, Copenhagen, Denmark
| | - Martha Emneus
- Institute of Applied Economics and Health Research, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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40
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Sung H, DeSantis C, Jemal A. Subtype-Specific Breast Cancer Incidence Rates in Black versus White Men in the United States. JNCI Cancer Spectr 2019; 4:pkz091. [PMID: 32337499 PMCID: PMC7050146 DOI: 10.1093/jncics/pkz091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/07/2019] [Accepted: 11/01/2019] [Indexed: 01/11/2023] Open
Abstract
Compared with white women, black women have higher incidence rates for triple-negative breast cancer but lower rates for hormone receptor (HR)–positive cancers in the United States. Whether similar racial difference occurs in male breast cancer is unclear. We examined racial differences in incidence rates of breast cancer subtypes defined by HR and human epidermal growth factor receptor 2 (HER2) by sex using nationwide data from 2010 to 2016. Among men, rates were higher in blacks than whites for all subtypes, with the black-to-white incidence rate ratios of 1.41 (95% confidence interval [CI ]= 1.32 to 1.50) for HR+/HER-, 1.65 (95% CI = 1.40 to 1.93) for HR+/HER2+, 2.62 (95% CI = 1.48 to 4.43) for HR-/HER2+, and 2.27 (95% CI = 1.67 to 3.03) for triple-negative subtype. Conversely, among women, rates in blacks were 21% lower for HR+/HER2- and comparable for HR+/HER2+ but 29% and 93% higher for HR-/HER2+ and triple-negative subtypes, respectively. Future studies are needed to identify contributing factors to the dissimilar racial patterns in breast cancer subtype incidence between men and women.
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Affiliation(s)
- Hyuna Sung
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Carol DeSantis
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
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41
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Talibov M, Hansen J, Heikkinen S, Martinsen JI, Sparen P, Tryggvadottir L, Weiderpass E, Pukkala E. Occupational exposures and male breast cancer: A nested case-control study in the Nordic countries. Breast 2019; 48:65-72. [PMID: 31539869 DOI: 10.1016/j.breast.2019.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Male breast cancer (MBC) is a rare and understudied disease. There is limited evidence on association between environmental and occupational agents and MBC. Some similarities in risk factors may be shared with female breast cancer. We evaluated solvents, metals, exhaust gases and other agents in relation to MBC within the large Nordic Occupational Cancer Study (NOCCA). METHODS The study included 1469 MBC cases and 7345 controls from Finland, Iceland and Sweden, matched for the date of birth, sex and country. Cases were identified through national cancer registries. Data on occupation and other demographic indicators were collected from census records and population registries. Overall, 24 occupational exposures were assessed. Exposure estimates were assigned by linking job titles to job-exposure matrices (NOCCA-JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. RESULTS Significantly decreased overall OR was observed for physical workload (OR = 0.78, 95% CI 0.67-0.91). Protective effect of physical workload was stronger by increasing exposure level with significant dose-response relationship (p-trend<0.01). Non-significantly increased ORs were observed for trichloroethylene, iron, lead, chromium, welding fumes and wood dust, and decreased ORs for asbestos, silica dust and perchloroethylene. However, these results were not consistent across all analyses. CONCLUSIONS The current study showed 20-25% protective effect for physical workload at work, while no strong evidence for other agents was observed.
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Affiliation(s)
- Madar Talibov
- Faculty of Social/Health Sciences, University of Tampere, Tampere, Finland.
| | - Johnni Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
| | | | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | | | - Eero Pukkala
- Faculty of Social/Health Sciences, University of Tampere, Tampere, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
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Abstract
Male breast cancer (MBC) is rare, tending to afflict sedentary men, with adolescent obesity being a risk factor. Men fare worse compared with matched females with breast cancer. The preponderance of ER+ve disease affects the molecular profile: most cases have luminal A tumors. Through male ignorance and risk-taking, delay is frequent and this lacuna needs addressing with health education. The major gene mutation responsible for MBC is BRCA2. Five single nucleotide polymorphisms (SNPs) are significantly and uniquely associated with MBC risk with two located in the 8q24.21 regions. Mastectomy is being gradually replaced by nipple-preserving surgery and radiotherapy but this trend could be expedited with neoadjuvant endocrine therapy. Significant advances will occur only after expansion of collaborative groups and this is a matter of pressing importance.
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Affiliation(s)
- Ian S Fentiman
- Research Oncology, Bermondsey Wing, Guy’s Hospital, London SE1 9RT
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Abstract
Male breast cancer (MBC) represents <1% of all breast cancers and little is known about its true etiology. The known risk factors associated with MBC are age, Klinefelter syndrome, BRCA2 mutation, high estrogen levels, gynecomastia, and cirrhosis of any cause. Obesity has been documented as a risk factor to MBC in some studies even though it is not officially recognized as a risk factor. Herein, we present a 53-year-old obese male with estrogen receptor-positive (ER+) breast cancer. Although this patient has a strong family history of ovarian cancer, obesity could have been an additive predisposing factor. As more cases of MBC in obese patients are explored, we might be able to gain a better understanding of its true etiology and mechanism.
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Affiliation(s)
- Joel Robinette
- Otolaryngology / Surgery, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Rob Olexo
- Family Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA
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Chai X, Sun MY, Jia HY, Wang M, Cao L, Li ZW, Wang DW. A prognostic nomogram for overall survival in male breast cancer with histology of infiltrating duct carcinoma after surgery. PeerJ 2019; 7:e7837. [PMID: 31632852 PMCID: PMC6796958 DOI: 10.7717/peerj.7837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The study was designed to construct and validate a nomogram for predicting overall survival (OS) of male breast cancer (MBC) patients with infiltrating duct carcinoma (IDC). Methods The cohort was selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 1, 2004 and December 31, 2013. Univariate and multivariate Cox proportional hazard (PH) regression models were performed. A nomogram was developed based on the significant prognostic indicators of OS. The discriminatory and predictive capacities of nomogram were assessed by Harrell's concordance index (C-index), calibration plots, area under the curve (AUC) and the decision curve analysis (DCA). Results The median and maximal survival time of 1862 eligible patients were 49 and 131 months, respectively. Multivariate analysis showed that age (P < 0.0001), marital status (P = 0.002), T stage (P < 0.0001), N stage (P = 0.021), M stage (P < 0.0001), progesterone receptor (PR) (P = 0.046), human epidermal growth factor receptor-2 (HER2) (P = 0.009), and chemotherapy (P = 0.003) were independent prognostic indicators of IDC of MBC. The eight variables were then combined to construct a 3-and 5-year nomogram. The C-indexes of the nomogram were0.740 (95% confidence interval [CI] [0.709-0.771]) and 0.718 (95% CI [0.672-0.764]) for the internal validation and external validation, respectively. A better discriminatory capacity was observed in the nomogram compared with the SEER summary stage (P < 0.001) and AJCC TNM staging systems (6th edition; P < 0.001) with respect to OS prediction. Good consistency was detected between the nomogram prediction and actual findings, as indicated by calibration curves. The AUC for 3-and 5-year OS was 0.739 (95% CI [0.693-0.786]) and 0.764 (95% CI [0.725-0.803]) in the training cohort and 0.737 (95% CI [0.671-0.803]) and 0.735 (95% CI [0.678-0.793]) in the validation cohort, respectively. The DCA demonstrated that the survival nomogram was clinically useful. Conclusions The nomogram was able to more accurately predict 3-and 5-year OS of MBC patients with IDC histology than were existing models.
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Affiliation(s)
- Xin Chai
- Breast Surgery Department, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Mei-Yang Sun
- Breast Surgery Department, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Hong-Yao Jia
- Breast Surgery Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Min Wang
- Department of Pathology, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Ling Cao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Zhi-Wen Li
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Dun-Wei Wang
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin, China
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Popa-Nimigean V, Ahmed M. Current state of surgical management for male breast cancer. Transl Cancer Res 2019; 8:S457-S462. [PMID: 35117123 PMCID: PMC8798217 DOI: 10.21037/tcr.2019.04.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/15/2019] [Indexed: 11/17/2022]
Abstract
Management guidelines for male breast cancer have long been extrapolated from those for female breast cancer, which are based on large, randomised-controlled trials. While there are no randomised-controlled trials for male breast cancer management mainly due to the rarity of the disease, the only type of evidence available comes from retrospective studies, subject to selection biases and small sample sizes. Male breast cancer, while similar to female breast cancer in many respects, has some important differences that can affect management choices. Most cancers are oestrogen and progesterone receptor positive, and usually more advanced at presentation than female breast cancer. This is likely due to less breast parenchyma in male patients and delay to diagnosis. The classical management option for male patients with breast cancer is mastectomy, due to small tumour-to-breast ratio and often central position of the tumour. Breast conserving surgery is still useful in selected cases and has similar outcomes when compared to mastectomies in these patients. For patients with clinically negative lymph nodes, sentinel lymph node biopsy offers the same prognosis as axillary lymph node dissection, but with less associated morbidity. Endocrine therapy is of particular use, due to high levels of receptor positivity. Adjuvant endocrine therapy seems to significantly improve overall survival of male patients with breast cancer and while no prospective evidence exists for neoadjuvant hormonal therapy, there is hope that this is a useful management option as well. Radiotherapy is also useful in an adjuvant setting, particularly when combined with endocrine therapy. Better identification of patients, less delay from presentation to diagnosis and more collaborative efforts are key in improving the management, prognosis and outcomes of patients with male breast cancer.
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Affiliation(s)
| | - Muneer Ahmed
- Division of Cancer Studies, King's College London, London WC2R 2LS, UK
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Agbroko SO, Rojas KE, Manasseh DM, Borgen P. Male DCIS diagnosed after use of over-the-counter hormonal supplement. Int J Surg Case Rep 2019; 57:60-62. [PMID: 30903856 PMCID: PMC6430715 DOI: 10.1016/j.ijscr.2019.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Male breast cancer is a rare disease. Although epidemiologic and genetic factors are associated with male breast cancer, hormonal factors may also play a role. CASE PRESENTATION We report the case of a 39-year-old BRCA negative male patient taking a sexual performance enhancement supplement who presented with worsening asymmetric gynecomastia and unilateral spontaneous bloody nipple discharge and was found to have ductal carcinoma in-situ. DISCUSSION The altered cellular environment related to the hormone contents of the supplement coincided with the rapid worsening of his gynecomastia and may have played a role in the development of the ductal carcinoma in-situ, or growth of an existing focus. CONCLUSION The use of hormonal male enhancement supplements can lead to higher levels of androgens in users. It is possible for this altered hormonal environment to cause the growth of tumor or promote the progression of an existing focus.
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Affiliation(s)
- S O Agbroko
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn NY, United States.
| | - K E Rojas
- Department of Surgery, Maimonides Medical Center, Brooklyn NY, United States
| | - D M Manasseh
- Department of Surgery, Maimonides Medical Center, Brooklyn NY, United States
| | - P Borgen
- Department of Surgery, Maimonides Medical Center, Brooklyn NY, United States
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47
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Insight into genetic susceptibility to male breast cancer by multigene panel testing: Results from a multicenter study in Italy. Int J Cancer 2019; 145:390-400. [DOI: 10.1002/ijc.32106] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/29/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022]
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Smith CJ, Perfetti TA, King JA. Rodent 2-year cancer bioassays and in vitro and in vivo genotoxicity tests insufficiently predict risk or model development of human carcinomas. TOXICOLOGY RESEARCH AND APPLICATION 2019. [DOI: 10.1177/2397847319849648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Carr J Smith
- Albemarle Corporation, Mobile, AL, USA
- Department of Nurse Anesthesia, Florida State University, Panama City, FL, USA
| | | | - Judy A King
- Department of Pathology and Translational Pathobiology, LSU Health Shreveport, Shreveport, LA, USA
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49
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Rizzolo P, Silvestri V, Bucalo A, Zelli V, Valentini V, Catucci I, Zanna I, Masala G, Bianchi S, Spinelli AM, Tommasi S, Tibiletti MG, Russo A, Varesco L, Coppa A, Calistri D, Cortesi L, Viel A, Bonanni B, Azzollini J, Manoukian S, Montagna M, Radice P, Palli D, Peterlongo P, Ottini L. Contribution of MUTYH Variants to Male Breast Cancer Risk: Results From a Multicenter Study in Italy. Front Oncol 2018; 8:583. [PMID: 30564557 PMCID: PMC6288482 DOI: 10.3389/fonc.2018.00583] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
Inherited mutations in BRCA1, and, mainly, BRCA2 genes are associated with increased risk of male breast cancer (MBC). Mutations in PALB2 and CHEK2 genes may also increase MBC risk. Overall, these genes are functionally linked to DNA repair pathways, highlighting the central role of genome maintenance in MBC genetic predisposition. MUTYH is a DNA repair gene whose biallelic germline variants cause MUTYH-associated polyposis (MAP) syndrome. Monoallelic MUTYH variants have been reported in families with both colorectal and breast cancer and there is some evidence on increased breast cancer risk in women with monoallelic variants. In this study, we aimed to investigate whether MUTYH germline variants may contribute to MBC susceptibility. To this aim, we screened the entire coding region of MUTYH in 503 BRCA1/2 mutation negative MBC cases by multigene panel analysis. Moreover, we genotyped selected variants, including p.Tyr179Cys, p.Gly396Asp, p.Arg245His, p.Gly264Trpfs*7, and p.Gln338His, in a total of 560 MBC cases and 1,540 male controls. Biallelic MUTYH pathogenic variants (p.Tyr179Cys/p.Arg241Trp) were identified in one MBC patient with phenotypic manifestation of adenomatous polyposis. Monoallelic pathogenic variants were identified in 14 (2.5%) MBC patients, in particular, p.Tyr179Cys was detected in seven cases, p.Gly396Asp in five cases, p.Arg245His and p.Gly264Trpfs*7 in one case each. The majority of MBC cases with MUTYH pathogenic variants had family history of cancer including breast, colorectal, and gastric cancers. In the case-control study, an association between the variant p.Tyr179Cys and increased MBC risk emerged by multivariate analysis [odds ratio (OR) = 4.54; 95% confidence interval (CI): 1.17-17.58; p = 0.028]. Overall, our study suggests that MUTYH pathogenic variants may have a role in MBC and, in particular, the p.Tyr179Cys variant may be a low/moderate penetrance risk allele for MBC. Moreover, our results suggest that MBC may be part of the tumor spectrum associated with MAP syndrome, with implication in the clinical management of patients and their relatives. Large-scale collaborative studies are needed to validate these findings.
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Affiliation(s)
- Piera Rizzolo
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Agostino Bucalo
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Veronica Zelli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Virginia Valentini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Irene Catucci
- Genome Diagnostics Program, IFOM - The FIRC Institute of Molecular Oncology, Milan, Italy
| | - Ines Zanna
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Stefania Tommasi
- Molecular Genetics Laboratory, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Maria Grazia Tibiletti
- Dipartimento di Patologia, ASST Settelaghi and Centro di Ricerca per lo studio dei tumori eredo-familiari, Università dell'Insubria, Varese, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | | | - Anna Coppa
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Calistri
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Laura Cortesi
- Department of Oncology and Haematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Viel
- Unità di Oncogenetica e Oncogenomica Funzionale, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Jacopo Azzollini
- Unità di Genetica Medica, Dipartimento di Oncologia Medica ed Ematologia, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Siranoush Manoukian
- Unità di Genetica Medica, Dipartimento di Oncologia Medica ed Ematologia, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Marco Montagna
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Paolo Radice
- Unità di Ricerca Medicina Predittiva: Basi molecolari Rischio genetico e Test genetici, Dipartimento di Ricerca, Fondazione IRCCS Istituto Nazionale Tumori (INT), Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Paolo Peterlongo
- Genome Diagnostics Program, IFOM - The FIRC Institute of Molecular Oncology, Milan, Italy
| | - Laura Ottini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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50
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Cronin PA, Romanoff A, Zabor EC, Stempel M, Eaton A, Smyth LM, Ho AY, Morrow M, El-Tamer M, Gemignani ML. Influence of Age on the Clinical Outcome of Breast Cancer for Men and the Development of Second Primary Cancers. Ann Surg Oncol 2018; 25:3858-3866. [PMID: 30298320 DOI: 10.1245/s10434-018-6767-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Low incidence of breast cancer in men (BCM) (< 1% of all breast cancers) has led to a paucity of outcome data. This study evaluated the impact of age on BCM outcomes. METHODS For this study, BCM patients treated between 2000 and 2011 were stratified by age (≤ 65 or > 65 years). Kaplan-Meier methods were used to compare overall survival (OS) and breast cancer-specific survival (BCSS). Competing-risk methods analyzed time to second primary cancers (SPCs), with any-cause death treated as a competing risk. RESULTS The study identified 152 BCM patients with a median age of 64 years (range 19-96 years). The median body mass index (BMI) was 28 kg/m2. Men age 65 years or younger (n = 78, 51%) were more overweight/obese than men older than 65 years (n = 74, 49%) (89% vs 74%, respectively; P = 0.008). Both groups had similar nodal metastases rates (P = 0.4), estrogen receptor positivity (P = 1), and human epidermal growth factor receptor 2 (HER2)neu overexpression (P = 0.6). Men 65 years of age or younger were more likely to receive chemotherapy (P = 0.002). The median follow-up period was 5.8 years (range 0.1-14.4 years). The 5-year OS was 86% (95% confidence interval [CI] 80-93%), whereas the 5-year BCSS was 95% (95% CI 91-99%). The BCM patients 65 years of age and younger had better OS (P = 0.003) but not BCSS (P = 0.8). The 5-year cumulative incidence of SPC was 8.4% (95% CI 3.4-13.4%). The prior SPC rate was higher for men older than 65 years (n = 20, 31%) than for those age 65 years or younger (n = 7, 11%) (P = 0.008). This did not account for differences in life years at risk. No difference was observed in SPC cumulative incidence stratified by age (P = 0.3). CONCLUSIONS Men 65 years of age or younger received more chemotherapy and had improved OS, but not BCSS, compared with men older than 65 years. For all BCM, SPC is a risk, and appropriate screening may be warranted.
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Affiliation(s)
- Patricia A Cronin
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anya Romanoff
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillian M Smyth
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice Y Ho
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mahmoud El-Tamer
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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