Male breast cancer: Progress, prognosis and future pathways

Long-term survival and BRCA status in male breast cancer: a retrospective single-center analysis

Background

Male breast cancer (MBC) is rare. Given the paucity of randomized trials, treatment is generally extrapolated from female breast cancer guidelines.

Methods

This is a retrospective analysis of all male patients presenting with MBC at the Department of Oncology at University Federico II of Naples between January 1989 and January 2014. We recorded the following data: baseline characteristics (age, height, weight, body mass index, risk factors, family history), tumor characteristics (side affected, stage, histotype, hormonal and HER2 status, and Ki-67 expression), treatment (type of surgery, chemotherapy, endocrine therapy, and/or radiotherapy), BRCA1/2 mutation status (if available), other tumors, and long-term survival.

Results

Forty-seven patients were analyzed. Median age was 62.0 [55.0–72.0]. Among risk factors, obesity and family history of breast cancer were associated with 21 % and 30 % of MBC cases, respectively. The majority of tumors were diagnosed at an early stage: stage I (34.0 %) and stage II (44.7 %). Infiltrating ductal carcinoma was the most frequent histologic subtype (95.8 %). Hormone receptors were generally positive (88.4 % of cases were Estrogen receptor [ER] positive and 81.4 % Progesteron receptor [PgR] positive). Human epidermal growth factor receptor 2 (HER2) was positive in 26.8 % of cases; 7.0 % of MBCs were triple negative. The tumor had high proliferation index (Ki67 ≥ 20 %) in 64.7 %. Surgery was predominantly mastectomy (85.1 %), whereas quadrantectomy was performed in 14.9 % of patients. Adjuvant chemotherapy was administered to 70.7 % of patients, endocrine therapy to 90.2 %, trastuzumab to 16.7 % and radiotherapy to 32.6 %. BRCA status was available for 17 patients: 10 wild-type, 1 BRCA1 carrier, 5 BRCA2 carriers, 1 unknown variant sequence. The overall estimated long-term survival was about 90 % at 5 years, 80 % at 10 years and 70 % at 20 years. Patients carrying a BRCA mutation had a significantly lower survival than patients with wild-type BRCA (p = 0.04).

Conclusions

Long-term survival was high in MBC patients referred to our clinical unit. Survival was poorer in BRCA-mutated patients than in patients with wild-type BRCA.

A male patient with acromegaly and breast cancer: treating acromegaly to control tumor progression

Background

Acromegaly is a rare disease associated with an increased risk of developing cancer.

Case presentation

We report the case of a 72-year-old man who was diagnosed with acromegaly (IGF-1 770 ng/ml) and breast cancer. Four years before he suffered from a colon-rectal cancer. Pituitary surgery and octreotide-LAR treatment failed to control acromegaly. Normalization of IGF-1 (97 ng/ml) was obtained with pegvisomant therapy. Four years after breast cancer surgery, 2 pulmonary metastases were detected at chest CT. The patient was started on anastrozole, but, contrary to medical advice, he stopped pegvisomant treatment (IGF-I 453 ng/ml). Four months later, chest CT revealed an increase in size of the metastatic lesion of the left lung. The patient was shifted from anastrozole to tamoxifen and was restarted on pegvisomant, with normalization of serum IGF-1 levels (90 ng/ml). Four months later, a reduction in size of the metastatic lesion of the left lung was detected by CT. Subsequent CT scans throughout a 24-month follow-up showed a further reduction in size and then a stabilization of the metastasis.

Conclusions

This is the first report of a male patient with acromegaly and breast cancer. The clinical course of breast cancer was closely related to the metabolic control of acromegaly. The rapid progression of metastatic lesion was temporally related to stopping pegvisomant treatment and paralleled a rise in serum IGF-1 levels. Normalization of IGF-1 after re-starting pegvisomant impressively reduced the progression of metastatic breast lesions. Control of acromegaly is mandatory in acromegalic patients with cancer.

Male breast cancer: a clinicopathologic study of 42 patients in eastern India

Retrospective review of presentation, treatment and outcome of male breast cancer in a tertiary cancer centre in eastern India. Data of 42 male breast cancer (MBC) patients, who presented between April, 2001 and March, 2008 were collected from institute records with respect to epidemiological characteristics, clinical and pathological parameters, treatment pattern and outcome. This series includes 42 patients with mean age of 56 years (range 31-78 years). MBC represented 1.1 % of all breast cancer. History of lump in the breast with duration ranging from 1 month to 4 years was the most common clinical presentation (80.95 %). Histopathology found infiltrating ductal carcinoma in 35 (83.33 %), followed by papillary carcinoma in 3 (7.14 %), undifferentiated carcinoma in 2 (4.76 %), mucinous carcinoma in 1 (2.38 %) and myxofibrosarcoma in 1 (2.38 %) patient. Hormone receptor (HR) study was performed on 29 patients. Twenty six (89.7 %) patients were hormone receptor positive in that 8 (27.6 %) were ER positive and 18 (62.1 %) were ER and PR positive. 3 (10.3 %) were hormone receptor negative.Axillary lymph node dissection was performed on 30 patients. Of those, 60 % were found to be positive (pN+) and 40 % were negative (pN-). Of the patients with invasive carcinoma 2.86 % were pathologic stage I, 37.14 % stage II, 42.86 % stage III and 17.14 % stage IV. Of the 35 treated patients, total 30 (85.71 %) patients underwent surgery. The surgery consisted of a modified radical mastectomy (MRM) 24 (80 %), radical mastectomy according to Halsted (RM) 6 (20 %). Adjuvant therapy i.e. Chemotherapy and Radiotherapy was administered to the patient based upon their stage. The standard treatment for all HR positive patients was administration of tamoxifen. Based upon the follow-up information (ranging from 17 month to 136 months), 4 (14.28 %) patients developed local recurrence over 4 to 26 months (mean17.5 months) and 5 patients developed distant metastasis over 24 to132 months (mean 78 months). Disease specific survival varied from 4 months to 132 months, with a mean of 56.75 months. Thirteen out of 28 evaluable patients (46.43 %) were disease free at 5 years. Male Breast cancer is a rare disease often ignored in the community, because of which it is seeks medical attention at advanced stage. Majority of MBC are found to be HR positive, hence hormonal therapy should to be strongly considered and multicentric prospective studies are needed to improve outcome.