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Sanli AN, Tekcan Sanli DE, Altundag MK, Aydogan F. Is There a Survival Difference Between Male and Female Breast Cancer Subtypes According to the Prognostic Staging System? A Population-Based Cohort Study. Am Surg 2024; 90:788-799. [PMID: 37916470 DOI: 10.1177/00031348231212588] [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: 11/03/2023]
Abstract
BACKGROUND In retrospective studies investigating the difference in survival by gender, there are conflicting results. It was aimed to compare overall survival (OS) and breast cancer-specific survival (BCSS) in male and female breast cancer subtypes according to the prognostic staging system. METHODS Overall survival rates and BCSS rates of patients diagnosed with breast cancer between 2010 and 2019 compared by gender for all cohorts, stages, and molecular subtypes using the SEER Database. The stage has been rearranged according to the eighth edition of the AJCC. RESULTS 364 039 patients were included in the study. .7% (n = 2503) of all breast cancers were male breast cancer. Overall survival (male: 5-year OS 73.9%, female = 5-year OS 86%) and BCSS rates (male: 5-year BCSS 78.9%, female = 5-year BCSS 94.7%) were significantly higher in females than in males for all cohorts. OS (male: 5-year OS 66.2% vs female: 5-year OS 88.3%), and BCSS (male: 5-year BCSS 88.4% vs female: 5-year 93.6%) rates were higher in hormone receptor (HR)-positive/Her2-negative female patients. Overall survival rate is higher in females in stage I (male: 5-year OS 81.5%, female: 5-year OS 92.8%), and BCSS rate is higher in stage I (male: 5-year BCSS 94.8%, female: 5-year BCSS 97.5%). Males have 2 times (HR = 2.023) higher overall mortality risk than females, but the risk of dying from breast cancer is only 1.6 times (HR = 1.596) higher. CONCLUSIONS Breast cancer-specific mortality is significantly higher in male breast cancers, especially in the early stage, and HR-positive subtype than females.
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Affiliation(s)
- Ahmet Necati Sanli
- Department of General Surgery, Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | | | | | - Fatih Aydogan
- Breast Health Center, Memorial Bahcelievler Hospital, Istanbul, Turkey
- Department of General Surgery, Faculty of Medicine, Kırklareli University, Kırklareli, Turkey
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Pistolese CA, Perretta T, Claroni G, Anemona L, Servadei F, Collura A, Censi M, Materazzo M, Pellicciaro M, Lamacchia F, Vanni G. A Prospective Evaluation of Tru-Cut Biopsy and Fine-needle Aspiration Cytology in Male Breast Cancer Detection. In Vivo 2021; 34:3431-3439. [PMID: 33144451 DOI: 10.21873/invivo.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Male breast-cancer (MBC) is often diagnosed late. Our purpose was to evaluate fine-needle aspiration cytology (FNAC) versus Tru-Cut biopsy (TCNB) in MBC diagnosis. PATIENTS AND METHODS Men with suspicious breast lesions were prospectively enrolled; 54 met the inclusion criteria and underwent FNAC and TCNB. FNAC, TCNB and gold-standard results were compared. RESULTS Unsatisfactory results were 11.1% after FNAC and none after TCNB (p=0.027). After gold-standard evaluation, the diagnosis of FNAC and TCNB was confirmed, respectively, in 63.0% and 98.1% and changed in 37.0% and 1.9% (p<0.001). The malignancy rate after FNAC, TCNB and surgery were, respectively, 25.9%, 33.3% and 35.1% (FNAC vs. TCNB p=0.5276, FNAC vs. surgery p=0.404; TCNB vs. surgery p=1). Among invasive carcinomas, 93.8% were identified by FNAC vs. 87.5% by TCNB (p=1); all ductal carcinoma in situ (DCIS) were detected after TCNB and none after FNAC (p=0.1). CONCLUSION FNAC leads to a significantly higher number of inadequate samplings and seems to be subject to increased DCIS misdiagnoses. TCNB correlated better to the final histological report.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Giulia Claroni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Alberto Collura
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Michela Censi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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Khan NAJ, Tirona M. An updated review of epidemiology, risk factors, and management of male breast cancer. Med Oncol 2021; 38:39. [PMID: 33721121 DOI: 10.1007/s12032-021-01486-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/24/2021] [Indexed: 01/21/2023]
Abstract
Unlike female breast cancer, male breast cancer (MBC) is rare and not very well understood. Prospective data in the management of MBC are lacking and majority of treatment strategies are adopted from the established guidelines for breast cancer in women. The understanding of biology, clinical presentation, genetics, and management of MBC is evolving but there still remains a large knowledge gap due to the rarity of this disease. Older age, high estradiol levels, klinefelter syndrome, radiation exposure, gynecomastia, family history of breast cancer, BRCA2 and BRCA1 mutation are some of the known risk factors for MBC. Routine screening mammography is not recommended for asymptomatic men. Diagnostic mammogram with or without ultrasound should be considered if there is a suspicion for breast mass. Majority of men with early-stage breast cancer undergo mastectomy whereas breast conserving surgery (BCS) with sentinel lymph node biopsy (SLNB) remains an alternative option in selected cases. Since the majority of MBC are hormone receptor positive (HR+), adjuvant hormonal therapy is required. Tamoxifen for a total of 5 to 10 years is the mainstay adjuvant hormonal therapy. The role of neoadjuvant and adjuvant chemotherapy for early-stage breast cancer is uncertain and not commonly used. The role of gene recurrence scores like oncotype Dx and mammaprint is evolving and can be used as an aid for adjuvant chemotherapy. Majority of metastatic MBC are treated with hormonal therapy with either tamoxifen, gonadotropin-releasing hormone agonist (GnRH) with aromatase inhibitors (AI), or fulvestrant. Chemotherapy is reserved for patients with visceral crisis or rapidly growing tumors.
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Affiliation(s)
- Noman Ahmed Jang Khan
- Department of Hematology and Oncology, Joan C. Edwards School of Medicine at Marshall University, 1400 Hal Greer Blvd, Huntington, WV, 25701, USA.
| | - Maria Tirona
- Department of Hematology and Oncology, Joan C. Edwards School of Medicine at Marshall University, 1400 Hal Greer Blvd, Huntington, WV, 25701, USA
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Italian Men Tested for BRCA1/2 Mutation: Psychological Distress during 6-Month Follow-Up. JOURNAL OF ONCOLOGY 2020; 2020:3987935. [PMID: 32089686 PMCID: PMC7013343 DOI: 10.1155/2020/3987935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/12/2019] [Accepted: 01/11/2020] [Indexed: 11/23/2022]
Abstract
Introduction. Male breast cancer (MBC) is a rare disease, whose main risk factor is genetic vulnerability. Despite care of men with MBC is modeled on care of women, men's experiences with the disease and concerns related to the status of genetic mutation carrier are unique. So far, little is known concerning the psychological impact in BRCA1/2 testing, especially with regard to specific subset of individuals, such as male subjects and the elderly.
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Bootsma TI, Duijveman P, Pijpe A, Scheelings PC, Witkamp AJ, Bleiker EMA. Unmet information needs of men with breast cancer and health professionals. Psychooncology 2020; 29:851-860. [PMID: 32040237 PMCID: PMC7317856 DOI: 10.1002/pon.5356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/26/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022]
Abstract
Objective Male breast cancer (MBC) is rare. Information about breast cancer is usually designed for female patients. However, in males this disease and some side effects differ from its female counterpart. Therefore, there is a need for male‐specific information. The aim was to assess unmet information needs of (a) MBC patients and (b) health professionals. Methods Dutch MBC patients (diagnosed between 2011 and 2016 in 21 hospitals), patient advocates and partners were invited to participate in focus groups and/or complete a paper‐based questionnaire on information needs. In addition, an online questionnaire on information needs was sent to health professionals involved in MBC patient care. Results In three focus groups with MBC patients (N = 12) and partners (N = 2) the following unmet information themes were identified: patients' experiences/photographs, symptoms, (delay of) diagnosis, treatments, side effects, follow‐up, psychological impact/coping, genetics and family, research and raising awareness. 77 of 107 MBC patients (72%) completed the questionnaire: most patients lacked information about acute (65%) or late (56%) side effects, particularly sexual side effects. Among health professionals, 110 of 139 (79%) had searched for MBC‐related information, specifically: patient information, anti‐hormonal therapy, genetic testing, research, and psychosocial issues. Conclusions Unmet information needs in MBC patients and health professionals were identified. Specific information on MBC should be developed to improve timely diagnosis, quality of life, treatment, and survival. A targeted website is an ideal tool to meet these needs. Therefore, we integrated these results into a user‐centered design to develop an informative website, www.mannenmetborstkanker.nl.
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Affiliation(s)
- Tom I Bootsma
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Petra Duijveman
- Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Anouk Pijpe
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pernilla C Scheelings
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arjen J Witkamp
- Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Pellini F, Granuzzo E, Urbani S, Mirandola S, Caldana M, Lombardi D, Fiorio E, Mandarà M, Pollini GP. Male Breast Cancer: Surgical and Genetic Features and a Multidisciplinary Management Strategy. Breast Care (Basel) 2020; 15:14-20. [PMID: 32231493 PMCID: PMC7098299 DOI: 10.1159/000501711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease with a rising incidence trend. The major risk factors related to MBC are a positive family history of breast cancer (BC) and BRCA1/2 mutations, which indicate a relevant genetic role. METHODS In this retrospective series, we enrolled 69 male patients presenting with male breast cancer (MBC) between 01/01/1992 and 31/12/2018, and 26 high-risk not-affected men presenting between 01/01/2016 and 31/12/2018. Participants' electronic clinical records were reviewed. Patients' data reported age at diagnosis, tumor characteristics, therapeutic management, and BRCA1/2 status as well as a family history of breast, ovarian, or prostate cancer (PCa) in first-degree relatives. RESULTS We analyzed 69 MBC patients. Median age was 64 years. The majority of tumors diagnosed were of an early TNM stage. The most frequent histological subtype was invasive ductal carcinoma (76.7%). Hormone receptors were positive in >90% of MBC cases. Nearly all patients underwent modified radical mastectomy or total mastectomy. Adjuvant endocrine therapy was delivered in 59.4%. Among MBC-affected patients, we recorded a high percentage of a positive family history of BC. Mutational analysis for the BRCA1/2 genes was performed in 17 MBC patients; 11.8% were carriers of BRCA2 pathogenic mutations. Among 26 healthy high-risk subjects included in this case series, 4 were BRCA1 mutation carriers and 9 were BRCA2 mutation carriers. DISCUSSION We evaluated the distribution of clinicopathological characteristics in MBC subjects and assessed the frequency of mutations in the BRCA genes in affected patients and healthy high-risk subjects, with the aim of proposing a surveillance program for BC and PCa.
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Affiliation(s)
- Francesca Pellini
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Eleonora Granuzzo
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Silvia Urbani
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Sara Mirandola
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Marina Caldana
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Davide Lombardi
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Elena Fiorio
- Complex Operative Unit of Oncology, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
| | - Marta Mandarà
- Unit of Oncology, San Bonifacio Hospital-ULSS 9, Verona, Italy
| | - Giovanni Paolo Pollini
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Verona, Italy
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Hwang EJ, Cha JH. A Review on Gynecomastia and Male Breast Cancer for Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1096-1108. [PMID: 36238022 PMCID: PMC9431879 DOI: 10.3348/jksr.2019.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Eun Jin Hwang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Gan Q, Joseph CT, Guo M, Zhang M, Sun X, Gong Y. Utility of NKX3.1 Immunostaining in the Detection of Metastatic Prostatic Carcinoma on Fine-Needle Aspiration Smears. Am J Clin Pathol 2019; 152:495-501. [PMID: 31175351 DOI: 10.1093/ajcp/aqz063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES NK3 homeobox 1 (NKX3.1) has been increasingly used to diagnose metastatic prostatic carcinoma in histologic samples. However, its utility and reliability in cytologic direct smears have not been studied. METHODS A total of 59 fine-needle aspiration (FNA) cases with a definitive diagnosis of metastatic carcinoma from the prostate were included. The cases were grouped based on different Gleason score in their corresponding primary tumors and morphologic variants. For each case, tumor cells were immunostained with NKX3.1, prostate-specific antigen (PSA), and prostatic acid phosphatase (PAP) on cell-transferred smears. RESULTS NKX3.1 was strongly and diffusely positive in all 40 metastatic prostatic adenocarcinomas, including those with ductal features, but negative for the 19 small cell carcinoma (SmCC) cases. NKX3.1 had a better detection rate than PSA (13/50, 26%) and PAP (0/47, 0%). CONCLUSIONS NKX3.1 immunostaining on FNA smears is highly reliable for detecting metastatic prostatic carcinomas of conventional and ductal types but not for SmCC.
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Affiliation(s)
- Qiong Gan
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Cicily T Joseph
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Ming Guo
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Miao Zhang
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Xiaoping Sun
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Yun Gong
- Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston
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Kinoshita H, Kashiwagi S, Teraoka H, Mori T, Kuroda K, Nanbara M, Noda E, Chikugo T, Hirakawa K, Ohira M. Intracystic papillary carcinoma of the male breast: a case report. World J Surg Oncol 2018; 16:15. [PMID: 29361955 PMCID: PMC5781267 DOI: 10.1186/s12957-018-1318-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 01/12/2018] [Indexed: 01/13/2023] Open
Abstract
Background Intracystic papillary carcinoma (IPC) is defined as cancer that develops from the wall of a cyst in the breast. As breast cancer in men accounts for only 1% of all breast cancers, male IPC is an extremely rare form of the disease. The present case report examines IPC in a man, along with an in-depth literature discussion. Case presentation A 64-year-old Japanese man noticed a mass in the right breast and sought medical attention. An elastic and soft neoplastic 3-cm lesion was palpated in the right papilla. As a 1-cm solid tumor with a gradual rise from the cyst wall was confirmed within the cyst, vacuum-assisted biopsy (VAB) was performed on that site. Pathological examination of the biopsy revealed heterotypic cells with an enlarged oval nucleus forming dense papillary structures mainly of vascular connective tissue component. Contrast-enhanced computed tomography (CT) confirmed thickening of the wall that protruded outside the cyst. The preoperative diagnosis was right breast cancer (male IPC) TisN0M0 stage 0 luminal B-like. Total mastectomy and sentinel lymph node biopsy were performed. In the excised specimen, a 4.0-cm unilocular cyst was found, along with a 1-cm solid tumor with a gradual rise from the cyst wall. Pathological diagnosis of the resected specimen shared similar characteristics with the solid tumor in the cyst: notably, an oval nucleus with histologically clear nucleolus and fine granular chromatin, cylindrically shaped heterotypic cells, and the presence of basophilic cells in the papillary growth with a thin stem of fibrovasculature as the axis. Some invasion of tumor cells into the interstitium was confirmed. As such, the final diagnosis was right breast cancer (male IPC) T2N0M0 stage IIA luminal B-like. The expression of hormone receptor (ER and PgR) was high, and endocrine therapy was initiated postoperatively (20 mg/day tamoxifen). At the present time (3 months postoperation), there has not been any evidence of metastasis. Conclusions We reported a rare case of an IPC in the male breast, along with a literature review.
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Affiliation(s)
- Haruhito Kinoshita
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Hitoshi Teraoka
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Takuya Mori
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Kenji Kuroda
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan.,Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mikio Nanbara
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Eiji Noda
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Takaaki Chikugo
- Department of Pathology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, 589-8511, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Li X, Yang J, Krishnamurti U, Huo L, Ward KC, O'Regan R, Peng L. Hormone Receptor-Positive Breast Cancer Has a Worse Prognosis in Male Than in Female Patients. Clin Breast Cancer 2017; 17:356-366. [DOI: 10.1016/j.clbc.2017.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 12/18/2022]
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