MBC behaves in a way similar to FBC in postmenopausal women [
6]. Unlike FBC, there is only one peak at 67–71 years of age [
2,
4,
6]. Family history, genetic factors (for example,
BRCA gene carriers,
AR and
CYP17 gene mutation, Klinefelter syndrome, Cowden syndrome), exogenous oestrogen administration and testicular anomalies are among the risk factors [
1‐
4,
6], while radiation, obesity and alcohol use are proposed but not widely accepted as risk factors [
2,
3,
6]. There is no proven association between gynaecomastia and MBC [
4,
6]. Histologically, more than 85% of tumours are of the invasive ductal type [
4,
6]. Furthermore, over 90% of MBC express ER while 81% express PgR [
5,
8]. C-erb-B2 is less likely to be expressed (about 5%) [
2,
3]. In men, 20% of the circulating estrogen is produced by the testis while about 80% results from peripheral aromatisation of androgens [
3,
9]. The usual presentation is a palpable painless lump with or without skin changes or nipple involvement but often diagnosis is delayed [
4,
6]. The sensitivity of the mammogram is reported to be 92% while specificity is 90% [
6]. Breast US can be used to evaluate the tumour in the same way as in women [
2,
4,
10]. The prognosis depends on tumour size, grade and extent of lymph node involvement in the same way as in FBC [
2,
6]. Overall survival rate when corrected for age is similar to that of FBC [
2,
6].
Traditionally patients with MBC undergo modified radical mastectomy with either SNB or axillary node clearance (ANC) [
2,
3,
6]. Despite the lack of firm evidence about the safety of SNB, increasingly there is an acceptance of the technique and its use [
2,
6]. Radiation therapy seems to prevent local recurrence but it is not known whether it adds anything to survival. The indications and dose remain the same as in women [
2,
6]. Ablative techniques aiming to control hormones, including orchidectomy, adrenalectomy and hypophysectomy, have been used in the past but had severe side effects, therefore medical hormone manipulation has been tried [
3,
5]. For those patients with hormone receptor-positive tumours, there is a clear benefit from the use of Tamoxifen in both disease-free and overall survival [
3,
5,
6,
11,
12]. There is also a proven effectiveness in those patients with metastatic disease and, therefore, Tamoxifen has been incorporated in the treatment of MBC [
2,
3,
5,
11]. There is not sufficient evidence for the use of aromatase inhibitors despite the advances and proven efficacy in FBC and more studies need to be done [
2,
3,
5]. There are case reports supporting a good response to Letrozole [
3,
13] even after failure of Tamoxifen [
3]. There is also some evidence about the effectiveness of adjuvant chemotherapy. One prospective study with a small number of patients (
N = 24) showed a survival benefit and other studies support this finding [
14]. Moreover, retrospective studies show reduction of the risk of local recurrence [
2,
6,
15].