Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases☆
Introduction
Male breast cancer (MBC) is a rare disease representing less than 1% of all malignancies in men and only 1% of all incident breast cancers (BC) in western countries [1], [2], [3], [4]. No randomized trials are available for this disease and less than ten retrospective studies including more than 200 cases have been reported [5], [6], [7], [8], [9], [10], [11].
This large co-operative study (489 cases) allowed us to assess histopathological features (e.g. axillary nodal involvement, hormone receptors status), locoregional and systemic treatment modalities, as well as clinical and histopathological prognostic factors.
Section snippets
Patients’ characteristics
From 1990 to 2005, 566 patients with MBC treated in eleven regional cancer centres, two private clinics and one university hospital were collected. Seventy-seven were excluded due to: metastasis at diagnosis (n = 24), previous or synchronous other cancer (n = 16), neoadjuvant treatment (n = 13), bilateral synchronous BC (n = 6) and pure in situ (DCIS) histology (n = 18). Hence, 489 cases were available for analysis. Median follow-up was 58 months.
Median age was 66 years (range: 24–94); 51 (10.5%)
Locoregional recurrences
Two patients out of 42 (5%) relapsed in the breast after conservative surgery and only 7 out of 433 (1.6%) after mastectomy. There are no significant predictive factors (e.g. tumours size/axillary nodal involvement/age) of local recurrence (LR).
Twenty-six (5.3%) patients had nodal relapse, 20 of whom in the axilla: 2 (12.5%) among 16 patients without axillary surgery, 23 (5.3%) among 436 patients who underwent AD (24 with previous SNB) and one (11%) among 9 patients who had SNB alone (p = NS).
Discussion
Our report confirms the high median age on the onset of the disease (66 years), such as in a large American series (67 years) [12]. Our axillary nodal involvement rate is similar to other reports [6], [13], [14], [15], [16], [17] and is significantly correlated to pT and SBR grading [5], [7]. In comparison with a recent national survey in women [18], the axillary nodal involvement rate in men is higher in pT1 (39% versus 34%), slightly less in pT2 (55% versus 60%) and identical (68%) in larger
Conclusion
Due to a better disease knowledge and optimal use of locoregional and systemic treatments, OS and DSS rates have recently become similar to women when compared at the same stage [63]. Whereas BC incidence seems to decline in women, several studies have shown a slight increase in men [64], [65], [66]. However, MBC occurs approximately 8–10 years later than FBC [2], [3], [11]; consequently, the impact of comorbidities and second neoplasm is more important and can induce confusion in comparative
Conflict of interest
There is no conflict of interest.
Acknowledgements
We are grateful to Natahlie HEIL and Diane PENET for their help in preparing this manuscript, and Pfizer for logistical support.
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Presented in part at the 30th Breast Cancer Symposium, San Antonio 12.12.07 and at the 6th European Breast Cancer Conference, Berlin 17.04.08.