Clinical Investigation
Management of Male Breast Cancer in the United States: A Surveillance, Epidemiology and End Results Analysis

Presented at the 54th Annual Meeting of the American Society for Radiology Oncology (ASTRO), October 28-November 1, 2012, Boston, MA.
https://doi.org/10.1016/j.ijrobp.2013.07.016Get rights and content

Purpose

To analyze the stage-specific management of male breast cancer (MBC) with surgery and radiation therapy (RT) and relate them to outcomes and to female breast cancer (FBC).

Methods and Materials

The Surveillance, Epidemiology, and End Results database was queried for all primary invasive MBC and FBC diagnosed from 1973 to 2008. Analyzable data included age, race, registry, grade, stage, estrogen and progesterone receptor status, type of surgery, and use of RT. Stage was defined as localized (LocD): confined to the breast; regional (RegD): involving skin, chest wall, and/or regional lymph nodes; and distant: M1. The primary endpoint was cause-specific survival (CSS).

Results

A total of 4276 cases of MBC and 718,587 cases of FBC were identified. Male breast cancer constituted 0.6% of all breast cancer. Comparing MBC with FBC, mastectomy (M) was used in 87.4% versus 38.3%, and breast-conserving surgery in 12.6% versus 52.6% (P<10−4). For males with LocD, CSS was not significantly different for the 4.6% treated with lumpectomy/RT versus the 70% treated with M alone (hazard ratio [HR] 1.33; 95% confidence interval [CI] 0.49-3.61; P=.57). Postmastectomy RT was delivered in 33% of males with RegD and was not associated with an improvement in CSS (HR 1.11; 95% CI 0.88-1.41; P=.37). There was a significant increase in the use of postmastectomy RT in MBC over time: 24.3%, 27.2%, and 36.8% for 1973-1987, 1988-1997, and 1998-2008, respectively (P<.0001). Cause-specific survival for MBC has improved: the largest significant change was identified for men diagnosed in 1998-2008 compared with 1973-1987 (HR 0.73; 95% CI 0.60-0.88; P=.0004).

Conclusions

Surgical management of MBC is dramatically different than for FBC. The majority of males with LocD receive M despite equivalent CSS with lumpectomy/RT. Postmastectomy RT is greatly underutilized in MBC with RegD, although a CSS benefit was not demonstrated. Outcomes for MBC are improving, attributable to improved therapy and its use in this unscreened population.

Introduction

Male breast cancer (MBC) is uncommon and rarely studied prospectively. As such, therapy recommendations are generally extrapolated from the female breast cancer (FBC) literature.

A large population-based study conducted in Europe and Asia demonstrated that males with breast cancer (BC) were significantly less likely to receive surgery and radiation therapy (RT) than females with BC. However, rates of use of chemotherapy and hormonal therapy were similar (1). Little is known about how MBC is treated across the United States, specifically with regard to the use of RT.

The goals of this study were to evaluate the stage-specific surgical and radiotherapeutic management of males with BC in the United States and relate them to outcomes with comparisons to the management and outcomes in FBC. United States population-based data were extracted from the Surveillance, Epidemiology and End Results (SEER) registry.

Section snippets

Methods and Materials

The SEER database is a National Cancer Institute database that now incorporates 17 registries representing approximately 26% of the population of the United States. Before 2001, when Kentucky, Louisiana, New Jersey, and all of California were added, approximately 14% of the US population was represented. To identify cases of MBC and FBC, the SEER database [SEER 17 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973-2008)] was queried for all males and females

Incidence and patient characteristics

The original data set consisted of 848,940; after removing patients with unrecoverable or missing data, a total sample size of 722,863 remained and was used for this analysis. These represented 4276 cases of MBC and 718,587 cases of FBC. Male breast cancer constituted 0.6% of all BC, and FBC constituted 99.4%. Median follow-up for all patients was 66 months (range, 0-431 months).

Male breast cancer was diagnosed at an older median age than FBC: 65-69 years versus 60-64 years (P<.0001). The

Discussion

To our knowledge, this is the largest study of MBC to address the utilization and impact of surgery and RT. As demonstrated in this and other studies, MBC is rare, with an incidence of 0.6% in the United States; it has an older age of disease onset and a greater likelihood of advanced disease presentation than FBC 1, 4, 5.

The initial surgical management of MBC is dramatically different than that of FBC. In this analysis the overwhelming majority of males treated definitively received a

References (20)

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Conflict of interest: none.

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