A recent analysis published by Yadav et al in Cancer reviewed how the treatment of male breast cancer has evolved over the years 2004 to 2014. In addition, certain patient-, tumor-, and treatment-related factors were found to be linked with better survival.
Male breast cancer comprises 1% of all breast cancer cases, yet no prospective randomized clinical trials specifically focused on male breast cancer have been successfully completed. Some studies suggest that the incidence of male breast cancer may be rising, however, and there is an increasing appreciation that the tumor biology of male breast cancer differs from that of female breast cancer.
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To examine how male breast cancer has been treated in the United States in recent years, and to identify factors associated with patient prognosis, a team led by Kathryn Ruddy, MD, MPH, and Siddhartha Yadav, MBBS, of the Mayo Clinic, analyzed information from the National Cancer Database on men diagnosed with stage I to III breast cancer between 2004 and 2014. A total of 10,873 patients were included, with a median age at diagnosis of 64 years old.
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Breast-conserving surgery was performed in 24% of patients, and 70% of patients undergoing breast conservation received radiation. Forty-four percent of patients received chemotherapy, and 62% of patients with estrogen receptor–positive disease received antiestrogen therapy.
During the study period, there was a significant increase in the rates of total mastectomy, contralateral prophylactic mastectomy, and post–breast-conservation radiation, as well as an increase in the rate of genomic testing on tumors and the use of antiestrogen therapy. Tamoxifen is the standard antiestrogen medication recommended for treatment of hormonally sensitive male breast cancer, but this study was not able to assess specific medications used.
Factors associated with worse overall survival were older age, black race, multiple comorbidities, high tumor grade and stage, and undergoing total mastectomy. Residing in higher income areas; having progesterone receptor–positive disease; and receiving chemotherapy, radiation, and antiestrogen therapy were associated with better overall survival.
“Our study highlights unique practice patterns and factors associated with prognosis in male breast cancer, furthering our understanding of the treatment and prognosis of male breast cancer,” said Dr. Ruddy. “The racial, economic, and age-related health disparities we found could inform future efforts to target interventions to optimize outcomes in men with breast cancer.”
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
