Breast Cancer in Men in the United States A Population-Based Study of Diagnosis, Treatment, and Survival

Applied Research Program, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
Cancer (Impact Factor: 4.9). 08/2010; 116(15):3558-68. DOI: 10.1002/cncr.25153
Source: PubMed

ABSTRACT Breast cancer in men is rare, so clinical trials are not practical. Recommendations suggest treating men who are diagnosed with breast cancer using the guidelines for postmenopausal women; however, to date, no population-based studies have evaluated patterns of care.
To examine characteristics, treatment, and survival among men with newly diagnosed breast cancer, in 2003 and 2004, 512 men were identified from the Surveillance, Epidemiology and End Results Program. Data were reabstracted and therapy was verified through the patients' treating physicians.
The majority of men (79%) were diagnosed through discovery of a breast lump or other signs/symptoms. Among men who had invasive disease, 86% underwent mastectomy, 37% received chemotherapy, and 58% received hormone therapy. In multivariate analysis, tumor size (P=.01) and positive lymph node status (P<.0001) were associated positively with the use of chemotherapy, whereas age group (P<.0001) and current unmarried status (P=.01) had negative associations. Among men who had invasive, estrogen receptor (ER)-positive/borderline tumors, the use of tamoxifen or aromatase inhibitors (AIs) was associated with age group (P=.05). Among men who had invasive disease, cancer mortality was associated with tumor size (P<.0001). Among men with ER-positive/borderline disease, increased cancer mortality was associated with tumor size (P<.0001), current unmarried status (P=.04), and decreased mortality with tamoxifen (P=.04).
Tumor characteristics and marital status were the primary predictors of therapy and cancer mortality among men with breast cancer. Although AIs are not currently recommended, they are commonly prescribed. However, their use did not result in a decrease in cancer mortality. Research must examine the efficacy of AIs with and without gonadotropin-releasing hormone analogues.

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    ABSTRACT: The use, effectiveness, and tolerability of tamoxifen, aromatase inhibitors, and trastuzumab in early and advanced male breast cancer were examined at a population level. A total of 158 consecutively referred men with invasive breast cancer diagnosed between 2000 and 2010 were identified. Stage and prognostic factors were compared with a random sample of contemporary female patients. Survival outcomes were compared with a separate female cohort matched 2:1 by prognostic and treatment factors. Men were older (median 69.5 years) than women (median 60 years) and presented with more advanced stage disease. Estrogen receptor was positive in 96% (n = 152) of cases. Tamoxifen was more commonly used than aromatase inhibitors in the curative and metastatic settings. Adherence to adjuvant tamoxifen therapy was generally adequate with estimated actuarial rates of persistence at 1 year and 3.5 years of 89% and 70%, respectively. For the 146 men treated with curative intent, 5-year overall survival, breast cancer-specific survival and progression-free survival were 72%, 86%, and 62%, respectively. Outcomes were similar to matched female patients in univariate and multivariate analyses. In this large population-based study, outcomes appear similar between male and risk-matched female patients with breast cancer. Side effect profiles, tolerance, adherence, and outcomes after tamoxifen, aromatase inhibitors, and trastuzumab in men appear comparable with those described in the literature for women.
    Clinical Breast Cancer 10/2013; 14(1). DOI:10.1016/j.clbc.2013.09.001 · 2.63 Impact Factor
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    ABSTRACT: To determine the impact of adjuvant treatment with tamoxifen and aromatase inhibitors (AI) on the survival of men with breast cancer. We analyzed 257 male patients with hormone-receptor-positive breast cancer from numerous German population-based cancer registries treated with tamoxifen (N = 207) or aromatase inhibitors (N = 50). The median follow-up was 42.2 (range 2-115) months. Median age at diagnosis was 68 (range 36-91) years. Thirty-seven (17.9 %) patients treated with tamoxifen and 16 (32.0 %) patients treated with AI died (log rank p = 0.007). After the adjustment for the patient's age, tumor size, node status, and tumor grading, the AI treatment was linked to a 1.5-fold increase in risk of mortality compared to tamoxifen (HR 1.55; 95 % CI: 1.13-2.13; p = 0.007). The overall survival in male breast cancer was significantly better after adjuvant treatment with tamoxifen compared to an aromatase inhibitor. Tamoxifen should be considered as the treatment of choice for hormone-receptor-positive male breast cancer.
    Breast Cancer Research and Treatment 12/2012; 137(2). DOI:10.1007/s10549-012-2355-3 · 4.20 Impact Factor
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    ABSTRACT: Background To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC.Patients and methodsFrom January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie (IC). We analysed the calibration and discrimination performance of two nomograms [IC, Memorian Sloan-Kettering Cancer Center (MSKCC)] originally designed to predict axillary lymph node metastases in female BC.ResultsAbout 55% and 24% of the tumours were pT1 and pT4, respectively. Nearly 46% demonstrated axillary lymph node metastasis. About 99% were oestrogen receptor positive and 94% HER2 negative. Lymph node status was the only significant prognostic factor of overall survival (P = 0.012). The area under curve (AUC) of IC and MSKCC nomograms were 0.66 (95% CI 0.54-0.79) and 0.64 (95% CI 0.52-0.76), respectively. The calibration of these two models was inadequate.Conclusions Multi-variate models designed to predict axillary lymph node metastases for female BC were not effective in our male BC series. Our results may be explained by (i) small sample size (ii) different biological determinants influencing axillary metastasis in male BC compared with female BC.
    Annals of Oncology 10/2012; 24(2). DOI:10.1093/annonc/mds283 · 6.58 Impact Factor


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