Poorer Survival of Male Breast Cancer Compared with Female Breast
Cancer Patients May Be Due to Biological Differences
Xingyu Chen1,2, Xiaodong Liu1,2, Li Zhang1,2, Shufen Li1,2, Yehui Shi1,2and Zhongsheng Tong1,2,*
1Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Breast,
Tianjin and2Department of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education,
Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
*For reprints and all correspondence: Zhongsheng Tong, Department of Breast Oncology, Tianjin Medical University
Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China. E-mail: firstname.lastname@example.org
Received June 6, 2013; accepted July 21, 2013
Objective: The objective of the study was to compare disease-free survival and overall survival
in a group of matched males and females with breast cancer, and to analyze possible treat-
ment- and gender-related differences.
Methods: We retrospectively analyzed the data of 150 operable male breast cancer patients
treated in our hospital from December 1980 to June 2012. Each male breast cancer patient
recorded in the database was matched with two female breast cancer patients of equal stage.
Prognosis in terms of disease-free survival and overall survival was evaluated.
Results: The mean age at diagnosis was 58.6+9.7 years for males and 57.2+10.3 years for
females. The median follow-up was 69 months for males and 81 months for females.
Significant differences were identified for tumor location, hormone receptor status, molecular
subtypes and hormone therapy between the two groups. Monofactorial analysis demonstrated
that tumor size, lymph node state, American Joint Committee on Cancer stage, molecular sub-
types and adjuvant chemotherapy treatment were prognostic factors in male breast cancer
patients. The 5- and 10-year disease-free survival rates were 65.6 and 40.1% for males, and
74.9 and 51.5% for females, respectively. The 5- and 10-year overall survival rates were 72.9
and 53.9% for males, and 83.2 and 68.5% for females, respectively. There was significantly
difference in disease-free survival and overall survival between the two matched groups
(P ¼ 0.002).
Conclusions: Male breast cancer patients had inferior outcome despite of equal stage in com-
parison with matched female breast cancer patients, which demonstrates that biological differ-
ences may contribute to the worse prognosis.
Key words: male breast cancer – female breast cancer – prognosis
Male breast cancer (MBC) is a rare and often overlooked
disease accounting for ,1% of all breast cancer cases (1).
However, the incidence of MBC has been steadily increasing
along with the increasing incidence of female breast cancer
(FBC) over the past three decades (2). The reason for the in-
creasing incidence of MBC is likely due to several factors, in-
cluding longer lifespan, increased public awareness and rising
levels of obesity in the male population (3). This increasing
trend highlights the importance of understanding MBC and
whether it differs from FBC.
Because of its low incidence, MBC has not been studied as
extensively as FBC. Its rarity has precluded prospective rando-
mized controlled trials and only data from retrospective and
often small series are available. Few retrospective studies have
included more than 100 cases. Appropriate management
guidelines for MBC have not yet been clearly established, and
limited information is available regarding the epidemiology,
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Jpn J Clin Oncol 2013;43(10)954–963
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by guest on October 29, 2015
treatment and prognosis of the disease (4). Therefore, despite
possible differences in pathogenesis, biology and genetics
between both the sexes, the treatment strategies for MBC have
been extrapolated from the data based on the FBC (5). As
more data on the tumor biology of MBC emerge, it is becom-
ing clear that MBC is a unique disease requiring its own trials
and treatment guidelines.
In the past two decades, several retrospective studies have
described the epidemiology and biological characteristics of
MBC and its prognosis compared with FBC, with inconsistent
results. It has been assumed that MBC carried a worse progno-
sis compared with FBC, which has mainly been attributed to
delays in diagnosis, more advanced stage at diagnosis, older
age at diagnosis and a higher incidence of lymph node metas-
tases in males with breast cancer (6–12). However, recent
studies revealed that MBC and FBC patients have a similar
prognosis (13–15). One study showed that although overall
survival (OS) was equivalent between both the sexes, disease-
specific survival was significantly better in MBC than in FBC
(16). Thus, there is no consensus on the relationship between
the patient’s sex and prognosis in breast cancer. Therefore, the
aim of the present study was to compare the survival in a
group of carefully matched males and females with breast
cancer, and to retrospectively analyze disease characteristics
of MBC in a Chinese population over the past 32 years. In this
regard, clinicopathological features, treatment patterns and
survival were investigated, and prognosis in terms of OS and
disease-free survival (DFS) was evaluated.
PATIENTS AND METHODS
We retrospectively reviewed the medical records of 150 MBC
patients who had been treated at the Cancer Institute and
Hospital of Tianjin Medical University, China, between
December 1980 and June 2012. To be included in this retro-
spective analysis, the following conditions had to be fulfilled:
all men had to suffer from invasive breast cancer curatively
treated with mastectomy, and had well-documented clinical
information and accurate TNM stage. Patients presenting with
metastatic lesions or second cancers at initial diagnosis were
excluded. Each male fulfilling the criteria was recorded in the
database and carefully matched with two females. Matching
criteria included the main potential prognostic factors such as
pathology of invasive ductal carcinoma in MBC and FBC, age
at diagnosis (+5 years), date of diagnosis (+5 years) (17)
and identical clinical stage of the primary cancer at diagnosis.
The females were selected from a total of 27 314 consecutive
patients whose data were recorded in the same database and
who underwent treatment at our institution during the same
period. When more than two females met the matching
criteria, the female patients whose date of diagnosis was
closer to the male patients were chosen (13). A total of 150
MBC patients and 300 matched FBC patients were enrolled in
The database was reviewed to obtain the demographic in-
formation, clinical history, tumor characteristics and treatment
characteristics. Follow-up information was obtained from the
database, the medical records and contact with the patients or
their family. Mortality due to breast cancer, second primary
cancer and other causes were the end points considered.
According to the standard of Perou (18) and Carey (19),
breast cancer molecular subtypes were classified according to
the immunohistochemical panel expression profile as follows:
ER positive and/or PR positive and HER2 negative for
Luminal A; ER positive and/or PR positive and HER2 positive
for Luminal B; ER and PR negative and HER2 positive for
HER2 over-expressed; ER, PR and HER2 all negative for
basal-like (triple negative).
We determined and compared the 5- and 10-year DFS time
and OS time for male- and female-matched groups. DFS was
defined as the time from the surgery until disease progression
or death by any cause on the date of the last follow-up. OS
was defined as the time from the surgery until death by any
cause. A statistical comparison of female-matched pair sur-
vival data was performed with the paired t-test. DFS and OS
were calculated using the Kaplan–Meier method from the
time of diagnosis (20). The log-rank test was used to assess
survival difference between the groups. Actuarial curves
were compared by the two-tailed log-rank test. The statistical
analysis was performed using SPSS software version 17.0.
A P value of , 0.05 was considered significant for both tests.
The 150 cases of MBC patients were matched with 300 FBC
patients during the same period. Table 1 displays the matching
information and demographic data of the matched male and
female breast cancer (FBC) patients. The mean age at diagno-
sis was similar for the two matched groups: 58.6+9.7 years
(range, 26–83) for males and 57.2+10.3 years (range,
22–81) for females. The mean follow-up time for the 32-year
study period was 85.8+49.7 months (range, 9–298) for
males and was 90.2+49.2 months (range, 12–287) for
females. Invasive ductal carcinoma was the pathological type
of all cases.
The clinicopathological characteristics of both male and
female patients are described in Table 2. Significant differ-
ences were identified for tumor location (P , 0.01), hormone
receptor status (P , 0.01), molecular subtypes (P ¼ 0.005)
and hormone therapy between male and female patients.
Males were more likely to have an unknown hormone receptor
and HER2 status (20.7%, 35.3%) compared with females
(17.3%, 24.3%). 99 cases of MBC patients had positive ER/
PR and 26 cases had positive HER2 expression, and 147 cases
of FBC patients had positive ER/PR and 62 cases had positive
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