A review on the management of male breast cancer

This review outlines the diagnosis, types, and treatments of breast cancer in male patients.

Male breast cancer (MBC) is a fairly rare condition, which accounts for 0.1% of all cancers in men and very little research has been done on the disease. Much of what is known about treatments and prognosis is based on what is known about female breast cancer (FBC). While that research is helpful in understanding MBC, there are some differences between MBC and FBC that still need to be more carefully studied.

Unlike FBC, MBC rates continue to climb after the age of 50, and are usually discovered by the patient finding a painless lump. 90% of these cases are due to invasive ductal carcinoma, in which the cancer begins in the milk ducts (the tubes that in women link the milk producing glands or lobules to the nipple) and spread to the breast tissue. Also, 90% of the MBC cases are estrogen-receptor positive (ER+), meaning that the cancer depends on the hormone estrogen (the main female sex hormone, also present in males) in order to grow. Since MBC is so rare, it is often found at a later stage compared to FBC, and the cancer is more likely to have spread beyond the breast tissue (advanced).

Treatment of MBC is similar to FBC. Most MBC patients undergo a mastectomy (removal of the cancerous lump along with all the breast tissue), which lowers the risk of recurrence (return of the cancer), compared to breast conserving surgery or lumpectomy (surgical removal of the cancerous lump only), more preferred in FBC patients. ER+ MBC patients respond well to hormonal therapy (treatment that aims at lowering estrogen levels, thus stopping the growth of the cancer). Tamoxifen (Nolvadex) has proven to be an effective hormone therapy in both MBC and FBC. This treatment has been found to increase 5-year survival rates by 17% in MBC. Men, however, tend to experience more adverse effects from the treatment than women. Radiotherapy is used more often in MBC than FBC, but is associated with high levels of heart and lung adverse effects. MBC patients with advanced stages benefit the most from hormone therapy, which can be followed by chemotherapy in patients who no longer respond to this treatment.

Survival rates in MBC often depend on factors other than the cancer, such as other concurrent conditions, the age of the patient, and the stage the cancer. Overall, the survival rate for MBC is 63% at 5 years and 41% at 10 years.

Much of what is known about MBC dependents on FBC research. While this has been very helpful to treatment and prognosis, MBC specifically is an important area for future research.