Male Breast Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]
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Male Breast Cancer Treatment
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.
Information about the following is included in this summary:
- Risk factors.
- Prognostic factors.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version, written in less technical language, and in Spanish.
Note: Estimated new cases and deaths from breast cancer (men only) in the United States in 2009:
- New cases: 1,910.
- Deaths: 440.
Predisposing risk factors  appear to include radiation exposure, estrogen administration, and diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter syndrome. Definite familial tendencies are evident with an increased incidence seen in men who have a number of female relatives with breast cancer. An increased risk of male breast cancer has been reported in families in which the BRCA2 mutation on chromosome 13q has been identified.[7,8]
The pathology is similar to that of female breast cancer, and infiltrating ductal cancer is the most common tumor type. Intraductal cancer has been described as well. Inflammatory carcinoma and Paget disease of the nipple have also been seen in men, but lobular carcinoma in situ has not. Lymph node involvement and the hematogenous pattern of spread are similar to those found in female breast cancer. The TNM staging system for male breast cancer is identical to the staging system for female breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
Prognostic factors that have been evaluated include the size of the lesion and the presence or absence of lymph node involvement, both of which correlate well with prognosis.[5,10] Whether ploidy and S phase correlate with survival is uncertain. Estrogen-receptor and progesterone-receptor status and HER2/neu gene amplification should be reported.
Treatment Options for Male Breast Cancer
Initial Surgical Management
Primary standard treatment is a modified radical mastectomy with axillary dissection.[1,2,3] Responses are generally similar to those seen in women with breast cancer. Breast conservation surgery with lumpectomy and radiation therapy has also been used and results have been similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
In men with node-negative tumors, adjuvant therapy should be considered on the same basis as for a woman with breast cancer since there is no evidence that response to therapy is different for men or women.
In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal therapy have been used and can increase survival to the same extent as in women with breast cancer. Currently, no controlled studies have compared adjuvant treatment options. Approximately 85% of all male breast cancers are estrogen receptor–positive, and 70% of them are progesterone receptor–positive.[2,6] Response to hormone therapy correlates with presence of receptors. Hormonal therapy has been recommended in all receptor-positive patients.[1,2] Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence in male breast cancer patients. (Refer to the PDQ summaries on Fever, Sweats, and Hot Flashes and Sexuality and Reproductive Issues for more information on these symptoms.) Responses are generally similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
Adjuvant chemotherapy regimens include:
- CMF: cyclophosphamide plus methotrexate plus fluorouracil.
- CAF: cyclophosphamide plus doxorubicin plus fluorouracil.
- Trastuzumab (under clinical evaluation).
- Tamoxifen (under clinical evaluation).
Locally Recurrent Disease
Surgical excision or radiation therapy combined with chemotherapy is recommended. Responses are generally similar to those seen in women with breast cancer.[2,5] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
Hormonal modalities include:
- Luteinizing hormone-releasing hormone agonist with or without total androgen blockage (anti-androgen).
- Tamoxifen for estrogen receptor–positive patients.
- Aromatase inhibitors.[9,10,11]
Hormonal therapies may be used sequentially. Standard chemotherapy combinations of CMF and CAF are recommended after failure of hormonal therapy. Responses are generally similar to those seen in women with breast cancer. (Refer to the PDQ summary on Breast Cancer Treatment for more information.)
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Changes to This Summary (12 / 14 / 2009)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
TREATMENT OPTIONS FOR MALE BREAST CANCER
Editorial changes were made to this section.
- PDQ® - NCI's Comprehensive Cancer Database.
Full description of the NCI PDQ database.
ADDITIONAL PDQ SUMMARIES
- PDQ® Cancer Information Summaries: Adult Treatment
Treatment options for adult cancers.
- PDQ® Cancer Information Summaries: Pediatric Treatment
Treatment options for childhood cancers.
- PDQ® Cancer Information Summaries: Supportive and Palliative Care
Side effects of cancer treatment, management of cancer-related complications and pain, and psychosocial concerns.
- PDQ® Cancer Information Summaries: Screening/Detection (Testing for Cancer)
Tests or procedures that detect specific types of cancer.
- PDQ® Cancer Information Summaries: Prevention
Risk factors and methods to increase chances of preventing specific types of cancer.
- PDQ® Cancer Information Summaries: Genetics
Genetics of specific cancers and inherited cancer syndromes, and ethical, legal, and social concerns.
- PDQ® Cancer Information Summaries: Complementary and Alternative Medicine
Information about complementary and alternative forms of treatment for patients with cancer.
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Date Last Modified: 2009-12-14