Male Breast Cancer: A Study on Clinical and Biological Characteristics from a Portuguese Certified Breast Center
DOI:
https://doi.org/10.34635/rpc.1070Keywords:
Breast Neoplasms, Male/drug therapy, Breast Neoplasms, Male/radiotherapy, Breast Neoplasms, Male/surgery, MastectomyAbstract
Introduction: To describe the clinical and biological characteristics of breast carcinoma in men, to compare with the characteristics observed in women and to evaluate the results of the treatment.Methods: A retrospective analysis was conducted involving all male patients with breast carcinoma treated between 2000 and 2022 at the Breast Center of the Unidade Local de Saúde de São João, Porto, Portugal. A 3:1 random selection of women, treated over the same period, was made for comparison. Patients were followed up until 2023 and survival analyses were performed.
Results: Thirty-two men and ninety-six women were analyzed. The median age of male patients at diagnosis was 62 years. Compared to women, there was a significantly higher percentage of male patients over the age of 50 years. BRCA2 mutations were identified in a significantly higher percentage of men. We observed larger tumor sizes in male patients (pT2 25.0%), a higher percentage of lymph node metastasis (pN1 40.6%) and a higher percentage of distant metastasis (21.9%) compared with female patients. Significant differences were found in the type of surgery (90.6% of men underwent mastectomy), the use of chemotherapy and axillary lymph node dissection (46.9% and 34.4% of men, respectively). Male patients diagnosed with breast cancer presented a lower cumulative survival than female patients. Age over 50 years and stage IV tumors increased the risk of death.
Conclusion: Male patients were diagnosed at an older age with more advanced tumors, which may explain the worse survival rates compared to female patients. Male breast cancer is a significant condition that needs increased awareness, to promote early detection.
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References
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29. Konishi T, Fujiogi M, Michihata N, Morita K, Matsui H, Fushimi K, et al. Comparison of short-term surgical outcomes between men and women with breast cancer: a retrospective study using nationwide inpatient data in Japan. Breast Cancer Res Treat 2021;186:731-739.
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31. Leone JP, Zwenger AO, Iturbe J, Leone J, Leone BA, Vallejo CT, et al. Prognostic factors in male breast cancer: A population‑based study. Breast Cancer Res Treat 2016;156:539‑548.
32. Abreu MH, Afonso N, Abreu PH, Menezes F, Lopes P, Henrique R, et al. Male breast cancer: Looking for better prognostic subgroups. Breast 2016;26:18‑24.
33. Nielsen TO, Leung SCY, Rimm DL, Dodson A, Acs B, Badve S, et al. Assessment of Ki67 in breast cancer: updated recommendations from the international Ki67 in breast cancer working group. J Natl Cancer Inst 2021;113:808-819.
34. Vermeulen MA, Slaets L, Cardoso F, Giordano SH, Tryfonidis K, van Diest PJ, et al. Pathological characterisation of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Eur J Cancer 2017;82:219-227.
35. Piscuoglio S, Ng CKY, Murray MP, Guerini-Rocco E, Martelotto LG, Geyer FC, et al. The genomic landscape of male breast cancers. Clin Cancer Res 2016;22:4045-4056.
36. Greif JM, Pezzi CM, Klimberg VS, Bailey L, Zuraek M. Gender differences in breast cancer: Analysis of 13,000 breast cancers in men from the National Cancer Data Base. Ann Surg Oncol 2012;19:3199‑3204.
2. European Cancer Information System.2023.ECIS. https://ecis.jrc.ec.europa.eu. Acessed 27th December, 2023.
3. OCDE. Observatório Europeu dos Sistemas e Políticas de Saúde. Portugal: Perfil de Saúde do País 2021. Bruxelas:2021. https://health.ec.europa.eu/system/files/2021-12/2021_chp_pt_portuguese.pdf. Acessed January 3th, 2024.
4. Registo Oncológico Nacional de Todos os Tumores na População Residente em Portugal, em 2020. Portugal:2023. https://ron.min-saude.pt/pt/biblioteca/publicacoes-ron/. Acessed January 3th, 2024.
5. Ferzoco RM, Ruddy KJ. The epidemiology of male breast cancer. Curr Onc Rep 2016;18:1.
6. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer 2004;101:51-57.
7. Speirs V, Shaaban AM. The rising incidence of male breast cancer. Breast Cancer Res Treat 2009;115:429-430.
8. Ly D, Forman D, Ferlay J, Brinton LA, Cook MB. An international comparison of male and female breast cancer incidence rates. Int J Cancer 2013;132:1918-1926.
9. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017;67:7–30.
10. Gargiulo P, Pensabene M, Milano M, Arpino G, Giuliano M, Forestieri V, et al. Long‑term survival and BRCA status in male breast cancer: A retrospective single‑center analysis. BMC Cancer 2016;16:375.
11. Pritzlaff M, Summerour P, McFarland R, Li S, Reineke P, Dolinsky JS, et al. Male breast cancer in a multi‑gene panel testing cohort: Insights and unexpected results. Breast Cancer Res Treat 2017;161:575‑586.
12. Rizzolo P, Zelli V, Silvestri V, Valentini V, Zanna I, Bianchi S, et al. Insight into genetic susceptibility to male breast cancer by multigene panel testing: Results from a multicenter study in Italy. Int J Cancer 2019;145:390-400.
13. White J, Kearins O, Dodwell D, Horgan K, Hanby AM, Speirs V. Male breast carcinoma: Increased awareness needed. Breast Cancer Res 2011;13:1-7.
14. Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen‑Stok E, Porter P, et al. Characterization of male breast cancer: Results of the EORTC 10085/TBCRC/BIG/NABCG international male breast cancer program. Ann Oncol 2018;29:405‑417.
15. Ottini L, Palli D, Rizzo S, Federico M, Bazan V, Russo A. Male breast cancer. Crit Rev Oncol Hematol 2010;73:141-155.
16. Gucalp A, Traina TA, Eisner JR, Parker JS, Selitsky SR, Park BH, et al. Male breast cancer: A disease distinct from female breast cancer. Breast Cancer Res Treat 2019;173:37-48.
17. Yu XF, Feng WL, Miao LL, Chen B, Yang HJ. The prognostic significance of molecular subtype for male breast cancer: a 10-year retrospective study. The Breast 2013;22:824-827.
18. Losurdo A, Rota S, Gullo G, Masci G, Torrisi R, Bottai G, et al. Controversies in clinicopathological characteristics and treatment strategies of male breast cancer: a review of the literature. Crit Rev Oncol Hematol 2017;113:283-291.
19. Yao N, Shi W, Liu T, Siyin ST, Wang W, Duan N, et al. Clinicopathologic characteristics and prognosis for male breast cancer compared to female breast cancer. Sci Rep 2022;12:220.
20. Yu XF, Yang HJ, Yu Y, Zou DH, Miao LL. A prognostic analysis of male breast cancer (MBC) compared with post-menopausal female breast cancer (FBC). PLoS One 2015;10:e0136670.
21. Liu N, Johnson KJ, Ma CX. Male Breast Cancer : An Updated Surveillance , Epidemiology , and End Results Data Analysis. Clin Breast Cancer 2018;18:997-1002.
22. Nilsson C, Johansson I, Ahlin C, Thorstenson S, Amini RM, Holmqvist M, et al. Molecular subtyping of male breast cancer using alternative definitions and its prognostic impact. Acta Oncol 2013;52:102-109.
23. Pereira AS, Silva T, Machado F, Vaz P, Aparício F, Silva M, et al. Male breast cancer: Specific biological characteristics and survival in a Portuguese cohort. Mol Clin Oncol 2019;10:644-654.
24. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. New Jersey: Wiley Blackwell; 2017.
25. Tan PH, Ellis I, Allison K, Brogi E, Fox SB, Lakhani S, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology 2020;77:181-5.
26. Shaaban AM, Ball GR, Brannan RA, Cserni G, Di Benedetto A, Dent J, et al. A comparative biomarker study of 514 matched cases of male and female breast cancer reveals gender-specific biological differences. Breast Cancer Res Treat 2012;133:949-58.
27. Johansson I, Killander F, Linderholm B, Hedenfalk I. Molecular profiling of male breast cancer – lost in translation? Int J Biochem Cell Biol 2014;53:526-35.
28. Keinan Boker L, Levine H, Leiba A, Derazne E, Kark JD. Adolescent obesity and adult male breast cancer in a cohort of 1,382,093 men. Int J Cancer 2018;142:910 918.
29. Konishi T, Fujiogi M, Michihata N, Morita K, Matsui H, Fushimi K, et al. Comparison of short-term surgical outcomes between men and women with breast cancer: a retrospective study using nationwide inpatient data in Japan. Breast Cancer Res Treat 2021;186:731-739.
30. Kluttig A, Schmidt A. Established and suspected risk factors in breast cancer aetiology. Breast Care 2009;4:82-87.
31. Leone JP, Zwenger AO, Iturbe J, Leone J, Leone BA, Vallejo CT, et al. Prognostic factors in male breast cancer: A population‑based study. Breast Cancer Res Treat 2016;156:539‑548.
32. Abreu MH, Afonso N, Abreu PH, Menezes F, Lopes P, Henrique R, et al. Male breast cancer: Looking for better prognostic subgroups. Breast 2016;26:18‑24.
33. Nielsen TO, Leung SCY, Rimm DL, Dodson A, Acs B, Badve S, et al. Assessment of Ki67 in breast cancer: updated recommendations from the international Ki67 in breast cancer working group. J Natl Cancer Inst 2021;113:808-819.
34. Vermeulen MA, Slaets L, Cardoso F, Giordano SH, Tryfonidis K, van Diest PJ, et al. Pathological characterisation of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Eur J Cancer 2017;82:219-227.
35. Piscuoglio S, Ng CKY, Murray MP, Guerini-Rocco E, Martelotto LG, Geyer FC, et al. The genomic landscape of male breast cancers. Clin Cancer Res 2016;22:4045-4056.
36. Greif JM, Pezzi CM, Klimberg VS, Bailey L, Zuraek M. Gender differences in breast cancer: Analysis of 13,000 breast cancers in men from the National Cancer Data Base. Ann Surg Oncol 2012;19:3199‑3204.
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2025-02-20
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