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Am Fam Physician. 1998;58(9):2138-2140

Carcinoma of the breast is uncommon in men; the incidence is less than 1 percent of the incidence of breast cancer in women. For this reason, less clinical information is available regarding prognosis, treatment and outcomes for men. Interestingly, the survival rate of men with breast cancer is lower than that of women with breast cancer. Donegan and colleagues performed a retrospective case review of men in Wisconsin who were diagnosed with breast cancer to determine treatment, survival rates and prognostic factors.

Data were collected from the tumor registries of 18 hospitals in nine cities in eastern Wisconsin. The cancer programs at these hospitals were approved by the Commission on Cancer of the American College of Surgeons. The cases of male breast cancer included in this study were diagnosed between 1953 and 1995. A total of 221 cases were identified, and acceptable data were available on 215 patients. The men ranged in age from 32 to 90 years, with an average age of 65.4 years. The symptoms lasted an average of 10 months. Tumors were identified in the left breast in 127 men and in the right breast in 87 men. There was also one patient with bilateral disease. The type of cancer that was most commonly observed was invasive ductal carcinoma. The mean size of the breast mass was 2.6 cm and, although location was unspecified in most cases, direct involvement of the nipple was noted in 42 patients. Gynecomastia was occasionally observed, and several patients had a prior history of trauma to the chest.

In the 105 patients for whom survival data were available, the mean follow-up time was 45 months. Of the 110 patients who were known to have died, 64.5 percent died of breast cancer, 20 percent died of an unidentified cause, 8 percent died of other malignancies and 7 percent died of cardiovascular disease. Observed survival for all 215 patients was approximately 50 percent at five years and 24 percent at 10 years. Factors that affected survival included TNM staging at the time of diagnosis, including the involvement of four or more axillary lymph nodes. A positive estrogen and progesterone receptor status was associated with a better prognosis. The most common course of treatment was modified radical mastectomy, followed by chest wall irradiation. Radiation did not improve observed survival or survival when patients were stratified for lymph node status. Systemic adjuvant therapy plus hormonal therapy benefited only patients with positive axillary lymph nodes who were estrogen-receptor positive.

The authors conclude that men with breast cancer have clinical presentations, trends in treatment and prognostic factors similar to those in women with breast cancer. Although the study spanned 42 years, one half of the patients were diagnosed in the last 10 years. This is believed to reflect a proliferation of tumor registries with better reporting systems. The poorer survival rate in men has been attributed to older age and more advanced disease at the time of diagnosis, inappropriate staging, anatomic factors and high mortality from comorbid disease. Earlier diagnosis, surgical intervention and, when appropriate, systemic adjuvant therapy appear to improve long-term survival.

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Copyright © 1998 by the American Academy of Family Physicians.

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