Haemochromatosis and breast cancer: a rare cause of a rare disease?

Abstract

I read with interest the review article on male breast cancer by Jepson and Fentiman.1 I would value their views on this short case history and subsequent questions. Mr AM, aged 52, presented with a painful left breast which was found to be an infiltrating ductal cancer with nodal involvement; immunohistological staining for oestrogen receptors was positive. Shortly after this he was also diagnosed as having haemochromatosis (ferritin 22,000 g/l; NR>179) having had insulin dependent diabetes for five years, progressively pigmented skin and hypopituitarism with a low androgen level (testosterone 2 nmol/l; NR 10-30). Hypopituitarism was present for at least three years before the diagnosis of breast cancer was made and for two of those years androgens were replaced with Sustanon injections. The patient remains well after a radical mastectomy and radiotherapy and is currently on tamoxifen. Firstly, I would like to ask the authors whether they have discovered a link between male breast cancer and haemochromatosis. There would appear to be two possible risk factors for breast cancer due to haemochromatosis in this patient: androgen deficiency due to pituitary failure before androgen replacement and excess oestrogen exposure due to defective hepatic function. My second question concerns continuing male hormone replacement therapy. At present the patient has marked hypogonadal symptoms. Should we reintroduce androgens?