Abstract
BackgroundMale breast cancer (MBC) is rare. Given the paucity of randomized trials, treatment is generally extrapolated from female breast cancer guidelines.MethodsThis is a retrospective analysis of all male patients presenting with MBC at the Department of Oncology at University Federico II of Naples between January 1989 and January 2014. We recorded the following data: baseline characteristics (age, height, weight, body mass index, risk factors, family history), tumor characteristics (side affected, stage, histotype, hormonal and HER2 status, and Ki-67 expression), treatment (type of surgery, chemotherapy, endocrine therapy, and/or radiotherapy), BRCA1/2 mutation status (if available), other tumors, and long-term survival.ResultsForty-seven patients were analyzed. Median age was 62.0 [55.0–72.0]. Among risk factors, obesity and family history of breast cancer were associated with 21 % and 30 % of MBC cases, respectively. The majority of tumors were diagnosed at an early stage: stage I (34.0 %) and stage II (44.7 %). Infiltrating ductal carcinoma was the most frequent histologic subtype (95.8 %). Hormone receptors were generally positive (88.4 % of cases were Estrogen receptor [ER] positive and 81.4 % Progesteron receptor [PgR] positive). Human epidermal growth factor receptor 2 (HER2) was positive in 26.8 % of cases; 7.0 % of MBCs were triple negative. The tumor had high proliferation index (Ki67 ≥ 20 %) in 64.7 %. Surgery was predominantly mastectomy (85.1 %), whereas quadrantectomy was performed in 14.9 % of patients. Adjuvant chemotherapy was administered to 70.7 % of patients, endocrine therapy to 90.2 %, trastuzumab to 16.7 % and radiotherapy to 32.6 %. BRCA status was available for 17 patients: 10 wild-type, 1 BRCA1 carrier, 5 BRCA2 carriers, 1 unknown variant sequence. The overall estimated long-term survival was about 90 % at 5 years, 80 % at 10 years and 70 % at 20 years. Patients carrying a BRCA mutation had a significantly lower survival than patients with wild-type BRCA (p = 0.04).ConclusionsLong-term survival was high in MBC patients referred to our clinical unit. Survival was poorer in BRCA-mutated patients than in patients with wild-type BRCA.
Highlights
Male breast cancer (MBC) shares some features of female breast cancer, it differs significantly in terms of epidemiology and biologic features
Data regarding estrogen receptor (ER), progesterone receptor (PgR), proliferation index (Ki-67), and Human epidermal growth factor receptor 2 (HER2) status of breast tumors were extracted from medical, pathology, or tumor registry records or obtained from the results of immunohistochemical analysis of sections of formalinfixed, paraffin-embedded primary mammary tumor blocks
According to international guidelines [16], ER and PgR were considered positive if ≥ 1 % of tumor cell nuclei were immunoreactive; whereas Ki-67 was considered high at ≥ 20 % cut-off
Summary
Given the paucity of randomized trials, treatment is generally extrapolated from female breast cancer guidelines. Treatment of MBC is based on female breast cancer guidelines and trials. MBC shares some features of female breast cancer, it differs significantly in terms of epidemiology and biologic features. The etiology of MBC is unclear anthropometric and hormonal factors appear to be involved in its development. Clinical disorders, such as Klinefelter’s syndrome, obesity, liver diseases and testicular abnormalities, represent risk factors for MBC. These disorders are associated with an imbalanced estrogen/androgen ratio that result in abnormal estrogen exposure [4]. Family history and genetic abnormalities, such as mutations of the BRCA1 and BRCA2 genes, play a relevant role in MBC pathogenesis [5]
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