Lumpectomy in Male Patients with Breast Cancer

Abstract

Approximately 1 % of breast cancer occurs in men. 1 As a result of the rarity of this disease, few studies have been conducted. Most of the existing information about breast cancer in men comes from small institutional series and population-based cancer registries. 2,3 No randomized clinical trials have been conducted, and treatment recommendations have generally been extrapolated from the results of clinical trials conducted in women. In particular, no prospective studies have been performed to evaluate the surgical management of male patients. Although breast conservation has been shown to have equivalent outcomes to mastectomy for selected female patients, little information exists about the use of breast conservation in men with a diagnosis of breast cancer. 4 Cloyd et al. 5 offer one of the first descriptions of a large series of male patients who were treated with lumpectomy. The authors used information from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, which collects data on cancer incidence, first course of treatment, and survival on * 28 % of the population of the United States. They identified a cohort of 718 male patients who underwent lumpectomy and 4,707 male breast cancer patients who were treated with mastectomy. Being treated with lumpectomy was associated with older age, stage IV disease, and lack of axillary surgery. In this observational cohort, no difference was seen in survival by type of surgery. In this study, the patients who underwent lumpectomy were a clinically heterogeneous group. Because this study did not specifically study the surgical management of patients with operable breast cancer, the resulting cohort is a mix of patients who had standard breast conservation therapy with lumpectomy and radiation and patients who underwent lumpectomy alone, perhaps for local management of metastatic disease or for patients who were at high operative risk. In fact, only 254 of the 718 patients (35 %) had standard breast conservation therapy with lumpectomy and radiation, and the rest of the patients had lumpectomy alone. The omission of radiation was not the only deviation from standard practice because 34 % of patients treated with lumpectomy did not have their axilla evaluated. These finding suggest that most male patients treated with lumpectomy are not receiving a standard approach to local therapy as an alternative to mastectomy.