Male gynecomastia and risk for malignant tumours--a cohort study.

H Olsson,P Alm,A Bladstrom

doi:10.1186/1471-2407-2-26

Abstract

BackgroundMen with gynecomastia may suffer from absolute or relative estrogen excess and their risk of different malignancies may be increased. We tested whether men with gynecomastia were at greater risk of developing cancer.MethodsA cohort was formed of all the men having a histopathological diagnosis of gynecomastia at the Department of Pathology, University of Lund, following an operation for either uni- or bilateral breast enlargement between 1970–1979. All possible causes of gynecomastia were accepted, such as endogenous or exogenous hormonal exposure as well as cases of unknown etiology. Prior to diagnosis of gynecomastia eight men had a diagnosis of prostate carcinoma, two men a diagnosis of unilateral breast cancer and one had Hodgkin's disease. These patients were included in the analyses. The final cohort of 446 men was matched to the Swedish Cancer Registry, Death Registry and General Population Registry.ResultsAt the end of the follow up in December 1999, the cohort constituted 8375.2 person years of follow-up time. A total of 68 malignancies versus 66.07 expected were observed; SIR = 1.03 (95% CI 0.80–1.30). A significantly increased risk for testicular cancer; SIR = 5.82 (95% CI 1.20–17.00) and squamous cell carcinoma of the skin; SIR = 3.21 (95% CI 1.71–5.48) were noted. The increased risk appeared after 2 years of follow-up. A non-significantly increased risk for esophageal cancer was also seen while no new cases of male breast cancer were observed. However, in the prospective cohort, diagnostic operations for gynecomastia may substantially have reduced this riskConclusionsThere is a significant increased risk of testicular cancer and squamous cell carcinoma of the skin in men who have been operated on for gynecomastia.

Highlights

Men with gynecomastia may suffer from absolute or relative estrogen excess and their risk of different malignancies may be increased
Androgen ratio, drugs having estrogenic effects or diseases associated with injuries to gonads or liver affecting the estrogen/androgen ratio may predispose to gynecomastia [2,3,4]
Sometimes the treatment of malignancies may be the cause for gynecomastia, such as oestrogen treatment in prostate carcinoma and cytostatic treatment in various malignancies [13,14,15,16]

Summary

Introduction

Men with gynecomastia may suffer from absolute or relative estrogen excess and their risk of different malignancies may be increased. We tested whether men with gynecomastia were at greater risk of developing cancer. Gynecomastia is a benign condition appearing both uniand bilaterally. It is more common during some time periods in life, such as early puberty and late adulthood [1]. Many anti-psychotic drugs may induce hyperprolactinemia and gynecomastia. It has been claimed (page number not for citation purposes). 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 =80 that gynecomastia is more common among men who later develop testicular cancer and breast cancer [5,6,7,8,9,10,11,12]. Sometimes the treatment of malignancies may be the cause for gynecomastia, such as oestrogen treatment in prostate carcinoma and cytostatic treatment in various malignancies [13,14,15,16]

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Results

Conclusion