Breast Cancer In Men Research Articles

Familial male breast carcinoma

Breast cancer in men is a rare disease, accounting for approximately 1% of all breast cancers. In a recent review of the literature, only 12 reports of breast cancer in related men have been recorded. A case of familial breast cancer is reported involving two men and two women. The role of hereditary factors and associated etiologic factors in male breast cancer are reviewed. The overall prognosis of male patients with breast cancer is poor compared with female patients with breast cancer, possibly related to a delay in diagnosis and difference in regional spread of the tumor. Increased surveillance of families with a history of male breast cancer and the presence of associated etiologic factors appears advisable.

Clinical applications of antiandrogens

Antiandrogens, substances that prevent androgens from expressing their activity at target cells, play an important role in the treatment of prostate cancer. The most frequently used substances have either a steroidal structure (cyproterone acetate) or a non-steroidal structure (Flutamide or Anandron). Antiandrogens have been tested both alone and in combination with treatments aimed at inhibiting testicular secretion (castration, LH-RH analogs), thereby producing complete blockade of androgen secretion and action. Patients treated by such combination protocols have often shown an improvement in the percentage of remissions and, less often, improvement in survival. Administration of antiandrogens improves the clinical symptoms of patients with benign prostatic hypertrophy, but the exact mechanism of their action requires further investigation. Cutaneous manifestations due to hyperandrogenicity (hirsutism, alopecia, acne) have also been improved by cyproterone acetate, which is often given together with estrogens (reversed sequential regime), by spironolactone or topically applied products. Finally, antiandrogens have been successfully used to treat breast cancer in men, early puberty, hypersexuality and sexual deviations.

Breast Cancer in a Male-to-Female Transsexual

The clinicopathological findings in a patient who developed breast carcinoma ten years after male-to-female sexual reassignment are reported. Only two other cases of transsexual men with breast carcinoma have been reported previously. All three patients received oral estrogens for prolonged periods to maintain secondary female characteristics. The controversies relating to hormonal influences in the etiology of breast cancer in men are discussed herein.

Breast cancer in men. Clinical features, hormone receptor status, and response to therapy.

Stage, estrogen receptor status, treatment and survival of 29 men with breast cancer attending the Breast Clinic of the Johannesburg Hospital between 1976 and 1985 are reviewed. Most patients had locoregionally advanced disease at presentation. Estrogen receptors (ER) were detected in significant concentration in 15/23 (65%). Local control was achieved in the majority, 19/26 (73%), by either surgery or radiation therapy alone or by combined modality treatment. Fifteen of 23 patients tested (65%) were ER-positive (greater than 10 fmol/mg protein). For patients with metastatic disease hormone receptor status was predictive of response to hormonal manipulation. Tamoxifen was the most acceptable and frequently used form of hormone therapy with 7/12 patients responding. Combination chemotherapy gave a response rate comparable to that seen in women with breast cancer.

Carcinoma of the Male Breast And Klinefelter's Syndrome: Is There an Association?

There appear to be no substantial data to confirm the assumption that breast cancer in men with Klinefelter's syndrome is as common as breast cancer in the normal female population. The number of reported cases of breast cancer in Klinefelter's males is only 27, a number too small for any meaningful statistical analysis. There is evidence, however, to suggest that Klinefelter's males have an increased risk of breast cancer that approaches three percent. Physicians should therefore be aware of potential breast pathology in XXY males and incorporate a careful breast examination and specific education into the routine health maintenance of men with Klinefelter's syndrome.

Thyroid Supplements and Breast Cancer

To the Editor.— The article of Drs Kapdi and Wolfe and subsequent reporting in the media seems, to us, to represent an incorrect review and analysis of what is already documented with respect to thyroid disease and the incidence of breast cancer in man. Contrary to what was concluded, namely, that thyroid therapy is associated with a higher incidence of breast cancer, we believe it should be concluded that there is a higher incidence of breast cancer in women with preexisting and frequently inadequately treated hypothyroidism or thyroiditis. Several published reports now suggest that failure to adequately treat hypothyroidism, goiters, or thyroiditis with thyroxin leads to enhanced development of breast cancer in susceptible persons. 1-5 There are, for example, confirmed reports of an increased incidence of breast cancer in hypothyroid patients 1 and in patients with Hashimoto thyroiditis, 2 and a greater incidence of elevated thyroidstimulating hormone (TSH) levels, an indication

Carcinoma of the male breast: Report of a series of 88 cases

A series of 88 cases of male breast cancer was compared with 241 cases of female breast cancer randomly selected from Departmental records. Cases of male breast cancer differed significantly from control female cases with regard to stage of the disease, age of onset and liability to the development of a second carcinoma. In 11 of the 88 cases (12.5%) of male breast cancer another primary malignant tumour developed. In seven instances the large bowel or rectum was the site of the other carcinoma. When correction was made for age and for the stage of the disease the prognosis of breast cancer in men and women was found to be similar. Only minor histological differences were found between male and female cases. Two of 54 cases examined for X-chromatin proved to be Barr-positive.

Breast cancer in men: Report illustrating the value of endocrine ablation

A male patient with breast cancer and diffuse osseous metastases had a favorable response for 14 months after orchiectomy and 16 months after adrenalectomy. The role of ablative procedures in the management of breast cancer in men is discussed. Breast cancer in the male appears to be more responsive to hormonal manipulations than its female counterpart. Reporting and study of such patients may provide additional information on hormone-dependent tumors in man.

Mammogenesis in Transsexuals

Photographs of modest to significant breast development in male transsexuals illustrate the range of male mammary tissue response, not strictly dose related, to hormonal feminization by exogenous estrogens and progestins, alone or in conjunction with castration. The histology of male mammary tissue is characterized in gynecomastia of varied etiology and in response to estrogen administration, with particular reference to lobule and aciniformation. Breast cancer is discussed in relation to both therapeutic and transsexual hormonal feminization of men. It does not appear that estrogens induce breast cancer in men.

Breast cancer in men.

T I IS A RARE PHYSICIAN or surgeon who encounters more than a few examples of breast cancer in men during his career. No more than one of every 100 carcinomas of the breast occurs in a man, and this tumor is responsible for only 0.38%1.5% of all cancers in men.’ Yet, to the 600 men who developed a carcinoma of the breast (and to the ‘250 who died) in 1973,’ and to their physicians, the issue was paramount. Experience acquired in dealing with breast cancer in women is not always applicable in men; appropriate and effective treatment and reasonably accurate prognosis require a separate body of knowledge. Finally, the rarity of breast cancer in the male, the major differences in his target organ, his hormonal environment, and his responses to treatment may offer a unique opportunity for study of the etiology and pathophysiology of this very common neoplasm. This report underscores the major differences in breast cancer between the sexes and stresses opportunities for better understanding of the natural history of breast cancer and for improvement of its treatment in men.

Hormonal management of breast cancer.

Because of the infrequent occurrence of breast cancer in men 2 brief case histories of male patients with breast cancer treated with progestins are presented. The first patient was a 61-year-old man with local recurrence of breast cancer 4 years after mastectomy. Orchidectomy then resulted in regression and control for 2 years. Diethylstilbestrol 15 mg daily was then given for 9 months but the tumor progressed. Then 5-fluorouracil and Thio-tepa (triethylenethiophosphoramide) were given. 1 year later Depo-Provera (medroxyprogesterone acetate) 100 mg im 3 times a week was begun. After 6 weeks without improvement diethylstilbestrol 15 mg daily was added. Recession occurred but after 6 months exacerbation again took place and the patient died 3 months later. The other patient was an 80-year-old man who had a radical mastectomy for breast cancer. The axillary nodes were found to be involved. After about 18 months pleural effusion led to pleural biopsy which confirmed metastasis. Bone metastases were also present and a cardiac arrhythmia refractory to digitalis. Bilateral orchidectomy was done. Medroxyprogesterone acetate 100 mg 3 times a week was given. Symptoms improved but bone metastases progressed. Progestins with or without estrogen are therefore recommended for cases of male breast carcinoma. Derivatives of 17-alpha hydroxyprogesterone seem best.

About breast cancer in men

Breast cancer in men is a relatively rare disease. From 1962 to 1967, we observed breast cancer in 6 men (age from 50 to 70 years).

Anterior pituitary function in patients with advanced breast cancer in reference to bilateral total adrenalectomy and oophorectomy

For decades it has been postulated that hormonal inbalance is a major factor in tumorigenesis in the target organ. The regression of breast cancer induced by oophorectomy has been attributed to the removal of ovarian hormones in which estrogens play a important role. It is also known that the adrenal cortex secrete an amount of estrogen. These findings led to the conclusion that oophorectomy and adrenalectomy should be recommended for advanced breast cancer in man. In addition, there are extensive experimental data suggesting that pituitary hormones also lead to mammary tumors.Recently, it has been established that adrenalectomy and oophorectomy, or hypophysectomy can induce prolonged regression of advanced breast cancer in 50 percent of patients. About 50 patients with advanced breast cancer received bilateral total adrenalectomy and oophorectomy in our clinic, 50 per-cent of these patients had remissions during more than 1 month and 40 per cent during more than 6 months. The average period of remission was 13.4 months. This operative procedure was effective because the mean survival time of remitted patients was 20.3 months compared with 2.3 months in non-remitted patients. Nearly half of the patients thus treated were benefited however, the rest had no remission.If the effectiveness of this procedure could be predicted for each patient, unncessary major surgery would be avoided for those patients who obtained no remission. Moreover, even among remitted patients who had a relapse after one year or so, the exact mechanism of the relapse remains obscure.The purpose of this paper is to put forward a working hypothesis in the hope that further investigation may lead to an anticipation of the effectiveness of surgery and an understanding of the exact mechanism of relapse. Several anterior pituitary functions before and after bilateral total adrenalectomy and oophorectomy were studied.Urinary excretion of prolactin was determined by pigeon crop-sac method, urinary excretion of gonadotrophin was determined by chemical assay and bio-assay (mouse uterine weight method), serum sulfation factor was determined by ALMQVIST's method, and blood ACTH activity was estimated by adrenal ascorbic acid depletion method in hypophysectomized rat.The summary of results was as followed : 1) No increase of excretion of prolactin, gonadotrophin and growth hormone was observed in patients with breast cancer. 2) No excess excretion of ACTH was observed in the adrectomized and oophorectomized patients with advanced breast cancer when they were maintained with adequate administration of steroid. No increase of excretion of prolactin, gonadotrophin and growth hormone was also observed in these patients.3) There was no correlation between efficiency of surgery and the urinary excretion of prolactin and gonadotrophin. Therefore, it was impossible to anticipate the response of adrenalectomy and oophorectomy.4) No increase of excretion of prolactin, gonadotrophin and ACTH was observed in the relapsed patients who previously had remissions after adrenalectomy and oophorectomy. It may be concluded that there are some other factors influencing the relapse besides pituitary hormones.