Male breast cancer is rare, accounting for less than 1% of breast cancer cases. Risk factors include older age, high estrogen levels, family history of breast cancer, and genetic conditions like Klinefelter syndrome. Male breast cancer usually presents as a breast lump and is often diagnosed at later stages than female breast cancer. Pathology typically shows invasive ductal carcinoma that is often estrogen receptor and progesterone receptor positive. Treatment involves surgery, hormone therapy, chemotherapy and radiation. Outcomes have improved but remain worse than for female breast cancer due to later stage at diagnosis and less use of screening. Survivorship issues can include greater psychological impacts and adjustment challenges compared to females.

1. TOPIC PRESENTATION - MALE BREAST
CANCER
DEPT OF MEDICAL ONCOLOGY
HOD : DR.V.ARUMUGAM MD DM
Dr.KARTHIC.S,
DM MedOnc SR1,
TVMCH

2.  Breast cancer in men (MBC) very rare
 Make up less than 1% of all breast cancer cases
 Incidence increased 26% over the past 25 years
 Account for less than 1% of male cancer cases & 26th
common cancer in men (2009, UK)
 Lifetime risk in men : 1 in 1000
 In US, female to male breast cancer ratio 100:1
 Represent for <0.5% cancer deaths in men in US
 More common in African men (6%)

3.  Arise in breast tissues, mainly from ductal epithelium
 Can occur at any age, but usually seen at ages 60 – 70
 Around 65% male breast cancer cases were in men aged
65 & more (2009, UK)

4. RISK FACTORS :
 Older age
 High estrogen levels
 Strong family history of breast cancer – 2.5% higher risk
(15 – 20% MBC)
 Klinefelter syndrome (47XXY) - 50 fold higher risk
atrophic testes, gynecomastia, high serum
gonadotrophins (FSH & LH), low serum testosterone,
net effect of high estrogen:testosterone ratio

5.  Genetic alterations :
BRCA-2 mutation (4 – 16% MBC) -> young age,
poor survival
PALB2, CYP17,CHEK2, PTEN, h MLH1, AR
 Testicular abnormalities : Undescended testis, mumps
orchitis, Infertility
 Radiation exposure to chest before age 30 (Chest wall,
Mantle RT for HL)
 Alcoholism
 Obesity

6.  Benign breast diseases
 Gynecomastia
 Liver disease
 Chemicals (aromatic hydrocarbons, chloroethylenes)

7. CLINICAL PRESENTATION :
 Breast lump
 Nipple pain
 Inverted nipple
 Nipple discharge
 Enlarged axillary lymph nodes

8. WORK-UP :
 Mammogram (92% sensitivity, 90% specificity)
spiculation, calcification, mass
 USG Breast is a useful add-on
 Trucut Biopsy from breast mass
 IHC : ER, PR, HER2neu
 Metastatic workup – CECT C/A/P + Bone scan

9. PATHOLOGY :
 90% MBC – Invasive Ductal Cancer
 Lobular cancer – 1.5%
Normal male breast lacks acini & lobules, but lobular
cancer can be induced by estrogenic stimulation
 DCIS less common than in females
Mostly low grade & intraductal papillary form
 Pagets disease & Inflammatory breast cancer rare

10. MOLECULAR CHARACTERISTICS :
 High ER/PR expression
ER 90% +ve
PR 81% +ve
 HER2neu 5 ~ 15% +ve
More in younger men
 TNBC ~ 4%
More in non-Hispanic black men

11. DIFFERENTIAL DIAGNOSIS :
 Gynecomastia
 Breast abscess
 Metastases to breast
 Sarcomas

12. DIFFERENCES FROM FEMALE BREAST CANCER :
 Average age of presentation is late (5-10 years)
 Presents in more advanced stages with retroareolar
location & chest wall involvement
 BRCA 2 >> BRCA 1
 Lobular histology uncommon
 High rates of HR expression

13. TREATMENT OPTIONS :
 Surgery
 Chemotherapy
 Hormone therapy
 Radiation therapy

14. SURGERY :
 MRM + ALND – standard approach
 BCS less appropriate
Presentation in more advanced stage
Retroareolar & chest wall involvement
Scanty breast tissue
 SLND – data limited, but feasible
ASCO acceptable
 Reconstruction : extensive resection, skin closure

15. HORMONE THERAPY :
 Tamoxifen 20 mg / day – 5 years recommended adjuvant
Based on data from trials on female breast cancer
patients
Data from MBC scarce
 Low adherence – VTE, Decreased libido, hot flushes,
weight gain, social support
 AI – Insufficient data in adjuvant setting
Testes derived estrogen -> 20% endogenous
estrogen in men

16. CHEMOTHERAPY :
 Less commonly used, than in female patients
 Used in HR –ve tumors
 Trials :
US National Cancer Institute Trial – CMF in 24
MBC patients stage II node +ve -> 80% 5-year OS,
higher than controls
MD Anderson Cancer Experience – FAC in 32
MBC, 5-year OS 85%

17. METASTATIC DISEASE :
 Hormone therapy – First line
Tamoxifen as effective as surgery ( orchidectomy or
adrenalectomy)
 AI – shown benefit in metastatic setting
AI + orchidectomy
AI + LHRH analogues
 Hormone refractory - Chemotherapy

18. CONTRALATERAL BREAST CANCER :
 Risk higher in men (90 fold higher) than females
 Standardized incidence ratio (SIR ) - 30
 Absolute risk 1.75%
 Inspite of higher C/L breast cancer risk in men, absolute
risk is higher in females due to much higher disease
incidence & prevalence
 Role of screening mammogram has not been explored

19. SURVIVORSHIP ISSUES :
 About 25% MBC patients discontinue treatment
 Socially isolating for men, stigmatized by their diagnosis
 Greater adjustment issues than women
 Poor physical & mental health
 Late age presentation –> more risk of co-morbidities