Male breast cancer treated with more mastectomies

Breast cancer is treated differently in men than in women, and men with breast cancer undergo mastectomy more often do women with the disease. Although locally advanced female breast cancer is commonly treated with radiation, this new study found that radiation is used less in male disease.

Researchers from the University of Colorado Cancer Center in Denver examined data from 4,276 cases of male breast cancer and 718,587 cases of female breast cancer. Their data came from the US Surveillance, Epidemiology, and End Results (SEER) Program database, which has collected cancer statistics since 1973 and includes tumor type, demographics, treatment, and outcome information for about 28% of the US population. Their study was published in the International Journal of Radiation Oncology*Biology*Physics (2013; doi:10.1016/j.ijrobp.2013.07.016).

"We know very little about male breast cancer since it comprises only 0.6% of all breast cancer, and nearly all therapy is based on female breast cancer studies,” said Rachel Rabinovitch, MD, investigator at the CU Cancer Center and professor of radiation oncology at the University of Colorado School of Medicine. This study demonstrates that outcomes in men with early stage breast cancer who undergo mastectomy or lumpectomy followed by radiation are the same as in women who follow the same treatment protocol. In most women, breast-conserving surgery is the standard and preferred treatment. Yet in this study, 87% of men underwent mastectomy for early-stage disease, whereas only 38% of women underwent the procedure in the same time period.

"Traditionally, breast conservation is not even considered for men with breast cancer. But in a world in which a man's appearance is increasingly important, and where it is common for men to be seen without a shirt in the gym or on the beach, mastectomy can have overlooked psycho-sexual impacts on men, just as in women," Rabinovitch said.

She explained that male breast cancer is not studied prospectively because it is a rare disease. This rarity makes it difficult to enroll enough patients to conduct a clinical trial. Therefore, the disease is studied through collected data such as the SEER database.

The study also shows that mastectomy may be over-used in male breast cancer, and radiation therapy may be under-utilized. In locally advanced breast cancer, the disease is comprised of a large tumor mass or has spread to the surrounding chest wall, nearby skin, or underarm lymph nodes but not yet to other organs. In the current study, 34% of males with locally advanced disease were treated with radiation therapy following mastectomy, compared with 45% of females with similar disease.

"I think these findings point to new areas of research and should push clinicians to consider the advantages of breast-conserving therapy with their patients. It's a new conversation—surgeons and oncologists shouldn't assume that men are fine with a mastectomy," Rabinovitch said.

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