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A retrospective chart review was conducted of men with the diagnosis of carcinoma of the breast seen at this institution between January 1967 and March 1981. Eighty-nine patients were available for analysis. These cases were evaluated to determine whether the natural history of this disease was similar to that of women with carcinoma of the breast and to identify prognostic variables in carcinoma of the male breast. The results of this review would suggest that many similarities exist between breast cancer in women and in men. The most common presenting symptom is a lump, the patterns of recurrence are similar for both men and women, and survival is determined by initial T stage and the presence or absence of nodes. Local postoperative radiotherapy does not influence overall survival in male breast cancer but does decrease the incidence of chest wall recurrence. Survival after recurrence is short and is similar to that observed for women with recurrent carcinoma of the breast. The differences observed in the present series were that the median age at presentation of 63.6 years is somewhat greater than that usually observed in women; no cases of lobular carcinoma were observed; and in the 44 patients who developed recurrences to date, none had evidence of liver metastases as the initial site of recurrence. In most respects the natural history of male breast cancer is similar to that of carcinoma of the breast in women. Since carcinoma of the male breast is a relatively rare malignancy. it is reasonable to recommend management of this disease be based on the greater base of knowledge available for carcinoma of the female breast.

Patients at high risk for inherited breast and/or ovarian cancer are frequently encountered in all medical specialties. Department of Defense, Health Affairs funding as part of the Breast Cancer Education and Awareness Program was used to develop a comprehensive program for the identification, counseling, genetic testing, and long-term follow-up of such high-risk patients. This article reports the recommendations for high-risk patient management based on 4 years of evaluation and care, including discussions of the approach to counseling, indications for genetic testing, post-testing counseling, patient surveillance with examination, imagining, and laboratory testing, and suggested options for surgical and chemoprophylaxis as well as lifestyle modifications.

The Department of Defense Familial Breast/Ovarian Cancer Research Project has offered genetic counseling and testing for BRCA1 and BRCA2 on a research basis to patients meeting specific diagnostic criteria, with risk for BRCA1 and BRCA2 mutations calculated based on the Couch model. In 2.5 years, 250 patients were evaluated and 101 patients met criteria requirements, including 33 who met criteria in more than one category. Ninety patients elected to undergo DNA testing. In this group of 90 patients, 14 mutations (15.5%) and 16 unclassified variants (17.7%) were identified. The most common inclusion criteria were onset of breast/ovarian cancer before age 45 years (n = 32) and onset of breast/ovarian cancer before age 45 years with strong family history (n = 21). However, when number of mutations and unclassified variants found were compared separately across all diagnostic criteria (including those of more than one capacity) using the chi 2 statistic, no significant differences were seen among the categories to suggest that one criterion was more predictive of mutations or variants than another. Couch risk values for patients with mutations showed a mean of 14% and ranged from 3.2 to 43.5% (range for all patients, 1.2-69.7%). These findings emphasize the importance of using multiple diagnostic criteria and suggest that a Couch risk value of > 3% may be useful in selecting patients for testing. The data also underscore the necessity of genetic counseling in the testing process, particularly given the large number of unclassified variants diagnosed and their uncertain status for disease predisposition.

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