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IntroductionOver the past two decades, major improvements have been achieved in the understanding of breast cancer, and cure can be offered if the disease is diagnosed at an early stage. However, the disease is more often diagnosed at more advanced stages (3 or 4) in men, in contrast to women. Its rarity among men as well as lack of awareness leads to its detection at later stages. Randomized studies cannot be carried on due to the low incidence of breast cancer in males, with only a few published prospective therapeutic studies in the literature. While the information on male breast cancer (MBC) was obtained from retrospective studies, the recommendations for treatment were derived from studies conducted on female breast cancer (1). This review presents the frequency, etiology, clinical-pathological characteristics and treatment approaches for the rare MBC. Epidemiology-EtiologyMale breast cancer is rare and constitutes 0.5-1% of all patients with breast cancer. The reason of the low incidence rate in men is the relatively low amount of breast tissue along with the difference in their hormonal environment. Even though breast tissue is less in men as compared to women, the factors that influence malignant changes are similar. The Surveillance, Epidemiology and End Result (SEER) Program reported that the incidence of breast cancer was highest at ages 52-71 during 1973-2000, whereas the peak incidence in males was 71 years (2). In fact, some authors state that MBC imitate the behavioral pattern of post-menopausal female breast cancer. The incidence of breast cancer in males and females has increased in the past 25 years. International Association of Cancer Registries (IACR) emphasized this increase and stated that the incidence of female breast cancer increased by 20%, while breast cancer-related deaths increased by 14%. The SEER data also showed that the rate that was 1.1 for 100.000 men in the mid-1970s and raised to 1.44 for 100.000 men by 2010 (3). In USA, 2240 men were diagnosed with breast cancer within the year 2013. The lifetime rate of diagnosis with male breast cancer is 1 in 1000. According to the IACR Turkey data, 0.37% of all cancer types among males are breast cancer (4, 5). IACR has published its new cancer estimates for the year 2012. The most recent cancer estimates for 28 cancer types in 184 countries, which record cancer data, have been made available for users on the GLOBOCAN 2012 website (6).The rate of presentation with advanced stage breast cancer has been decreasing in men. As a matter of fact, a study conducted in 1995 reported the rate of Stage 1-2 disease on diagnosis as 70%, whereas it was reported as 67% in 2010 and 82% in 2015 (7-9). MBC constitutes less than 1% of male cancers and it has a varying rate of incidence across different geographies and ethnic groups (10, 11). Its annual prevalence in Europe is 1 in 10.000 men and these cases constitute less than 1% of all patients with breast cancer (4). However, this rate is above 6% in Central African countries (12). This relatively hig...
IntroductionOver the past two decades, major improvements have been achieved in the understanding of breast cancer, and cure can be offered if the disease is diagnosed at an early stage. However, the disease is more often diagnosed at more advanced stages (3 or 4) in men, in contrast to women. Its rarity among men as well as lack of awareness leads to its detection at later stages. Randomized studies cannot be carried on due to the low incidence of breast cancer in males, with only a few published prospective therapeutic studies in the literature. While the information on male breast cancer (MBC) was obtained from retrospective studies, the recommendations for treatment were derived from studies conducted on female breast cancer (1). This review presents the frequency, etiology, clinical-pathological characteristics and treatment approaches for the rare MBC. Epidemiology-EtiologyMale breast cancer is rare and constitutes 0.5-1% of all patients with breast cancer. The reason of the low incidence rate in men is the relatively low amount of breast tissue along with the difference in their hormonal environment. Even though breast tissue is less in men as compared to women, the factors that influence malignant changes are similar. The Surveillance, Epidemiology and End Result (SEER) Program reported that the incidence of breast cancer was highest at ages 52-71 during 1973-2000, whereas the peak incidence in males was 71 years (2). In fact, some authors state that MBC imitate the behavioral pattern of post-menopausal female breast cancer. The incidence of breast cancer in males and females has increased in the past 25 years. International Association of Cancer Registries (IACR) emphasized this increase and stated that the incidence of female breast cancer increased by 20%, while breast cancer-related deaths increased by 14%. The SEER data also showed that the rate that was 1.1 for 100.000 men in the mid-1970s and raised to 1.44 for 100.000 men by 2010 (3). In USA, 2240 men were diagnosed with breast cancer within the year 2013. The lifetime rate of diagnosis with male breast cancer is 1 in 1000. According to the IACR Turkey data, 0.37% of all cancer types among males are breast cancer (4, 5). IACR has published its new cancer estimates for the year 2012. The most recent cancer estimates for 28 cancer types in 184 countries, which record cancer data, have been made available for users on the GLOBOCAN 2012 website (6).The rate of presentation with advanced stage breast cancer has been decreasing in men. As a matter of fact, a study conducted in 1995 reported the rate of Stage 1-2 disease on diagnosis as 70%, whereas it was reported as 67% in 2010 and 82% in 2015 (7-9). MBC constitutes less than 1% of male cancers and it has a varying rate of incidence across different geographies and ethnic groups (10, 11). Its annual prevalence in Europe is 1 in 10.000 men and these cases constitute less than 1% of all patients with breast cancer (4). However, this rate is above 6% in Central African countries (12). This relatively hig...
Objective: Due to a lack of sufficient data, the treatment protocols for male breast cancer are usually the same as those used for female breast cancer. The aim of the current study was to present our clinical experience with male breast cancer. Materials and Methods:The records of 37 patients who were treated for male breast cancer in our hospital between 2004 and 2014 were reviewed retrospectively. The data of patients were recorded and analyzed.Results: The mean age of the patients was 63.03±12.36 years. Thirty-three patients (89.2%) had invasive ductal carcinoma, two (5.4%) had ductal carcinoma in situ, and two had invasive lobular carcinoma (5.4%). The most common molecular subtype was luminal A (17 cases, 45.9%). Twentynine patients with male breast cancer underwent mastectomy and two underwent breast conserving surgery. Axillary lymph node dissection was performed in 25 patients. The most common surgical procedure was modified radical mastectomy. Distant metastases were present in 17 (45.9%) patients. Overall, the 5-year survival was 60%. The 5-year survival was 100% for those with stage 0-I disease, 87% for stage II, and 42% for stage III. The 3-year survival was 14% for stage IV. Conclusion:Patients with male breast cancer presented at an older age, a later stage, and with earlier metastasis. Early metastasis and death increases with increasing stage. Poor prognosis correlates with late admission. Data from different centers should be compiled and reviewed in order to determine a specific treatment protocol for male breast cancer; each paper published reveals new data.
BACKGROUND.In contrast to female breast carcinoma, information regarding the prevalence and prognostic information of new molecular markers is limited in male breast carcinoma. The objective of this study was to assess the degree of expression and prognostic value of estrogen receptors (ER), progesterone receptors (PR), androgen receptors (AR), bcl-2, p53, HER-2/neu, cyclin D1, and MIB-1 in a cohort of male breast carcinoma patients. METHODS.A computerized search of the medical index, tumor registry, and tissue registry was used to identify 111 male patients with a diagnosis of primary adenocarcinoma of the breast seen between 1950 -1992 at the Mayo Clinic. Of these, 77 patients had adequate tissue specimens available for the immunohistochemical analysis of the markers. Immunoperoxidase staining was performed by an automated avidin-biotin complex method. Progression free (PFS) and overall (OS) survival distributions were estimated using the Kaplan-Meier method. The log rank test was used to determine whether any patient characteristic, tumor feature, or molecular marker was associated significantly with PFS or OS. RESULTS.The majority of tumor specimens were positive for ER (91%), PR (96%), AR (95%), and bcl-2 (94%). Fewer positive specimens were found for cyclin D1 (58%), MIB-1 (38%), HER-2/neu (29%), and p53 (21%). The 5-year PFS and 10-year OS for the entire patient cohort was estimated to be 66% (95% confidence interval[CI], 57-77%) and 38% (95% CI, 29 -50%), respectively. PFS was decreased significantly for those patients with tumors staining positively for MIB-1 (P ϭ 0.012) or negatively for cyclin D1 (P ϭ 0.009). OS was not found to differ significantly with respect to these markers. CONCLUSIONS.The nearly universal expression of hormone receptors in these tumors suggests a central role for endogenous hormones in male breast carcinoma.The high degree of AR expression would suggest that antiandrogen therapy should be explored further. The high frequency of bcl-2 positivity may implicate antiapoptotic mechanisms in the carcinogenesis of male breast carcinoma. The finding of decreased PFS in MIB-1 positive tumors supports the role of proliferative activity as a negative prognostic factor in male breast carcinoma. Positive cyclin D1 expression is associated with increased PFS in male breast carcinoma patients, which suggests that interactions among cell cycle regulatory proteins may be important in this disease.
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