It has been noted in a recent study that men who develop recurrent breast cancer are less likely to survive than women. This may be due in part to the less aggressive treatment offered to men than women.
In the first study to review recurrence patterns between both men and women, this research can have tremendous impact on male breast cancer survivors. Though fewer in number, overall survival benefit was half that of women.1 One reason may be the burden of additional comorbidities that make using more aggressive treatment less desirable.
In this study, a cohort of 23 males was matched with a cohort of 69 females with breast cancer to estimate the effects of treatment patterns on disease outcomes after recurrence. Variables used to match the groups were year of diagnosis, age at diagnosis (within 5 years), stage, and tumor profile subtypes. Type of surgery, adjuvant treatments, chemotherapeutic regimens (based on taxanes and anthracyclines), and median time from diagnosis to recurrence were found to be the same among male and female subjects.1
In the majority of cases, distant recurrence was the most prevalent, which was noted primarily in the bone (52.5% in males and 66.7% in females), followed by the lung (39.1% and 17.4%), and liver (13.0% and 20.3%), respectively; 4.3% of females also had brain metastases.
Abreu and colleagues also found that improved survival was observed in male patients who were estrogen receptor- and/or progesterone receptor-positive, androgen receptor-negative, HER2-negative, and who had low levels of the ki67 protein and the p53 tumor suppressor gene as similarly in women.2 This suggested that prognostic information based on subgroups was different for males and females, “and documentation is needed for new subgroups in males,” said Abreu.3
In our breast cancer service, we have had several male breast cancer patients. Most were found to be BRCA gene-positive. In one case, this gene had been passed on to a son, who chose bilateral mastectomies in an attempt to forestall a diagnosis of breast cancer.
What we have come to know as we reach out to male breast cancer survivors is that they have similar concerns as our female breast cancer patients in terms of psychosocial, financial, and interpersonal relationships. The psychological impact of being diagnosed with a “female” disease has created an opportunity to heighten awareness in this population from other survivors.
Men Have Breasts Too has greatly helped lend support to those with breast cancer.4 Founded in 2014 by Bret Miller, there are now many chapters across the country. Only with the support of clinical teams and male breast cancer survivors will there be a paradigm shift to find appropriate treatment and support for this small but vulnerable population.
Has anyone had a male breast cancer patient? Did they need support services? How has your cancer team approached this population of cancer survivors?
- Abreu MH, Abreu PH, Afonso N, et al. Patterns of Recurrence and Treatment in Male Breast Cancer: A Clue to Prognosis? Int J Cancer., 2016 Oct 15;139(8):1715-20.
- Abreu MH, Gomes M, Menezes F, et al. CYP2D6*4 Polymorphism: A New Marker of Response to Hormonotherapy in Male Breast Cancer? Breast., 2015 Aug;24(4):481-6.
- Abreu MH, Afonso N, Abreu PH, et al. Male Breast Cancer: Looking for Better Prognostic Subgroups. Breast. 2016 Apr;26:18-24.
- The Male Breast Cancer Coalition.