Male breast cancer accounts for about 1% of all breast cancer cases in the United States, therefore it can be a shocking diagnosis. During my career as a nurse practitioner in the field of breast oncology, I have been involved in the care of only five male breast cancer cases over the last 25 years.
Male breast cancer is generally treated with total mastectomy due to later stage at diagnosis and the centrally located tumor under the nipple, which makes cosmesis somewhat limiting. Most women are treated with breast conservation, and numerous national guidelines suggest lumpectomy as the first choice in surgical treatment followed by radiation.
In a recent study by Gomberawalla and colleagues, the authors presented the following case study1:
A 62-year-old male was found to have a 1.6-cm palpable mass at the 10:00 position 1 cm radially from the nipple in the right breast. Core biopsy demonstrated invasive ductal carcinoma, moderately differentiated, estrogen receptor– and progesterone receptor–positive, and HER2-negative. The patient had a strong desire for breast conservation, and needed to minimize daily radiation treatments due to his work schedule.
The multidisciplinary group considered the treatment options and felt that this patient was a candidate for lumpectomy followed by intraoperative radiation therapy (IORT). The patient had negative margins on his final pathology. After a 6-month follow-up, the patient was doing very well with no untoward sequelae.2 He was pleased with the cosmetic outcome and shortly thereafter returned to regular activities and work schedule.
In our own institutional experience, we had a similar patient with early-stage breast cancer, promising histologic markers, and negative lymph nodes. He went on to have conventional treatment with mastectomy; however, he later opted for reconstruction, causing him to require more time off for recovery and a second procedure that carried all the potential risks of surgery. Could we have saved him from a two-step procedure and completed his treatment more rapidly if we had allowed him to voice his preference? Could this lead to a paradigm shift in caring for male breast cancer patients if data supports similar survival benefit?
Breast conservation offers psychologic, functional, and cosmetic benefit when compared with mastectomy in the female population. Should we not consider these same issues when planning treatment for our male patients, however few they are?
Have you ever worked with a male breast cancer patient? What was the experience like for him and his family?
1. Gomberawalla A, Liou P, Martinez R, Rajpara R, et al. Breast conservation for male breast cancer: Case report of intraoperative radiation. Breast J. 2017 Jun 8. doi: 10.1111/tbj.12847. [Epub ahead of print]
2. Zaenger D, Rabatic BM, Dasher B, Mourad WF. Is breast conserving therapy a safe modality for early-stage male breast cancer? Clin Breast Cancer. 2016; 16:101-4.