Breast cancer in men and women contrasts in the age at diagnosis, the frequency of the histological types, and the frequency of expression of steroid hormone receptor and molecular markers. The median age at diagnosis in men in most series is 68 years compared with 63 years in women. Men with breast cancer have a higher occurrence of ductal histology. More than 85% of all cases are invasive ductal carcinomas; in women the frequency of ductal histology is 70-75%. Estrogen, androgen, and progesterone steroid receptor expression is also higher in men with breast cancer. Her-2/neu, a proto-oncogene cell surface receptor, has been found to be expressed in 0-95% of men with breast cancer—the expression rate varies according to the number of patients examined. In women 20-40% of patients have Her-2/neu positive tumors and an association with adverse prognosis is established. The significance of Her-2/neu in breast cancer in men remains unclear. While germ line genetic mutations of BRCA 1 in women can confer a 60-80% lifetime risk for breast cancer, mutations in BRCA 1 do not increase the risk of breast cancer in men. BRCA 2 mutations, however, do appear to be a risk factor for breast cancer in men.

Despite the biological differences, clinical outcomes for breast cancer in men are similar to those for women when they are matched for age, treatment, and stage of cancer. Older series have reported worse outcomes but were confounded by comparably later stage at presentation, long duration of symptoms before treatment, failure to account for nodal disease, and suboptimal treatment. Most men are treated with mastectomy. However, without established criteria for adjuvant treatment, men are more likely than women to receive suboptimal radiation treatment. Several randomized trials have established limited surgery plus radiation as the standard of care for women. In some series of men with breast cancer, however, they receive limited surgery without radiation. Likewise, post mastectomy radiation criteria are also established for women. Yet some men receive radiation inappropriately, which perhaps results in significant cardiac doses, contributing to decreased survival.

A recent analysis at our centre of men with breast cancer who were not treated with radiation after mastectomy showed that current guidelines for radiation treatment for women are applicable to men with breast cancer and can help optimize local regional control. Data derived from other studies at our centre show that men treated with adjuvant doxorubicin based chemotherapy for stage II or III disease had five year survival rates greater than 85%. Furthermore using the guidelines established for women can help optimize systemic control. Currently we recommend chemotherapy for men with breast cancer with positive nodes, tumors larger than 1 cm, and hormone receptor negative metastases. We also recommend hormonal treatment for five years. Yet many men with breast cancer do not receive chemotherapy or hormonal treatment, although they have a higher rate of hormone receptor positive tumors, and tamoxifen has been shown to improve survival in men.

Men with breast cancer, in summary, are older, more likely to have hormone receptor positive disease, nodal metastases, and advanced stage disease than women with breast cancer. They are also likely to receive suboptimal treatment. The published data to date indicate a need for benchmarks that can be examined prospectively to determine the optimal treatment of breast cancer in men. We currently use and recommend for men the same guidelines used for treatment of breast cancer in women. As the incidence of breast cancer is currently rising in younger men we should generate new data that will contribute towards guidelines for determining when treatment for men and women should be the same or differ, and that will help optimize treatment.

What is breast cancer in men?

A breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into surrounding tissues or spread to distant areas of the body. Breast cancer occurs mainly in women, but men can get it, too. Many people do not realize that men have breast tissue and that they can develop breast cancer.

Normal breast structure

To understand breast cancer, it helps to have some basic knowledge about the normal structure of the breasts.
The breast is made up mainly of lobules (milk-producing glands in women), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).
Until puberty (usually around 13 or 14), young boys and girls have a small amount of breast tissue consisting of a few ducts located under the nipple and areola (area around the nipple). At puberty, a girl's ovaries make female hormones, causing breast ducts to grow, lobules to form at the ends of ducts, and the amount of stroma to increase. In boys, hormones made by the testicles keep breast tissue from growing much. Men's breast tissue has ducts, but only a few if any lobules.
Like all cells of the body, a man's breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because their breast cells are not constantly exposed to the growth-promoting effects of female hormones.

diagram of the internal structure of the breast

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Saturday, July 9, 2011

Breast Cancer Cases Among Men

What is breast cancer in men?

Normal breast structure

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