TITLE:
Breast Cancer in Males (BCM), Does It Really Differ? National Cancer Institute Experience (NCI), Cairo University, Egypt
AUTHORS:
Ahmed El Sayed Fathalla, Marwa Nabil Abd El Hafez
KEYWORDS:
Male Breast Cancer, Clinicopathological, Females, Outcome
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.5,
May
13,
2016
ABSTRACT: Background: Carcinoma of the male breast is relatively a rare disease accounting
for about 1% of all cancer in men. Its treatments are based mainly on those of Female
Breast Cancer (BCF). Materials and Methods: This is a single institution retrospective
study including all presenting to the NCI, Cairo University with Breast Cancer in
a Male (BCM) in the last 11 years between Jan. 2005 until Jan. 2016. Data were collected
from patient’s files from the statistical department then analyzed. Aims: To study
the clinico-pathological characteristics, the presentation, workup, surgical approaches
and postoperative complications and outcome of management, with addressing similarities
and difference from BCF. Results: 64 patients were included in this cohort. The
mean age was 58.6 & the median age was 59 years (range: 31 - 87 years). The
main presenting symptomatology was retroareolar breast lump (50 cases, 78.1%). Most
of our cases were advanced; 22 cases (34.3%) were stage III & 16 cases (25%)
were stage IV. Surgery was performed for 50 patients; MRM for 26 cases (40.6%),
RM for 18 cases (28.1%) & toilet mastectomy for 6 cases (9.3%). Primary closure
was feasible in 34 patients (68%) while 16 cases (32%) required reconstruction by
local or pedicled flaps. Tamoxifen is the most important non-surgical treatment.
It was given to all our cases (64 cases, 100%) either postoperatively as adjuvant
management (36 cases, 56.2%) or as palliation for metastatic disease (28 cases,
43.8%). Chemotherapy was given to 32 patients (100%) as an adjuvant for 24 cases
(75%) and as a palliation for 8 cases (25%). Radiotherapy was given to 26 patients
(100%) as adjuvant therapy for 20 cases (76.9%) and as a palliation for 6 cases
(23.1%). The only significant factor determining the overall 5 years survival was
the stage of the disease. LN status & surgery type were of border line significance
(better survival with negative LN & with MRM). The 5-year Overall Survival (OS)
& Disease Free Survival (DFS) for the whole group were 66% & 52% respectively.
Within the DFS there was no significant variable; however, the stage and type of
surgery were of borderline significance, with better survival with early stage disease
(I & II) and with MRM (both were 61%). Conclusion: BCM has many similarities
to BCF, but it harbours many different genetic and pathologic features. They obtain
similar prognostic factors and similar stage-for-stage survival. They are always
advanced to T4 stage rapidly due to the lack of breast parenchyma with higher ER
expression in BCM than BCF patients.