Treatment

The general approach in management is similar to that of female breast cancer (1). Therapeutic options include: surgery, radio-therapy and systemic therapies (2).

For localized disease, radical mastectomy was preferred as the standard treatment. This has now been replaced with less invasive procedures like modified radical or simple mastectomy.

• axillary node dissection may be carried out (although this is associated with complications like lymphedema and parasthesia
• more recently sentinel-node biopsy has become the accepted method to confirm axillary node status for invasive MBC (1).

Postoperative radiotherapy is often given for a bulky tumour, involved or close margins, clinically positive nodes, or inflammatory carcinoma (3).

Systemic therapy includes:

• anti-estrogen - tamoxifen
• although there are no clinical trials which evaluate the use of tamoxifen in MBC, men who have received tamoxifen had improved disease-free and overall survival rates
  • five-year disease-free rate improved from 28 to 56%
  • five-year overall survival rate improved from 44 to 61% (1)
• chemotherapy
• improves survival and prevents recurrence (mainly in node positive men)
• aromatase inhibitors - there is insufficient data to support the use in treatment of MBC (1)

Management of metastatic and recurrent disease is similar to that of female breast cancer (3).

Reference:

• (1) Johansen Taber KA et al.Male breast cancer: risk factors, diagnosis, and management (Review). Oncol Rep. 2010;24(5):1115-20.
• (2) White J et al. Male breast carcinoma: increased awareness needed. Breast Cancer Res. 2011;13(5):219.
• (3) Niewoehner CB, Schorer AE. Gynaecomastia and breast cancer in men. BMJ. 2008;336(7646):709-13.