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For further information, see CMDT Part 19-08: Carcinoma of the Male Breast

KEY FEATURES

  • Rare; average age, 70 years

    • Poorer prognosis than for female breast cancer (even stage I)

  • Hormonal influences likely play an important role

  • Over 95% of men have ER-positive tumors and less than 10% have overexpression of HER2

CLINICAL FINDINGS

  • Painless lump beneath the areola, usually found after age 50

    • Nipple discharge, retraction, or ulceration

    • Gynecomastia may precede or accompany male breast cancer and may itself be a risk factor

    • Increased incidence of breast cancer in men with prostate cancer

    • Examination usually shows a hard, ill-defined, nontender mass beneath the nipple or areola

  • Cancer staging is the same in men as in women

  • Bone is the most frequent site of metastases

DIAGNOSIS

  • Biopsy is required to confirm diagnosis

  • Examine for hormone receptors and HER2 overexpression as assessment for adjuvant therapy

  • Differential diagnosis

    • Gynecomastia

    • Metastatic cancer from another site (eg, prostate)

    • Fatty breast enlargement of obesity

TREATMENT

  • Modified radical mastectomy in operable patients who should be chosen by the same criteria as women with the disease

  • Breast-conserving therapy remains underutilized

  • Irradiation for localized, symptomatic metastases to skin, lymph nodes, or skeleton

  • Adjuvant systemic therapy and radiation are used for the same indications as in breast cancer in women

  • Tamoxifen, 20 mg orally once daily

    • Main medication for management of advanced breast cancer in men

    • Should be the initial treatment

  • Aromatase inhibitors

    • Few data regarding their use in men, but they are used frequently

  • Castration in advanced breast cancer

    • More beneficial than the same procedure in women but is rarely used

  • 5-year survival rate for node-positive disease: ∼69%

  • 5-year survival rate for node-negative disease: ∼88%

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