Treatment Options for Male Breast Cancer

Initial Surgical Management

Primary standard treatment is a modified radical mastectomy with axillary dissection.[1,2,3] Responses are generally similar to those seen in women with breast cancer.[2] Breast conservation surgery with lumpectomy and radiation therapy has also been used and results have been similar to those seen in women with breast cancer.[4] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Adjuvant Therapy

In men with node-negative tumors, adjuvant therapy should be considered on the same basis as for a woman with breast cancer since there is no evidence that response to therapy is different for men or women.[5]

In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal therapy have been used and can increase survival to the same extent as in women with breast cancer. Currently, no controlled studies have compared adjuvant treatment options. Approximately 85% of all male breast cancers are estrogen receptor–positive, and 70% of them are progesterone receptor–positive.[2,6] Response to hormone therapy correlates with presence of receptors. Hormonal therapy has been recommended in all receptor-positive patients.[1,2] Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence in male breast cancer patients.[7] (Refer to the PDQ summaries on Fever, Sweats, and Hot Flashes and Sexuality and Reproductive Issues for more information on these symptoms.) Responses are generally similar to those seen in women with breast cancer.[2] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Adjuvant chemotherapy regimens include:

• CMF: cyclophosphamide plus methotrexate plus fluorouracil.[8]
• CAF: cyclophosphamide plus doxorubicin plus fluorouracil.
• Trastuzumab (under clinical evaluation).[9]
• Tamoxifen (under clinical evaluation).[9]

Locally Recurrent Disease

Surgical excision or radiation therapy combined with chemotherapy is recommended.[2] Responses are generally similar to those seen in women with breast cancer.[2,5] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

Distant Metastases

Hormonal therapy, chemotherapy, or a combination of both have been used with some success. Initially, hormonal therapy is recommended.[2,5]

Hormonal modalities include:

• Orchiectomy.
• Luteinizing hormone-releasing hormone agonist with or without total androgen blockage (anti-androgen).
• Tamoxifen for estrogen receptor–positive patients.[1]
• Progesterone.
• Aromatase inhibitors.[9,10,11]

Hormonal therapies may be used sequentially. Standard chemotherapy combinations of CMF and CAF are recommended after failure of hormonal therapy. Responses are generally similar to those seen in women with breast cancer.[2] (Refer to the PDQ summary on Breast Cancer Treatment for more information.)

References:

1. Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992.
2. Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.
3. Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991.
4. Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007.
5. Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007.
6. Joshi MG, Lee AK, Loda M, et al.: Male breast carcinoma: an evaluation of prognostic factors contributing to a poorer outcome. Cancer 77 (3): 490-8, 1996.
7. Anelli TF, Anelli A, Tran KN, et al.: Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74 (1): 74-7, 1994.
8. Walshe JM, Berman AW, Vatas U, et al.: A prospective study of adjuvant CMF in males with node positive breast cancer: 20-year follow-up. Breast Cancer Res Treat 103 (2): 177-83, 2007.
9. Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.
10. Cocconi G, Bisagni G, Ceci G, et al.: Low-dose aminoglutethimide with and without hydrocortisone replacement as a first-line endocrine treatment in advanced breast cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 10 (6): 984-9, 1992.
11. Gale KE, Andersen JW, Tormey DC, et al.: Hormonal treatment for metastatic breast cancer. An Eastern Cooperative Oncology Group Phase III trial comparing aminoglutethimide to tamoxifen. Cancer 73 (2): 354-61, 1994.