Treatment Options for Male Breast Cancer

Primary standard treatment is a modified radical mastectomy with axillary dissection.[1-3] 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.)

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]

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.)

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.[9-11]

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.  [PUBMED Abstract]
   
   
2. Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002.  [PUBMED Abstract]
   
   
3. Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991.  [PUBMED Abstract]
   
   
4. Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007.  [PUBMED Abstract]
   
   
5. Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007.  [PUBMED Abstract]
   
   
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.  [PUBMED Abstract]
   
   
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.  [PUBMED Abstract]
   
   
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.  [PUBMED Abstract]
   
   
9. Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005.  [PUBMED Abstract]
   
   
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.  [PUBMED Abstract]
    
    
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.  [PUBMED Abstract]
    
    

Changes to This Summary (01/06/2012)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Male Breast Cancer

Updated statistics with estimated new cancer cases and deaths for 2012 (cited American Cancer Society as reference 1).

Updated Burstein et al. as reference 9.

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.

About This PDQ Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).

Board members review recently published articles each month to determine whether an article should:

• be discussed at a meeting,
• be cited with text, or
• replace or update an existing article that is already cited.

Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.

The lead reviewer for Male Breast Cancer Treatment is:

• Beverly Moy, MD, MPH (Massachusetts General Hospital)

Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

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The preferred citation for this PDQ summary is:

National Cancer Institute: PDQ® Male Breast Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/malebreast/HealthProfessional. Accessed <MM/DD/YYYY>.

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