Male breast cancer: diagnosis, treatment and support

Research output: Contribution to journalMeeting abstractResearch

Abstract

Male breast cancer (MBC) is rare, with an estimated 145 men diagnosed in Australia this year and up to 12% of these having a BRCA2 mutation. The median age at diagnosis for men is 71 years versus 60 years for women. Most men with enlarged breasts have lipomastia or pseudogynaecomastia. Gynaecomastia refers to unilateral or bilateral breast tenderness due to hormonal changes. Conversely, MBC tends to present as unilateral, often nodular tumours located close to the nipple and bloody nipple discharge can occur.

Initial investigation includes ultrasound and mammography followed by core-biopsy of the primary lesion and often fine-needle biopsy of abnormal axillary nodes. Breast MRI may be helpful.

Common histologies include infiltrating ductal (90%) followed by papillary carcinomas (3%) and DCIS in 2% of patients. ER-positive disease accounts for 80% of patients and HER2-positive disease is uncommon (<5%).

Treatment is total mastectomy and sentinel node biopsy. If a patient presents with a larger mass, a PET-CT or CT and bone scan is necessary to assess loco-regional and distant disease and this often helps determine whether axillary dissection, sentinel node biopsy or IMC irradiation is required.

Most patients require post-mastectomy radiotherapy, as the disease is often advanced at presentation and obtaining clear margins can be difficult. Limited studies support the use of adjuvant tamoxifen and/or chemotherapy, but not aromatase inhibitors alone. Herceptin is advisable if patient is HER2 positive, but studies are limited.

Follow-up and review in a family history clinic is important, as 12.5% of patients will develop a second cancer. BRCA2 mutation may account for increased risk of pancreatic, prostate and gastric cancer.

There is significant psychological impact from MBC with issues including “contested masculinity”, “concealment” and “interacting with health services” for patients facing a disease dominated by pink and the female sex. Increasing awareness is essential.

LanguageEnglish
Article number90
Pages90-91
Number of pages2
JournalAsia-Pacific Journal of Clinical Oncology
Volume11
Issue numberS4
Publication statusPublished - Nov 2015

Cite this

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title = "Male breast cancer: diagnosis, treatment and support",
abstract = "Male breast cancer (MBC) is rare, with an estimated 145 men diagnosed in Australia this year and up to 12{\%} of these having a BRCA2 mutation. The median age at diagnosis for men is 71 years versus 60 years for women. Most men with enlarged breasts have lipomastia or pseudogynaecomastia. Gynaecomastia refers to unilateral or bilateral breast tenderness due to hormonal changes. Conversely, MBC tends to present as unilateral, often nodular tumours located close to the nipple and bloody nipple discharge can occur.Initial investigation includes ultrasound and mammography followed by core-biopsy of the primary lesion and often fine-needle biopsy of abnormal axillary nodes. Breast MRI may be helpful.Common histologies include infiltrating ductal (90{\%}) followed by papillary carcinomas (3{\%}) and DCIS in 2{\%} of patients. ER-positive disease accounts for 80{\%} of patients and HER2-positive disease is uncommon (<5{\%}).Treatment is total mastectomy and sentinel node biopsy. If a patient presents with a larger mass, a PET-CT or CT and bone scan is necessary to assess loco-regional and distant disease and this often helps determine whether axillary dissection, sentinel node biopsy or IMC irradiation is required.Most patients require post-mastectomy radiotherapy, as the disease is often advanced at presentation and obtaining clear margins can be difficult. Limited studies support the use of adjuvant tamoxifen and/or chemotherapy, but not aromatase inhibitors alone. Herceptin is advisable if patient is HER2 positive, but studies are limited.Follow-up and review in a family history clinic is important, as 12.5{\%} of patients will develop a second cancer. BRCA2 mutation may account for increased risk of pancreatic, prostate and gastric cancer.There is significant psychological impact from MBC with issues including “contested masculinity”, “concealment” and “interacting with health services” for patients facing a disease dominated by pink and the female sex. Increasing awareness is essential.",
author = "John Boyages",
year = "2015",
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volume = "11",
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}

Male breast cancer : diagnosis, treatment and support. / Boyages, John.

In: Asia-Pacific Journal of Clinical Oncology, Vol. 11, No. S4, 90, 11.2015, p. 90-91.

Research output: Contribution to journalMeeting abstractResearch

TY - JOUR

T1 - Male breast cancer

T2 - Asia-Pacific Journal of Clinical Oncology

AU - Boyages, John

PY - 2015/11

Y1 - 2015/11

N2 - Male breast cancer (MBC) is rare, with an estimated 145 men diagnosed in Australia this year and up to 12% of these having a BRCA2 mutation. The median age at diagnosis for men is 71 years versus 60 years for women. Most men with enlarged breasts have lipomastia or pseudogynaecomastia. Gynaecomastia refers to unilateral or bilateral breast tenderness due to hormonal changes. Conversely, MBC tends to present as unilateral, often nodular tumours located close to the nipple and bloody nipple discharge can occur.Initial investigation includes ultrasound and mammography followed by core-biopsy of the primary lesion and often fine-needle biopsy of abnormal axillary nodes. Breast MRI may be helpful.Common histologies include infiltrating ductal (90%) followed by papillary carcinomas (3%) and DCIS in 2% of patients. ER-positive disease accounts for 80% of patients and HER2-positive disease is uncommon (<5%).Treatment is total mastectomy and sentinel node biopsy. If a patient presents with a larger mass, a PET-CT or CT and bone scan is necessary to assess loco-regional and distant disease and this often helps determine whether axillary dissection, sentinel node biopsy or IMC irradiation is required.Most patients require post-mastectomy radiotherapy, as the disease is often advanced at presentation and obtaining clear margins can be difficult. Limited studies support the use of adjuvant tamoxifen and/or chemotherapy, but not aromatase inhibitors alone. Herceptin is advisable if patient is HER2 positive, but studies are limited.Follow-up and review in a family history clinic is important, as 12.5% of patients will develop a second cancer. BRCA2 mutation may account for increased risk of pancreatic, prostate and gastric cancer.There is significant psychological impact from MBC with issues including “contested masculinity”, “concealment” and “interacting with health services” for patients facing a disease dominated by pink and the female sex. Increasing awareness is essential.

AB - Male breast cancer (MBC) is rare, with an estimated 145 men diagnosed in Australia this year and up to 12% of these having a BRCA2 mutation. The median age at diagnosis for men is 71 years versus 60 years for women. Most men with enlarged breasts have lipomastia or pseudogynaecomastia. Gynaecomastia refers to unilateral or bilateral breast tenderness due to hormonal changes. Conversely, MBC tends to present as unilateral, often nodular tumours located close to the nipple and bloody nipple discharge can occur.Initial investigation includes ultrasound and mammography followed by core-biopsy of the primary lesion and often fine-needle biopsy of abnormal axillary nodes. Breast MRI may be helpful.Common histologies include infiltrating ductal (90%) followed by papillary carcinomas (3%) and DCIS in 2% of patients. ER-positive disease accounts for 80% of patients and HER2-positive disease is uncommon (<5%).Treatment is total mastectomy and sentinel node biopsy. If a patient presents with a larger mass, a PET-CT or CT and bone scan is necessary to assess loco-regional and distant disease and this often helps determine whether axillary dissection, sentinel node biopsy or IMC irradiation is required.Most patients require post-mastectomy radiotherapy, as the disease is often advanced at presentation and obtaining clear margins can be difficult. Limited studies support the use of adjuvant tamoxifen and/or chemotherapy, but not aromatase inhibitors alone. Herceptin is advisable if patient is HER2 positive, but studies are limited.Follow-up and review in a family history clinic is important, as 12.5% of patients will develop a second cancer. BRCA2 mutation may account for increased risk of pancreatic, prostate and gastric cancer.There is significant psychological impact from MBC with issues including “contested masculinity”, “concealment” and “interacting with health services” for patients facing a disease dominated by pink and the female sex. Increasing awareness is essential.

UR - https://doi.org/10.1111/ajco.12432

M3 - Meeting abstract

VL - 11

SP - 90

EP - 91

JO - Asia-Pacific Journal of Clinical Oncology

JF - Asia-Pacific Journal of Clinical Oncology

SN - 1743-7555

IS - S4

M1 - 90

ER -