Breast Cancer in Males (BCM), Does It Really Differ? National Cancer Institute Experience (NCI), Cairo University, Egypt

Abstract

Background: Carcinoma of the male breast is relatively a rare disease accounting for about 1% of all cancer in men. Its treatments are based mainly on those of Female Breast Cancer (BCF). Materials and Methods: This is a single institution retrospective study including all presenting to the NCI, Cairo University with Breast Cancer in a Male (BCM) in the last 11 years between Jan. 2005 until Jan. 2016. Data were collected from patient’s files from the statistical department then analyzed. Aims: To study the clinico-pathological characteristics, the presentation, workup, surgical approaches and postoperative complications and outcome of management, with addressing similarities and difference from BCF. Results: 64 patients were included in this cohort. The mean age was 58.6 & the median age was 59 years (range: 31 - 87 years). The main presenting symptomatology was retroareolar breast lump (50 cases, 78.1%). Most of our cases were advanced; 22 cases (34.3%) were stage III & 16 cases (25%) were stage IV. Surgery was performed for 50 patients; MRM for 26 cases (40.6%), RM for 18 cases (28.1%) & toilet mastectomy for 6 cases (9.3%). Primary closure was feasible in 34 patients (68%) while 16 cases (32%) required reconstruction by local or pedicled flaps. Tamoxifen is the most important non-surgical treatment. It was given to all our cases (64 cases, 100%) either postoperatively as adjuvant management (36 cases, 56.2%) or as palliation for metastatic disease (28 cases, 43.8%). Chemotherapy was given to 32 patients (100%) as an adjuvant for 24 cases (75%) and as a palliation for 8 cases (25%). Radiotherapy was given to 26 patients (100%) as adjuvant therapy for 20 cases (76.9%) and as a palliation for 6 cases (23.1%). The only significant factor determining the overall 5 years survival was the stage of the disease. LN status & surgery type were of border line significance (better survival with negative LN & with MRM). The 5-year Overall Survival (OS) & Disease Free Survival (DFS) for the whole group were 66% & 52% respectively. Within the DFS there was no significant variable; however, the stage and type of surgery were of borderline significance, with better survival with early stage disease (I & II) and with MRM (both were 61%). Conclusion: BCM has many similarities to BCF, but it harbours many different genetic and pathologic features. They obtain similar prognostic factors and similar stage-for-stage survival. They are always advanced to T4 stage rapidly due to the lack of breast parenchyma with higher ER expression in BCM than BCF patients.