Biological Differences in Male vs Female Breast Cancer

Janis C. Kelly

September 15, 2011

September 15, 2011 — Men are on average older than women when diagnosed with breast cancer and have differences in disease characteristics compared with their female counterparts, confirmed a new study presented at the 2011 Breast Cancer Symposium in San Francisco, California.

"Men are diagnosed with breast cancer at an older age and more frequently have lymph node involvement at diagnosis compared to women," said lead author Siva K. Talluri, MD, in an interview with Medscape Medical News. He is a clinical assistant professor in the McLaren Internal Medicine Residency Program at Michigan State University in Flint, Michigan.

The fact that men present later in life and with more advanced disease than women "may be related possibly to the lack of awareness among patients as well as primary care physicians and absence of screening routinely done in women," Dr. Talluri said.

Dr. Talluri and colleagues conducted a retrospective cohort study that included information on 2475 men and 393,259 women with breast cancer from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.

Median age at diagnosis was 67 years for men vs 61 for men. Lymph node involvement was present in 32% of men and 22% of women, and men were more likely to be estrogen receptor (ER) positive or progesterone receptor (PR) positive than women.

In men with breast cancer, overall median survival duration was 9 years, the 5-year survival rate was 63%, and the 10-year survival rate was 43%. Factors associated with decreased survival were age older than 65 years at diagnosis, larger tumor size, positive lymph node status, ER-negative status, and poorly differentiated grade (P = 0.02). PR status was not a significant predictor of survival.

Median survival was significantly shorter in African-American men with breast cancer than in white men (7.08 vs. 9.2 years; P = .02).

"We updated the information on survival and predictors of male breast cancer by analyzing more recent data from 1990-2007," said Dr. Talluri. "There is a paucity of epidemiologic data on male breast cancer because it so rare; therefore any information garnered from such large datasets as SEER is valuable." She added that presence of ER-negative status was not an independent predictor in previous studies but was significant in this study.

Dr. Talluri added that the study was missing some potentially important data. "We did not have information about our study population on the risk factors like BRCA, and family history of breast cancer. I am interested to know about risk factors that will help us identify the men at high risk. This may help the clinicians to diagnose men with breast cancer at an earlier stage of the disease."

Gail S. Lebovic, MD, a member of the 2011 Breast Cancer Symposium News Planning Team and past president of the American Society of Breast Disease, commented, "While the study itself has some limitations, the authors confirm what has been shown historically. Breast cancer in men occurs later in life, is frequently associated with a delay in diagnosis, and is commonly associated with lymph node involvement. Although breast cancer is rare in men, these findings demonstrate that it is critically important to continue to raise awareness about the occurrence of breast cancer in men."

Dr. Talluri and Dr. Lebovic have disclosed no relevant financial relationships.

2011 Breast Cancer Symposium; abstract #39. Presented September 8, 2011.

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