Women with breast cancer are more likely than their male counterparts to refuse hormone therapy or surgery, according to a retrospective study published in Clinical Breast Cancer.

The researchers noted that treatment refusal among breast cancer patients has been studied in the past, but few studies have evaluated refusal among male patients with breast cancer.

With this in mind, the researchers retrospectively analyzed data from patients diagnosed with breast cancer between 2004 and 2016 who were entered into the National Cancer Database.

The cohort included patients treated with hormone therapy (n=906,342), surgery (n=1,228,132), chemotherapy (n=596,229), and radiation (n=858,050). Men comprised 0.82% of the cohort treated with hormone therapy, 0.84% treated with surgery, 0.91% treated with chemotherapy, and 0.67% treated with radiation.

Baseline characteristics between male and female patients differed. A higher proportion of the male patients were Black. Men were more likely to be diagnosed at an older age and be insured by Medicare. And the men tended to have higher tumor grades, more advanced disease stage, and more comorbidities. 

For the entire cohort, chemotherapy was the most commonly refused treatment (16.23%), followed by hormone therapy (7.65%), radiation (5.14%), and surgery (0.40%).

The difference in chemotherapy refusal between men and women was not statistically significant (adjusted odds ratio [AOR], 0.98; 95% CI, 0.89-1.07; P =.62).

However, men were significantly less likely to refuse hormone therapy (AOR, 0.83; 95% CI, 0.75-0.92; P <.01) or surgery (AOR, 0.67; 95% CI, 0.50-0.90; P =.01) compared with women.

And men were significantly more likely to refuse radiation compared with women (AOR, 1.14; 95% CI, 1.03-1.30; P =.04).

“Certain factors such as advanced age and lack of insurance were significantly associated with each treatment refusal,” the researchers wrote. They concluded that these findings could be used “to identify the risk groups and barriers associated with refusal for each treatment and to develop interventions.”


Shahi S, Meza J, Tandra P, et al. Gender differences in recommended treatment decisions among breast cancer patients: A study using the National Cancer Database. Clin Breast Cancer. Published online November 8, 2021. doi:10.1016/j.clbc.2021.11.001