Awareness of male breast cancer has significantly lagged behind that of the disease in women, which has undoubtedly contributed to frequent late diagnosis in many men with breast cancer. How has awareness of the disease in men changed over the past few decades and what still needs to be done?
“Thankfully, I think there is more awareness of male breast cancer in the last few years, with many organizations bringing attention to this diagnosis, the risk factors associated with male breast cancer, and how to access care,” said Dr Gucalp.
“From my experience taking care of men with breast cancer, anecdotally, many men are not aware they can get breast cancer, so there is still lots to be done to educate the public that men are at risk of this disease. I think there has been some improvement, but there clearly still is a long way to go if men are presenting with disease that’s already spread to the lymph nodes,” said Dr Giordano.
The CDC report highlights the role of family history of cancer and genetic testing in identifying men who might be more likely to develop breast cancer. It suggests the possibility of breast exams for men with BRCA1 or BRCA2 mutations starting at the age of 35 years.
“Men can use the US Surgeon General’s ‘My Family Health Portrait’ tool to collect family health history of breast, ovarian, and other cancers.2 Routinely discussing their family health history with their health care providers can identify if they are at increased risk and should undergo counseling and testing for genetic mutations,” said Henley.
Although men with breast cancer have a good survival rate if diagnosed early, treatments for male breast cancer are almost always adapted from clinical trial data involving solely or mostly female patients, with little currently known specifically about the biology of male breast tumors.
“Research that explores the underlying biology of male breast cancer and how it differs from female breast cancer, and clinical trials designed to include male patients, are key to improving the management of male breast cancer,” said Dr Gucalp.
Dr Giordano is part of a large collaborative study (ClinicalTrials.gov Identifier: NCT01101425) involving patients from 3 continents to collect samples from men with breast cancer to better understand their biology and clinical characteristics.
“We have about 1500 samples now, reviewed by a pathologist; lots of studies coming out of that work. The first thing we have seen is that almost all tumors in men are estrogen receptor–(ER) positive.3 We have sequencing studies ongoing to see the differences and similarities between breast cancers in men and women,” added Dr Giordano.
The planned next step of this work is run a clinical trial for men with breast cancer to identify therapies that benefit these patients. Giordano and colleagues aim to enroll 500 patients over 2 years.
Disclosure: Ayca Gucalp discloses the following relationships and financial interests: American Association for Cancer Research, Innocrin Pharmaceuticals Inc, and Pfizer Inc.
- Ellington TD, Henley SJ, Wilson RJ, et al. Breast cancer survival among males by race, ethnicity, age, geographic region, and stage — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2020;69:1481-1484.
- Centers for Disease Control and Prevention. Office of Genomics and Precision Public Health, Center for Surveillance, Epidemiology and Laboratory Services (CSELS). Public Health Genomics Knowledge Base (v6.6). My Family Health Portrait tool. Updated May 1, 2020. Accessed November 17, 2020. 3. Cardoso F, Bartlett J, Slaets L et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol. 2018;29(2):405-417. doi:10.1093/annonc/mdx651