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A systematic literature review of the management, oncological outcomes and psychosocial implications of male breast cancer

      Abstract

      Background

      Although male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancers, it has significant oncological, survival and psychosocial implications for patients. The aim of this study is to assess the latest literature in the diagnosis, management, oncological outcomes, and psychosocial impact of MBC.

      Methods

      A systematic literature review was conducted using the PRISMA guidelines (Moher et al., 2009) [1] to explore the management of MBC, with particular focus on investigative imaging, surgical management, oncological outcomes, survival, genetic screening and psychosocial effects. Electronic databases were searched for randomised control trials, cohort studies and case series involving more than 10 patients. Imaging and surgical techniques, local and distant disease recurrence, survival, genetic screening and psychosocial implications in the setting of MBC were assessed.

      Results

      The search criteria identified 199 articles, of which 59 met the inclusion criteria. This included 39,529 patients, with a mean age of 64.5 years (55–71), and a mean follow-up of 66.3 months (26.2–115). Mastectomy remains the most frequently used surgical technique, with an average of 89.6%. Loco-regional and distant recurrence rate was 10.1% and 21.4% respectively. Disease-free survival (DFS) at 5 and 10 years was 66.8% and 54.5% respectively. Disease-specific survival (DSS) at 5 and 10 years was 87.1% and 67.1% respectively. Overall survival (OS) at 5 and 10 years was 72.7% and 50.7% respectively. Genetic screening was conducted in 38.6% of patients of which 4.8% and 15.8% were found to be BRCA1 and BRCA2 carriers respectively. Psychosocial studies were conducted mainly using questionnaire and interview-based methodology focusing primarily on awareness of breast cancer in men, support available and impact on gender identity.

      Conclusions

      This review demonstrates that men present with later stage disease with subsequent impact on survival outcomes. There remains a paucity of high-level evidence and prospective studies are required. There is a need for increasing awareness amongst the public and health care professionals in order to improve outcomes and reduce stigma associated with MBC.

      Keywords

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      References

        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Uk C.R.
        Breast cancer incidence (invasive) statistics.
        2017
        • Wang F.
        • Shu X.
        • Meszoely I.
        • et al.
        Overall mortality after diagnosis of breast cancer in men vs women.
        JAMA Oncol. 2019; 5: 1589-1596
        • Hassett M.J.
        • Somerfield M.R.
        • Baker E.R.
        • et al.
        Management of male breast cancer: ASCO guideline.
        J Clin Oncol. 2020; 38: 1849-1863
        • Anderson W.F.
        • Althuis M.D.
        • Brinton L.A.
        • Devesa S.S.
        Is male breast cancer similar or different than female breast cancer?.
        Breast Cancer Res Treat. 2004; 83: 77-86
        • Wang J.
        • Zhao S.
        • Luo L.
        • et al.
        5-alpha Reductase Inhibitors and risk of male breast cancer: a systematic review and meta-analysis.
        Int Braz J Urol. 2018; 44: 865-873
        • Brinton L.A.
        • Cook M.B.
        • McCormack V.
        • et al.
        Anthropometric and hormonal risk factors for male breast cancer: male breast cancer pooling project results.
        J Natl Cancer Inst. 2014; 106: djt465
        • Dixon J.
        Breast surgery - a companion to specialist surgical practice.
        fifth ed. Elsevier, 2014
        • Jardel P.
        • Vignot S.
        • Cutuli B.
        • et al.
        Should adjuvant radiation therapy Be systematically proposed for male breast cancer? A systematic review.
        Anticancer Res. 2018; 38: 23-31
        • Ruddy K.J.
        • Winer E.P.
        Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship.
        Ann Oncol. 2013; 24: 1434-1443
        • Dakin Haché K.
        • Gray S.
        • Barnes P.J.
        • et al.
        Clinical and pathological correlations in male breast cancer: intratumoral aromatase expression via tissue microarray.
        Breast Cancer Res Treat. 2007; 105: 169-175
        • Wang-Rodriguez J.
        • Cross K.
        • Gallagher S.
        • et al.
        Male breast carcinoma: correlation of ER, PR, Ki-67, Her2-Neu, and p53 with treatment and survival, a study of 65 cases.
        Mod Pathol. 2002; 15: 853-861
        • De La Cruz L.M.
        • Thiruchelvam P.T.R.
        • Shivani J.
        • et al.
        Saving the male breast: a systematic literature review of breast-conservation surgery for male breast cancer.
        Ann Surg Oncol. 2019; 26: 3939-3944
        • Fentiman I.S.
        Surgical options for male breast cancer.
        Breast Cancer Res Treat. 2018; 172: 539-544
        • Aggarwal A.
        • Adepoju B.
        • Yacur M.
        • Maron D.
        • Sharma M.C.
        Gender disparity in breast cancer: a veteran population-based comparison.
        Clin Breast Cancer. 2021; 21: e471-e478
        • Andrykowski M.A.
        Physical and mental health status and health behaviors in male breast cancer survivors: a national, population-based, case-control study.
        Psycho Oncol. 2012; 21: 927-934
        • Bootsma T.I.
        • Duijveman P.
        • Pijpe A.
        • et al.
        Unmet information needs of men with breast cancer and health professionals.
        Psycho Oncol. 2020; 29: 851-860
        • Co M.
        • Lee A.
        • Kwong A.
        Delayed presentation, diagnosis, and psychosocial aspects of male breast cancer.
        Cancer Med. 2020; 9: 3305-3309
        • Cutuli B.
        • Le-Nir C.C.
        • Serin D.
        • et al.
        Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases.
        Crit Rev Oncol Hematol. 2010; 73: 246-254
        • Doyle S.
        • Steel J.
        • Porter G.
        Imaging male breast cancer.
        Clin Radiol. 2011; 66: 1079-1085
        • Johnson A.E.
        • Coopey S.B.
        • Spring L.M.
        • et al.
        Management and outcomes of men diagnosed with primary breast cancer.
        Breast Cancer Res Treat. 2021; 188: 561-569
        • Kiluk J.V.
        • Lee M.C.
        • Park C.K.
        • et al.
        Male breast cancer: management and follow-up recommendations.
        Breast J. 2011; 17: 503-509
        • Kipling M.
        • Ralph J.E.
        • Callanan K.
        Psychological impact of male breast disorders: literature review and survey results.
        Breast Care. 2014; 9: 29-33
        • Lomma C.
        • Chan A.
        • Chih H.
        • Reid C.
        • Peter W.
        Male breast cancer in Australia.
        Asia Pac J Clin Oncol. 2021; 17: e57-e62
        • McKinley N.
        • McCain S.
        • Kirk S.
        Long term follow up of male breast cancer.
        Ulster Med J. 2017; 86: 177-180
        • Nguyen T.S.
        • Bauer M.
        • Maass N.
        • Kaduszkiewicz H.
        Living with male breast cancer: a qualitative study of men's experiences and care needs.
        Breast Care. 2020; 15: 6-12
        • Midding E.
        • Halbach S.M.
        • Kowalski C.
        • et al.
        Social support of male breast cancer patients-a mixed-methods analysis.
        Am J Men's Health. 2019; 131557988319870001
        • Pellini F.
        • Granuzzo E.
        • Urbani S.
        • et al.
        Male breast cancer: surgical and genetic features and a multidisciplinary management strategy.
        Breast Care. 2020; 15: 14-20
        • Ravi A.
        • Bang H.
        • Karsif K.
        • Nori D.
        Breast cancer in men: prognostic factors, treatment patterns, and outcome.
        Am J Men's Health. 2012; 6: 51-58
        • Rayne S.
        • Schnippel K.
        • Thomson J.
        • Reid J.
        • Benn C.
        Male breast cancer has limited effect on survivor's perceptions of their own masculinity.
        Am J Men's Health. 2017; 11: 246-252
        • Skop M.
        • Lorentz J.
        • Jassi M.
        • Vesprini D.
        • Einstein G.
        Guys don't have breasts": the lived experience of men who have BRCA gene mutations and are at risk for male breast cancer.
        Am J Men's Health. 2018; 12: 961-972
        • Thompson Jr., E.H.
        • Haydock A.S.
        Men's lived experiences with breast cancer: the double consciousness of marginal men. Sex Roles.
        J Res. 2020; 82: 28-43
        • Vermeulen M.A.
        • Slaets L.
        • Cardoso F.
        • et al.
        Pathological characterisation of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG international male breast cancer program.
        Eur J Cancer. 2017; 82: 219-227
        • Wan B.A.
        • Ganesh V.
        • Zhang L.
        • et al.
        Treatment outcomes in male breast cancer: a retrospective analysis of 161 patients.
        Clin Oncol. 2018; 30: 354-365
        • Weir J.
        • Zhao Y.D.
        • Herman T.
        • Algan Ö.
        Clinicopathologic features and radiation therapy utilization in patients with male breast cancer: a national cancer database study.
        Breast Cancer. 2018; 121178223418770687
        • Masci G.
        • Caruso M.
        • Caruso F.
        • et al.
        Clinicopathological and immunohistochemical characteristics in male breast cancer: a retrospective case series.
        Oncol. 2015; 20: 586-592
        • Bradley K.L.
        • Tyldesley S.
        • Speers C.H.
        • Woods R.
        • Villa D.
        Contemporary systemic therapy for male breast cancer.
        Clin Breast Cancer. 2014; 14: 31-39
        • Madden N.A.
        • Macdonald O.K.
        • Call J.A.
        • et al.
        Radiotherapy and male breast cancer: a population-based registry analysis.
        Am J Clin Oncol. 2016; 39: 458-462
        • Rushton M.
        • Kwong A.
        • Visram H.
        • et al.
        Treatment outcomes for male breast cancer: a single-centre retrospective case-control study.
        Curr Oncol. 2014; 21: e400-e407
        • Iorfida M.
        • Bagnardi V.
        • Rotmensz N.
        • et al.
        Outcome of male breast cancer: a matched single-institution series.
        Clin Breast Cancer. 2014; 14: 371-377
        • Nilsson C.
        • Holmqvist M.
        • Bergkvist L.
        • et al.
        Similarities and differences in the characteristics and primary treatment of breast cancer in men and women - a population based study (Sweden).
        Acta Oncol. 2011; 50: 1083-1088
        • Moten A.
        • Obirieze A.
        • Wilson L.L.
        Characterizing lobular carcinoma of the male breast using the SEER database.
        J Surg Res. 2013; 185: e71-e76
        • Fogh S.
        • Kachnic L.A.
        • Goldberg S.I.
        • et al.
        Localized therapy for male breast cancer: functional advantages with comparable outcomes using breast conservation.
        Clin Breast Cancer. 2013; 13: 344-349
        • Fields E.C.
        • DeWitt P.
        • Fisher C.M.
        • Rabinovitch R.
        Management of male breast cancer in the United States: a surveillance, epidemiology and end results analysis.
        Int J Radiat Oncol Biol Phys. 2013; 87: 747-752
        • Yu X.F.
        • Feng W.L.
        • Miao L.L.
        • Chen B.
        • Yang H.J.
        The prognostic significance of molecular subtype for male breast cancer: a 10-year retrospective study.
        Breast. 2013; 22: 824-827
        • Sime C.
        Men's experiences of having breast cancer: a comparison with women's experiences.
        PhD Doctoral, 2012
        • Halls A.
        Marginal men: men with breast cancer negotiating gender (durham thesis).
        PhD Doctoral, 2013
        • Müller A.C.
        • Gani C.
        • Rehm H.M.
        • et al.
        Are there biologic differences between male and female breast cancer explaining inferior outcome of men despite equal stage and treatment?.
        Strahlenther Onkol. 2012; 188: 782-787
        • Dabakuyo T.S.
        • Dialla O.
        • Gentil J.
        • et al.
        Breast cancer in men in Cote d'Or (France): epidemiological characteristics, treatments and prognostic factors.
        Eur J Cancer Care. 2012; 21: 809-816
        • Yu E.
        • Suzuki H.
        • Younus J.
        • et al.
        The impact of post-mastectomy radiation therapy on male breast cancer patients--a case series.
        Int J Radiat Oncol Biol Phys. 2012; 82: 696-700
        • Arslan U.Y.
        • Oksüzoğlu B.
        • Ozdemir N.
        • et al.
        Outcome of non-metastatic male breast cancer: 118 patients.
        Med Oncol. 2012; 29: 554-560
        • Nilsson C.
        • Johansson I.
        • Ahlin C.
        • et al.
        Molecular subtyping of male breast cancer using alternative definitions and its prognostic impact.
        Acta Oncol. 2013; 52: 102-109
        • Pituskin E.
        • Williams B.
        • Au H.-J.
        • Martin-McDonald K.
        Experiences of men with breast cancer: a qualitative study.
        J Men's Health & Gend. 2007; 4: 44-51
        • Naymark P.
        Male breast cancer: incompatible and incomparable.
        J Men's Health & Gend. 2006; 3: 160-165
        • Brain K.
        • Williams B.
        • Iredale R.
        • France L.
        • Gray J.
        Psychological distress in men with breast cancer.
        J Clin Oncol. 2006; 24: 95-101
        • Ottini L.
        • Rizzolo P.
        • Zanna I.
        • et al.
        BRCA1/BRCA2 mutation status and clinical-pathologic features of 108 male breast cancer cases from Tuscany: a population-based study in central Italy.
        Breast Cancer Res Treat. 2009; 116: 577-586
        • Zhou F.F.
        • Xia L.P.
        • Guo G.F.
        • et al.
        Changes in therapeutic strategies in Chinese male patients with breast cancer: 40 years of experience in a single institute.
        Breast. 2010; 19: 450-455
        • Atahan L.
        • Yildiz F.
        • Selek U.
        • Sari S.
        • Gurkaynak M.
        Postoperative radiotherapy in the treatment of male breast carcinoma: a single institute experience.
        J Natl Med Assoc. 2006; 98: 559-563
        • Macdonald G.
        • Paltiel C.
        • Olivotto I.A.
        • Tyldesley S.
        A comparative analysis of radiotherapy use and patient outcome in males and females with breast cancer.
        Ann Oncol. 2005; 16: 1442-1448
        • Liukkonen S.
        • Saarto T.
        • Mäenpää H.
        • Sjöström-Mattson J.
        Male breast cancer: a survey at the helsinki university central hospital during 1981-2006.
        Acta Oncol. 2010; 49: 322-327
        • Iredale R.
        • Williams B.
        • Brain K.
        • France E.
        • Gray J.
        The information needs of men with breast cancer.
        Br J Nurs. 2007; 16: 540-544
        • Ge Y.
        • Sneige N.
        • Eltorky M.A.
        • et al.
        Immunohistochemical characterization of subtypes of male breast carcinoma.
        Breast Cancer Res. 2009; 11: R28
        • Giordano S.H.
        • Cohen D.S.
        • Buzdar A.U.
        • Perkins G.
        • Hortobagyi G.N.
        Breast carcinoma in men: a population-based study.
        Cancer. 2004; 101: 51-57
        • Borgen P.I.
        • Wong G.Y.
        • Vlamis V.
        • et al.
        Current management of male breast cancer. A review of 104 cases.
        Ann Surg. 1992; 215 (; discussion 57-9): 451-457
        • Williams B.G.
        • Iredale R.
        • Brain K.
        • et al.
        Experiences of men with breast cancer: an exploratory focus group study.
        Br J Cancer. 2003; 89: 1834-1836
        • Chakravarthy A.
        • Kim C.R.
        Post-mastectomy radiation in male breast cancer.
        Radiother Oncol. 2002; 65: 99-103
        • Yildirim E.
        • Berberoğlu U.
        Male breast cancer: a 22-year experience.
        Eur J Surg Oncol. 1998; 24: 548-552
        • Willsher P.C.
        • Leach I.H.
        • Ellis I.O.
        • et al.
        A comparison outcome of male breast cancer with female breast cancer.
        Am J Surg. 1997; 173: 185-188
        • Izquierdo M.A.
        • Alonso C.
        • De Andres L.
        • Ojeda B.
        Male breast cancer. Report of a series of 50 cases.
        Acta Oncol. 1994; 33: 767-771
        • Moore J.
        • Friedman M.I.
        • Gansler T.
        • et al.
        Prognostic indicators in male breast carcinoma.
        Breast J. 1998; 4: 261-269
        • Rayson D.
        • Erlichman C.
        • Suman V.J.
        • et al.
        Molecular markers in male breast carcinoma.
        Cancer. 1998; 83: 1947-1955
        • Cloyd J.M.
        • Hernandez-Boussard T.
        • Wapnir I.L.
        Outcomes of partial mastectomy in male breast cancer patients: analysis of SEER, 1983-2009.
        Ann Surg Oncol. 2013; 20: 1545-1550
        • Scott-Conner C.E.
        • Jochimsen P.R.
        • Menck H.R.
        • Winchester D.J.
        An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.
        Surgery. 1999; 126 (discussion 80-1): 775-780
        • Eggemann H.
        • Ignatov A.
        • Smith B.J.
        • et al.
        Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients.
        Breast Cancer Res Treat. 2013; 137: 465-470
        • Li W.P.
        • Gao H.F.
        • Ji F.
        • et al.
        The role of adjuvant chemotherapy in stage I-III male breast cancer: a SEER-based analysis.
        Ther Adv Med Oncol. 2020; 121758835920958358
        • Lautrup M.D.
        • Thorup S.S.
        • Jensen V.
        • et al.
        Male breast cancer: a nation-wide population-based comparison with female breast cancer.
        Acta Oncol. 2018; 57: 613-621
        • Cancer.org
        Breast cancer survival rates in men.
        2022
        • Fentiman I.
        Male breast cancer: a review.
        Ecancermedicalscience. 2009; 3: 140
      1. www.canrisk.org. 2021.

        • Lee A.
        • Mavaddat N.
        • Wilcox A.N.
        • et al.
        BOADICEA: a comprehensive breast cancer risk prediction model incorporating genetic and nongenetic risk factors.
        Genet Med. 2019; 21: 1708-1718
        • Gaddam S.
        • Heller S.L.
        • Babb J.S.
        • Gao Y.
        Male breast cancer risk assessment and screening recommendations in high-risk men who undergo genetic counseling and multigene panel testing.
        Clin Breast Cancer. 2021; 21: e74-e79
        • Schayek H.
        • Korach H.
        • Laitman Y.
        • Bernstein-Molho R.
        • Friedman E.
        Mutational analysis of candidate genes in Israeli male breast cancer cases.
        Breast Cancer Res Treat. 2018; 170: 399-404
        • de Blok C.J.M.
        • Wiepjes C.M.
        • Nota N.M.
        • et al.
        Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in The Netherlands.
        Br Med J. 2019; 365: l1652
        • Marino M.A.
        • Gucalp A.
        • Leithner D.
        • et al.
        Mammographic screening in male patients at high risk for breast cancer: is it worth it?.
        Breast Cancer Res Treat. 2019; 177: 705-711
        • Gao Y.
        • Goldberg J.E.
        • Young T.K.
        • et al.
        Breast cancer screening in high-risk men: a 12-year longitudinal observational study of male breast imaging utilization and outcomes.
        Radiology. 2019; 293: 282-291