By: Victoria Forster, PhD
From: cancertherapyadvisor.com
A recent report from the Centers for Disease Control and Prevention (CDC) has provided new information about a large cohort of male breast cancer cases collected in the United States between 2007 and 2016.1
“Because breast cancer among men is rare, there are not many comprehensive studies that look at survival differences by race and other factors like age, stage, and geographic region,” said S. Jane Henley, MSPH, an epidemiologist at the CDC and one of the authors of the report.
The report, published in October 2020, looked at a number of metrics for men diagnosed with breast cancer, including survival, ethnicity and stage at diagnosis.
“I think what was nice about the report was that the report covered 94% of the US population, so almost all of the male breast cancer patients across the country,” said Sharon Giordano, MPH, MD, chair of health services research and professor of breast medical oncology at MD Anderson Cancer Center in Houston, Texas. “Most other studies I’ve seen are really a subset of patients across the US. Not many of the other findings about survival, etc, are particularly new, but the survival estimates are useful because the study involved so many patients,” Dr Giordano added.
Male breast cancer accounts for around 1% of all breast cancer diagnoses, but similar to in women, men diagnosed at a later stage of disease have a far worse prognosis than those diagnosed earlier.
“Men are generally diagnosed with breast cancer at more advanced stages, highlighting the need for better education among patients and health care providers about common presenting symptoms of male breast cancer leading to early diagnosis and improved outcomes,” said Ayca Gucalp, MD, assistant attending, breast medicine service, department of medicine, Memorial Sloan Kettering Cancer Center and assistant professor of medicine, Weill Cornell Medical College, both in New York.
The report found that overall, 5-year survival was 84.7% for male breast cancer, but that this varied widely with stage of disease at diagnosis. Males diagnosed with breast cancer at a distant stage had a 5-year survival rate of 25.9%, whereas those diagnosed with localized disease had a 98.7% survival rate.
“When men and women are diagnosed with the same stage of breast cancer, they generally have similar survival outcomes. When male breast cancer is diagnosed early or when it is localized (as highlighted in the CDC report), it is more likely to be cured. Unfortunately, because many men do not realize they can develop breast cancer, they don’t always seek immediate medical attention when they first discover a mass or lump in their chest wall,” said Dr Gucalp.
There were also differences in five-year survival among different races/ethnicities, with Black men having a 5-year survival of 77.6%; white men, 86.0%; and Hispanic men, 82.5%. Men of other ethnicities including non-Hispanic Asian/Pacific Islanders and non-Hispanic American Indians had a 5-year survival rate of 86.2%.
“The discrepancies in relative survival rates among men diagnosed with breast cancer in relation to race and census region stood out for me, as these data highlight areas of potential improvement in terms of screening, diagnosis, and access to treatment,” said Dr Gucalp.
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.
References
- 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
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.