Review| Volume 13, ISSUE 5, P309-314, October 2013

Download started.


New Approaches in the Management of Male Breast Cancer

  • Darren K. Patten
    Address for correspondence: Darren K. Patten, Department of Biosurgery and Surgical Oncology, 10th Floor, QEQM Building, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W12 0NY, United Kingdom
    Department of Biosurgery and Surgical Oncology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK

    Department of Breast and General Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
    Search for articles by this author
  • Laurence K. Sharifi
    Department of Breast and General Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, UK
    Search for articles by this author
  • Maisam Fazel
    Department of Breast Surgery, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, UK
    Search for articles by this author


      Male breast cancer (MBC) is a rare condition that accounts for 0.1% of all male cancers. Our current evidence base for treatment is derived from female breast cancer (FBC) patients. Risk factors for MBC include age, genetic predisposition, race, sex hormone exposure, and environmental factors. Most patients present later and with more advanced disease than comparable FBC patients. Tumors are likely to be estrogen receptor and progesterone receptor positive, with the most common histologic type being invasive ductal carcinoma. Triple assessment remains the criterion standard for diagnosis. Primary MBC is mostly managed initially by simple mastectomy, with the option of breast conserving surgery, which carries an increased risk of recurrence. Sentinel node biopsy is recommended as the initial procedure for staging the axilla. Reconstructive surgery focuses on achieving primary skin closure, and radiotherapy largely follows treatment protocols validated in FBC. We recommend chemotherapy for men with more advanced disease, in particular, those with estrogen receptor negative histology. MBC responds well to endocrine therapy, although it is associated with significant adverse effects. Third-generation aromatase inhibitors are promising but raise concerns due to their failure to prevent estrogen synthesis in the testes. Fulvestrant remains unproven as a therapy, and data on trastuzumab is equivocal with HER2 receptor expression and functionality unclear in MBC. In metastatic disease, drug-based hormonal manipulation remains a first-line therapy, followed by systemic chemotherapy for hormone-refractory disease. Prognosis for MBC has improved over the past 30 years, with survival affected by disease staging, histologic classification, and comorbidity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anderson W.F.
        • Althuis M.D.
        • Brinton L.A.
        • et al.
        Is male breast cancer similar or different than female breast cancer?.
        Breast Cancer Res Treat. 2004; 83: 77-86
        • Donegan W.L.
        • Redlich P.N.
        Breast cancer in men.
        Surg Clin North Am. 1996; 76: 343-363
        • Agrawal A.
        • Ayantunde A.A.
        • Rampaul R.
        • et al.
        Male breast cancer: a review of clinical management.
        Breast Cancer Res Treat. 2007; 103: 11-21
        • Fentiman I.S.
        • Fourquet A.
        • Hortobagyi G.N.
        Male breast cancer.
        Lancet. 2006; 367: 595-604
        • Gu G.-L.
        • Wang S.-L.
        • Wei X.-M.
        • et al.
        Axillary metastasis as the first manifestation of male breast cancer: a case report.
        Cases J. 2008; 1: 285
        • Doyle S.
        • Steel J.
        • Porter G.
        Imaging male breast cancer.
        Clin Radiol. 2011; 66: 1079-1085
        • Günhan-Bilgen I.
        • Bozkaya H.
        • Ustün E.E.
        • et al.
        Male breast disease: clinical, mammographic, and ultrasonographic features.
        Eur J Radiol. 2002; 43: 246-255
        • Stewart R.A.
        • Howlett D.C.
        • Hearn F.J.
        Pictorial review: the imaging features of male breast disease.
        Clin Radiol. 1997; 52: 739-744
        • Korde L.A.
        • Zujewski J.A.
        • Kamin L.
        • et al.
        Multidisciplinary meeting on male breast cancer: summary and research recommendations.
        J Clin Oncol. 2010; 28: 2114-2122
        • Giordano S.H.
        • Cohen D.S.
        • Buzdar A.U.
        • et al.
        Breast carcinoma in men: a population-based study.
        Cancer. 2004; 101: 51-57
        • Chen V.W.
        • Correa P.
        • Kurman R.J.
        • et al.
        Histological characteristics of breast carcinoma in blacks and whites.
        Cancer Epidemiol Biomarkers Prev. 1994; 3: 127-135
        • Erlichman C.
        • Murphy K.C.
        • Elhakim T.
        Male breast cancer: a 13-year review of 89 patients.
        J Clin Oncol. 1984; 2: 903-909
        • Johansen Taber K.A.
        • Morisy L.R.
        • Osbahr A.J.
        • et al.
        Male breast cancer: risk factors, diagnosis, and management [review].
        Oncol Rep. 2010; 24: 1115-1120
        • Palli D.
        • Falchetti M.
        • Masala G.
        • et al.
        Association between the BRCA2 N372H variant and male breast cancer risk: a population-based case-control study in Tuscany, Central Italy.
        BMC Cancer. 2007; 7: 170
        • Martin A.M.
        • Weber B.L.
        Genetic and hormonal risk factors in breast cancer.
        J Natl Cancer Inst. 2000; 92: 1126-1135
        • Thorlacius S.
        • Tryggvadottir L.
        • Olafsdottir G.H.
        • et al.
        Linkage to BRCA2 region in hereditary male breast cancer.
        Lancet. 1995; 346: 544-545
        • Orr N.
        • Lemnrau A.
        • Cooke R.
        • et al.
        Genome-wide association study identifies a common variant in RAD51B associated with male breast cancer risk.
        Nat Genet. 2012; 44: 1182-1184
        • McClure J.A.
        • Higgins C.C.
        Bilateral carcinoma of male breast after estrogen therapy.
        J Am Med Assoc. 1951; 146: 7-9
        • Symmers W.S.
        Carcinoma of breast in trans-sexual individuals after surgical and hormonal interference with the primary and secondary sex characteristics.
        Br Med J. 1968; 2: 83-85
        • Hultborn R.
        • Hanson C.
        • Köpf I.
        • et al.
        Prevalence of Klinefelter's syndrome in male breast cancer patients.
        Anticancer Res. 1997; 17: 4293-4297
        • Swerdlow A.J.
        • Schoemaker M.J.
        • Higgins C.D.
        • et al.
        Cancer incidence and mortality in men with Klinefelter syndrome: a cohort study.
        J Natl Cancer Inst. 2005; 97: 1204-1210
        • Krause W.
        Male breast cancer—an andrological disease: risk factors and diagnosis.
        Andrologia. 2004; 36: 346-354
        • Thomas D.B.
        • Jimenez L.M.
        • McTiernan A.
        • et al.
        Breast cancer in men: risk factors with hormonal implications.
        Am J Epidemiol. 1992; 135: 734-748
        • Sørensen H.T.
        • Friis S.
        • Olsen J.H.
        • et al.
        Risk of breast cancer in men with liver cirrhosis.
        Am J Gastroenterol. 1998; 93: 231-233
        • Lahmann P.H.
        • Friedenreich C.
        • Schuit A.J.
        • et al.
        Physical activity and breast cancer risk: the European Prospective Investigation into Cancer and Nutrition.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 36-42
        • Guénel P.
        • Cyr D.
        • Sabroe S.
        • et al.
        Alcohol drinking may increase risk of breast cancer in men: a European population-based case-control study.
        Cancer Causes Control. 2004; 15: 571-580
        • Keller A.Z.
        Demographic, clinical and survivorship characteristics of males with primary cancer of the breast.
        Am J Epidemiol. 1967; 85: 183-199
        • Ron E.
        • Ikeda T.
        • Preston D.L.
        • et al.
        Male breast cancer incidence among atomic bomb survivors.
        J Natl Cancer Inst. 2005; 97: 603-605
        • Hansen J.
        Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products.
        Am J Ind Med. 2000; 37: 349-352
        • Dershaw D.D.
        • Fleischman R.C.
        • Liberman L.
        • et al.
        Use of digital mammography in needle localization procedures.
        AJR Am J Roentgenol. 1993; 161: 559-562
        • Yang W.T.
        • Whitman G.J.
        • Yuen E.H.
        • et al.
        Sonographic features of primary breast cancer in men.
        AJR Am J Roentgenol. 2001; 176: 413-416
        • Ozdemir A.
        • Oznur II,
        • Vural G.
        • et al.
        TL-201 scintigraphy, mammography and ultrasonography in the evaluation of palpable and nonpalpable breast lesions: a correlative study.
        Eur J Radiol. 1997; 24: 145-154
        • Rosen D.G.
        • Laucirica R.
        • Verstovsek G.
        Fine needle aspiration of male breast lesions.
        Acta Cytol. 2009; 53: 369-374
        • Wauters C.A.P.
        • Kooistra B.W.
        • de Kievit-van der Heijden I.M.
        • et al.
        Is cytology useful in the diagnostic workup of male breast lesions? A retrospective study over a 16-year period and review of the recent literature.
        Acta Cytol. 2010; 54: 259-264
        • Boerner S.
        • Fornage B.D.
        • Singletary E.
        • et al.
        Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA.
        Cancer. 1999; 87: 19-24
        • Westenend P.J.
        Core needle biopsy in male breast lesions.
        J Clin Pathol. 2003; 56: 863-865
        • Ottini L.
        • Palli D.
        • Rizzo S.
        • et al.
        Male breast cancer.
        Crit Rev Oncol Hematol. 2010; 73: 141-155
        • Ribeiro G.G.
        • Swindell R.
        • Harris M.
        • et al.
        A review of the management of the male breast carcinoma based on an analysis of 420 treated cases.
        Breast. 1996; 5: 141-146
        • Joshi M.G.
        • Lee A.K.
        • Loda M.
        • et al.
        Male breast carcinoma: an evaluation of prognostic factors contributing to a poorer outcome.
        Cancer. 1996; 77: 490-498
        • Bloom K.J.
        • Govil H.
        • Gattuso P.
        • et al.
        Status of HER-2 in male and female breast carcinoma.
        Am J Surg. 2001; 182: 389-392
        • Goss P.E.
        • Reid C.
        • Pintilie M.
        • et al.
        Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955-1996.
        Cancer. 1999; 85: 629-639
        • Cutuli B.
        • Dilhuydy J.M.
        • De Lafontan B.
        • et al.
        Ductal carcinoma in situ of the male breast. Analysis of 31 cases.
        Eur J Cancer. 1997; 33: 35-38
        • Golshan M.
        • Rusby J.
        • Dominguez F.
        • et al.
        Breast conservation for male breast carcinoma.
        Breast. 2007; 16: 653-656
        • 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 457-9): 451-457
        • Di Benedetto G.
        • Pierangeli M.
        • Bertani A.
        Carcinoma of the male breast: an underestimated killer.
        Plast Reconstr Surg. 1998; 102: 696-700
        • Spear S.L.
        • Bowen D.G.
        Breast reconstruction in a male with a transverse rectus abdominis flap.
        Plast Reconstr Surg. 1998; 102: 1615-1617
        • Nakao A.
        • Saito S.
        • Naomoto Y.
        • et al.
        Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis.
        Anticancer Res. 2002; 22: 2477-2479
        • Cagliá P.
        • Veroux P.F.
        • Cardillo P.
        • et al.
        Carcinoma of the male breast: reconstructive technique [in Italian with English abstract].
        G Chir. 1998; 19: 358-362
        • Kwong A.
        • Suen D.T.
        Male breast cancer in Chinese population: a ten year review.
        Cancer Res. 2009; (Available at:): 69
        • Hill A.D.
        • Borgen P.I.
        • Cody H.S.
        Sentinel node biopsy in male breast cancer.
        Eur J Surg Oncol. 1999; 25: 442-443
        • Rusby J.E.
        • Smith B.L.
        • Dominguez F.J.
        • et al.
        Sentinel lymph node biopsy in men with breast cancer: a report of 31 consecutive procedures and review of the literature.
        Clin Breast Cancer. 2006; 7: 406-410
        • Boughey J.C.
        • Bedrosian I.
        • Meric-Bernstam F.
        • et al.
        Comparative analysis of sentinel lymph node operation in male and female breast cancer patients.
        J Am Coll Surg. 2006; 203: 475-480
        • Schlag P.M.
        • Bembenek A.
        Specification of potential indications and contraindications of sentinel lymph node biopsy in breast cancer.
        Recent Results Cancer Res. 2000; 157: 228-236
        • Wong S.L.
        • Chao C.
        • Edwards M.J.
        • et al.
        Accuracy of sentinel lymph node biopsy for patients with T2 and T3 breast cancers.
        Am Surg. 2001; 67 (discussion 527-8): 522-526
        • Izquierdo M.A.
        • Alonso C.
        • De Andres L.
        • et al.
        Male breast cancer. Report of a series of 50 cases.
        Acta Oncol. 1994; 33: 767-771
        • Patel H.Z.
        • Buzdar A.U.
        • Hortobagyi G.N.
        Role of adjuvant chemotherapy in male breast cancer.
        Cancer. 1989; 64: 1583-1585
        • Scott-Conner C.E.
        • Jochimsen P.R.
        • Menck H.R.
        • et al.
        An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.
        Surgery. 1999; 126 (discussion 780-1): 775-780
        • Bagley C.S.
        • Wesley M.N.
        • Young R.C.
        • et al.
        Adjuvant chemotherapy in males with cancer of the breast.
        Am J Clin Oncol. 1987; 10: 55-60
        • Giordano S.H.
        • Perkins G.H.
        • Broglio K.
        • et al.
        Adjuvant systemic therapy for male breast carcinoma.
        Cancer. 2005; 104: 2359-2364
      1. Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group.
        Lancet. 1998; 352: 930-942
        • Cutuli B.
        • Cohen-Solal-le Nir C.
        • de Lafontan B.
        • et al.
        Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers' experience.
        Int J Radiat Oncol Biol Phys. 2002; 53: 868-879
        • Pemmaraju N.
        • Munsell M.F.
        • Hortobagyi G.N.
        • et al.
        Retrospective review of male breast cancer patients: analysis of tamoxifen-related side-effects.
        Ann Oncol. 2012; 23: 1471-1474
        • Nabholtz J.M.
        • Buzdar A.
        • Pollak M.
        • et al.
        Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. Arimidex Study Group.
        J Clin Oncol. 2000; 18: 3758-3767
        • Bonneterre J.
        • Thurlimann B.
        • Robertson J.F.
        • et al.
        Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability Study.
        J Clin Oncol. 2000; 18: 3748-3757
        • Lopez M.
        • Di Lauro L.
        • Lazzaro B.
        • et al.
        Hormonal treatment of disseminated male breast cancer.
        Oncology. 1985; 42: 345-349
        • Harris A.L.
        • Dowsett M.
        • Stuart-Harris R.
        • et al.
        Role of aminoglutethimide in male breast cancer.
        Br J Cancer. 1986; 54: 657-660
        • Goldhirsch A.
        • Ingle J.N.
        • Gelber R.D.
        • et al.
        Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer.
        Ann Oncol. 2009; 20: 1319-1329
        • Giordano S.H.
        • Valero V.
        • Buzdar A.U.
        • et al.
        Efficacy of anastrozole in male breast cancer.
        Am J Clin Oncol. 2002; 25: 235-237
        • Rudlowski C.
        Male breast cancer.
        Breast Care (Basel). 2008; 3: 183-189
        • Hayashi H.
        • Kimura M.
        • Yoshimoto N.
        • et al.
        A case of HER2-positive male breast cancer with lung metastases showing a good response to trastuzumab and paclitaxel treatment.
        Breast Cancer. 2009; 16: 136-140
        • Clarke M.
        • Collins R.
        • Darby S.
        • et al.
        Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials.
        Lancet. 2005; 366: 2087-2106
        • Stierer M.
        • Rosen H.
        • Weitensfelder W.
        • et al.
        Male breast cancer: Austrian experience.
        World J Surg. 1995; 19 (discussion 692-3): 687-692
        • Chakravarthy A.
        • Kim C.R.
        Post-mastectomy radiation in male breast cancer.
        Radiother Oncol. 2002; 65: 99-103
        • Jaiyesimi I.A.
        • Buzdar A.U.
        • Sahin A.A.
        • et al.
        Carcinoma of the male breast.
        Ann Intern Med. 1992; 117: 771-777
        • Doberauer C.
        • Niederle N.
        • Schmidt C.G.
        Advanced male breast cancer treatment with the LH-RH analogue buserelin alone or in combination with the antiandrogen flutamide.
        Cancer. 1988; 62: 474-478
        • Nahleh Z.A.
        Hormonal therapy for male breast cancer: a different approach for a different disease.
        Cancer Treat Rev. 2006; 32: 101-105
        • La Vecchia C.
        • Levi F.
        • Lucchini F.
        Descriptive epidemiology of male breast cancer in Europe.
        Int J Cancer. 1992; 51: 62-66
        • Xia Q.
        • Shi Y.X.
        • Liu D.G.
        • et al.
        Clinicopathological characteristics of male breast cancer: analysis of 25 cases at a single institution.
        Nan Fang Yi Ke Da Xue Xue Bao. 2011; 31 ([in Chinese with English abstract]): 1469-1473
        • O'Malley C.D.
        • Prehn A.W.
        • Shema S.J.
        • et al.
        Racial/ethnic differences in survival rates in a population-based series of men with breast carcinoma.
        Cancer. 2002; 94: 2836-2843