Breast cancer in men rarer but more deadly than in women

By Dr. Ananya Mandal, MDMay 8 2012

According to new research, breast cancer may be much less common than it is in women, but it may be more deadly.

“Men with breast cancer don't do as well as women with breast cancer, and there are opportunities to improve that,” said study author Dr. Jon Greif, a breast surgeon in San Francisco. “They were less likely to get the standard treatments that women get.” Survival rates for men with breast cancer, overall, are lower than those for women, at least when it is diagnosed in the early stages, Greif found. The cancers differ in other respects too.

Greif was scheduled to present his findings Friday at the American Society of Breast Surgeons annual meeting in Phoenix. Greif and his team warn, however, that some of the differences they found may not bear out in clinical practice.

Although many men may not be aware that they can get breast cancer, nearly 2,200 new cases of male breast cancer are expected this year, according to the American Cancer Society. The society estimates 410 men will die of breast cancer in 2012 in the United States.

For his research Greif compared about 13,000 men with breast cancer, identified from the National Cancer Data Base, to more than 1.4 million women with breast cancer. The data covered 1998 to 2007. The investigators evaluated cancer characteristics and survival rates, taking into account age, ethnicity and other factors.

Men with breast cancer were more likely to be black than women with breast cancer (11.7 percent versus 9.9 percent) and less likely to be Hispanic (3.6 percent versus 4.5 percent), the researchers found. In addition, men were older at diagnosis -- 63, on average, compared to 59 for women.

Men's tumours were larger when diagnosed; they were more likely to have later-stage tumours, involvement of lymph nodes, spreading to other parts of the body and other differences. Men with breast cancer were less likely to get a partial mastectomy and to receive radiation, the study found. Greif also found that women's overall five-year survival rate was 83 percent, but men's was 74 percent. That was looking at all breast cancers, whatever the stage. When Greif's team looked at survival stage by stage, women with early stage cancer had better survival rates than men with early stage disease. The gap closed when men and women had more advanced disease.

A big limitation to the research: The database they drew from keeps track of which breast cancer patients die, but not what they died from. So it is impossible to tell if they died from their cancer or something else, he explained.

“Women are encouraged to get breast exams [and] mammograms,” Greif said. That is why their cancers are often diagnosed earlier, when the tumours are smaller, he said. More awareness of male breast cancer is crucial.

“It's not really been on the radar screen to think about breast cancer in men,” said Dr. David Winchester, a breast cancer surgeon in North Shore University Health System in suburban Chicago who was not involved in the study. Winchester treats only a few men with breast cancer each year, compared with at least 100 women.

The study is valuable in pointing out gender differences, even with its limitations, said Dr. Susan Boolbol, chief of the division of breast surgery at Beth Israel Medical Center in New York City. “Over the years, it was thought that, stage for stage, women and men had equal outcomes,” Boolbol said. The new research finds otherwise, and includes larger numbers of men with breast cancer than many previous studies did, she noted.

Lack of information on cause of death is a major limitation of the finding, she said. Even so, “this is a very interesting study, and ... it will open the door to more research being done in male breast cancer.” The study may also raise awareness that men can indeed develop breast cancer, Boolbol said.

Dr. Akkamma Ravi, a breast cancer specialist at Weill Cornell Medical College in New York, said the research bolsters results in smaller studies and may help raise awareness. Because the disease is so rare in men, research is pretty scant, and doctors are left to treat it the same way they manage the disease in women, she said.

The American Cancer Society estimates 1 in 1,000 men will get breast cancer, versus 1 in 8 women. By comparison, 1 in 6 men will get prostate cancer, the most common cancer in men. Men should be aware of potential symptoms of breast cancer, the American Cancer Society suggests. Men's breast cancer usually shows up as a lump under or near a nipple. Nipple discharge and breasts that are misshapen or don't match are also possible signs that should be checked out.