Male Breast Cancer Treatment (PDQ®)–Health Professional Version
Treatment Option Overview for Male Breast Cancer
Standard treatment options for men with breast cancer are described in Table 2.
Treatment Options for Male Breast Cancer
The approach to the treatment of breast cancer in men is similar to that in women. Because male breast cancer is rare, there is a lack of randomized data to support specific treatment modalities.
Treatment of Early/Localized/Operable Male Breast Cancer
As in women, standard treatment options for men with early-stage breast cancer include the following:
- Surgery with or without radiation therapy (locoregional therapy).
- Adjuvant therapy (systemic therapy).
- Chemotherapy.
- Endocrine therapy.
- Human epidermal growth factor receptor 2 (HER2)–directed therapy.
Surgery with or without radiation therapy
Primary standard treatment is a modified radical mastectomy with axillary dissection.[1-3] Responses are generally similar to those seen in women with breast cancer.[2] Breast conservation surgery with lumpectomy and radiation therapy has also been used, and results have been similar to those seen in women with breast cancer.[4]
(Refer to Surgery in the Early/Localized/Operable Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
Adjuvant therapy
In men, no controlled studies have compared adjuvant treatment options. Adjuvant therapies used to treat early/localized/operable male breast cancer are outlined in Table 3.
In men with node-negative tumors, adjuvant therapy should be considered on the same basis as for women with breast cancer because there is no evidence that response to therapy is different between men and women.[11]
In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal therapy have been used and are believed to increase survival to the same extent as in women with breast cancer.
Approximately 85% of all male breast cancers are estrogen receptor–positive, and 70% of them are progesterone receptor–positive.[2,12] Response to hormone therapy correlates with the presence of these receptors. Hormonal therapy has been recommended in all patients with receptor-positive cancers.[1,2] Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence, in male breast cancer patients.[13] Responses are generally similar to those seen in women with breast cancer.[2] (Refer to Postoperative Systemic Therapy and Preoperative Systemic Therapy in the Early/Localized/Operable Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
Regarding endocrine therapy, tamoxifen is generally used instead of an aromatase inhibitor (AI) because the data supporting the use of an AI in men with breast cancer are limited. A retrospective analysis of 257 men with stage I to stage III breast cancer included 50 men treated with an AI and 207 men treated with tamoxifen. The following results were observed:
- With a median follow-up of 42 months, treatment with an AI was associated with a higher risk of death compared with tamoxifen (32% with AI vs. 18% with tamoxifen; hazard ratio, 1.55; 95% confidence interval, 1.13–2.13).[14]
- These findings suggest that instead of an AI, tamoxifen should be used as adjuvant endocrine therapy for men with breast cancer.
The use of AI therapy with a luteinizing hormone-releasing hormone agonist has been reported in several cases in the literature.[7] The German Breast Group is conducting a randomized phase II clinical trial (NCT01638247) of tamoxifen with or without gonadotropin-releasing hormone (GnRH) analogue versus AI plus GnRH analogue in men with early-stage, hormone receptor–positive breast cancer; results are pending.
Treatment of Locoregional Recurrent Male Breast Cancer
Standard treatment options for men with locoregional recurrent breast cancer include the following:[2]
- Surgical excision.
- Radiation therapy combined with chemotherapy.
(Refer to the Locoregional Recurrent Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
Treatment of Metastatic Male Breast Cancer
Standard treatment options for men with metastatic breast cancer include the following:
- Hormone therapy and/or chemotherapy.
Hormonal therapy is used as the initial treatment. Responses are generally similar to those seen in women with breast cancer.[2,11]
(Refer to the Metastatic Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
References
- Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992. [PUBMED Abstract]
- Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002. [PUBMED Abstract]
- Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991. [PUBMED Abstract]
- Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007. [PUBMED Abstract]
- Walshe JM, Berman AW, Vatas U, et al.: A prospective study of adjuvant CMF in males with node positive breast cancer: 20-year follow-up. Breast Cancer Res Treat 103 (2): 177-83, 2007. [PUBMED Abstract]
- Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005. [PUBMED Abstract]
- Giordano SH, Hortobagyi GN: Leuprolide acetate plus aromatase inhibition for male breast cancer. J Clin Oncol 24 (21): e42-3, 2006. [PUBMED Abstract]
- Cocconi G, Bisagni G, Ceci G, et al.: Low-dose aminoglutethimide with and without hydrocortisone replacement as a first-line endocrine treatment in advanced breast cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 10 (6): 984-9, 1992. [PUBMED Abstract]
- Gale KE, Andersen JW, Tormey DC, et al.: Hormonal treatment for metastatic breast cancer. An Eastern Cooperative Oncology Group Phase III trial comparing aminoglutethimide to tamoxifen. Cancer 73 (2): 354-61, 1994. [PUBMED Abstract]
- Zagouri F, Sergentanis TN, Koutoulidis V, et al.: Aromatase inhibitors with or without gonadotropin-releasing hormone analogue in metastatic male breast cancer: a case series. Br J Cancer 108 (11): 2259-63, 2013. [PUBMED Abstract]
- Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007. [PUBMED Abstract]
- Joshi MG, Lee AK, Loda M, et al.: Male breast carcinoma: an evaluation of prognostic factors contributing to a poorer outcome. Cancer 77 (3): 490-8, 1996. [PUBMED Abstract]
- Anelli TF, Anelli A, Tran KN, et al.: Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74 (1): 74-7, 1994. [PUBMED Abstract]
- Eggemann H, Ignatov A, Smith BJ, et al.: Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients. Breast Cancer Res Treat 137 (2): 465-70, 2013. [PUBMED Abstract]
Changes to This Summary (03/28/2019)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2019 (cited American Cancer Society as reference 1).
Revised text about determining factors for the disease stage to include human epidermal growth factor receptor 2 status in the tumor and grade.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Male Breast Cancer Treatment are:
- Joseph L. Pater, MD (NCIC-Clinical Trials Group)
- Karen L. Smith, MD, MPH (Johns Hopkins University at Sibley Memorial Hospital)
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Male Breast Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/breast/hp/male-breast-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389234]
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Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
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