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breast cancer in men; comparison of male vs female breast cancer
Etiology:
risk factors
- older age
- black
- family history of breast cancer
- genetic predisposition (see Genetics
- radiation exposure
- increased serum estradiol
- Klinefelter's syndrome
- gynecomastia
- liver disease
- obesity
- testicular anomaly
Epidemiology:
- median age at diagnosis = 67 years vs 62 years for women [1]
Pathology:
- 1% invasive lobular type vs 12% for women
- 99% estrogen receptor + vs 83% for women
- 9% HER2+ vs 17% for women
- 97% androgen receptor + vs 16% for women
- 42% with lymph node involvement at diagnosis vs 33% for women
- median tumor diameter at diagnosis = 20 mm vs 15 mm for women
Genetics:
increased risk associated with
- BRCA1 gene mutation (1%) vs 65% for women
- BRCA2 gene mutation (7%) vs 45% for women
- CHEK2 gene mutation
- PALB2 gene mutation
mutations in DNA repair genes more likely in men than women
Management:
- surgery
- tamoxifen*
- genetic couseling all patients vs selected patients for women
* vs tamoxifen or aromatase inhibitor for postmenopausal women
General
breast cancer
References
- Giordano SH
Breast Cancer in Men
N Engl J Med 2018; 378:2311-2320
PMID: 29897847
https://www.nejm.org/doi/full/10.1056/NEJMra1707939
- Rothaus C
Breast Cancer in Men
NEJM REsident 360. Jun 13, 2018
https://resident360.nejm.org/content_items/breast-cancer-in-men