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Mastectomy More Common, Radiation Less Common for Men With Breast Cancer

This is the largest study to date to focus on treatment and outcomes for men with breast cancer

February 13, 2014

Written By Josh Fernandez, Writer and Web Content Coordinator
Reviewed By Lisa Jablon, MD

Men are more likely than women to undergo mastectomy when diagnosed with breast cancer, a study published in the International Journal of Radiation Oncology • Biology • Physics revealed. 

The study is the largest to date to focus on treatment and outcomes for men with breast cancer in the United States. Researchers compared the medical records of more than 4,000 men with those of more than 700,000 women diagnosed with breast cancer over 4 decades.

Background and Reason for the Study

According to the American Cancer Society, breast cancer in men is nearly 100 times less common than in women. Men in the United States have about a 1 in 1,000 lifetime risk of getting the disease, whereas women have a 1 in 8 chance of diagnosis. Yet, recent studies suggest the rate of breast cancer in men may be increasing slightly.

Little is known about the standard of care for men with breast cancer in the United States, especially with regard to the use of radiation therapy. To gain greater clarity, researchers studied treatment trends for men with breast cancer in relation to those for women with the same disease stage.

Study Structure

The research team accessed data from the U.S.Surveillance, Epidemiology and End Results, or SEER, database of the National Cancer Institute. They compared invasive breast cancer diagnoses and treatment among men and women between 1973 and 2008. 

Besides sex, they collected and reviewed data on age, race, tumor grade, cancer stage, type of surgery, and whether radiation was given. Data on the hormone status of tumors for those treated around 1988, when this information began to be reported, was also assessed.

 Breast cancer stage was defined as follows:

  • localized – early-stage or cancer confined to the breast
  • regional – breast cancer in the skin, chest wall or both
  • distant –  metastatic disease or breast cancer that spread to other body parts

The study’s primary goal was to assess cause-specific survival, the time from diagnosis until death from breast cancer. This is also known as breast cancer-specific survival.

Results

Of the 722,863 breast cancer cases studied, 4,276 were of men and 718,587 were of women. Analysis showed:

  • Overall, about 87 percent of men treated definitively for breast cancer received mastectomy compared with 47 percent of women.
    • A definitive treatment is one chosen as the best option, among all possible choices, for an individual’s care.
  • Among the 1,951 men with localized breast cancer, 1,371 (70 percent) had a mastectomy, with only 90 (5 percent) having a lumpectomy with radiation.
  • Of the 187,884 men and women with regional breast cancer, rates of radiation therapy use were low no matter the type of surgery received.
    • 34 percent of men vs. 45 percent of women had radiation.
  • Among the 1,379 men with regional disease who had a mastectomy, 450 (33 percent) later received radiation.
    • There was a notable increase in the use of radiation therapy over time.

Analysis showed that among men with local disease, lumpectomy plus radiation therapy resulted in an improved but not significant difference in breast cancer-specific survival compared with those receiving mastectomy. The estimated 5-year survival rate of men was 99 percent for those receiving a lumpectomy with radiation compared with 96 percent for those who had a mastectomy. 

What This Means for You

If you are a man newly diagnosed with breast cancer, findings suggest you are more likely than women to be offered a mastectomy instead of a lumpectomy followed by radiation therapy to treat your disease. One reason for this is that men often have central tumors around the nipple area. This can make lumpectomy less easy to perform without sacrificing the nipple. Still, the study authors note that the areola, or area around the nipple, can be reconstructed.

Because no notable survival benefit was seen in those treated with one surgery over the other, you may wish to discuss the choice of surgeries with your surgeon. Compared with mastectomy, lumpectomy is a less invasive surgery with a faster recovery time and less scarring. Yet, to date, no randomized trials have compared lumpectomy plus radiation to mastectomy in men. 

Randomized studies are ones in which participants are assigned to a treatment group, such as mastectomy OR lumpectomy plus radiation, at random. Neither those taking part in the study nor the researchers can choose, which means the characteristics of those in each group are more likely to be similar. This also means the treatments can be viewed objectively, or without bias.

Fields, E, DeWitt, P, Fisher, C, Rabinovitch, R.  Management of male breast cancer in the United States: A Surveillance, Epidemiology and End Results AnalysisInt J Radiat Oncol Bio Phys. 2013;87(4):747-752.

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