Men may have lower breast cancer survival rates than women, according to a new analysis of information from the National Cancer Data Base. The data suggest that the differences could stem from delays in seeking treatment and in physicians' responses, researchers say.
"If the example of female breast cancer is any indication, simply raising awareness of male breast cancers could make a huge difference," lead investigator Dr Jon Greif from Bay Area Breast Surgeons, Inc., in Oakland, California, said at a press conference.
More awareness needed
"As a man gets older and into the range where breast cancer becomes an issue, beyond age 40, he should periodically take a look for anything that's out of the ordinary, and then feel for anything unusual," Dr Greif says. "It's easier for men to detect it by touch than for women. It shouldn't take more than a minute" to do a self exam.
Dr Greif presented his team's results at the annual meeting of the American Society of Breast Surgeons in Phoenix, Arizona. Dr Greif's team found 13,457 cases of male breast cancer in the database from 1998 to 2007, which accounted for 0.9% of all of breast cancers recorded.
Men's five-year overall survival rate was 74%, with a median of 101 months, compared to 83% for women with a median of 129 months (p<0.0001).
For Stage 0 cancer, five-year survival rates were 90% for men and 94% for women. At Stage I, five-year survival was 87% for men vs 90% for women, and at Stage II, men's survival rate was 74% vs 82% for women (p<0.0001). There were no statistically significant differences in survival rates between men and women for Stage III and IV cancers, however.
Men hesitate to seek treatment
The data suggest that men tend to seek treatment later than women after their cancers have progressed. The men had larger tumours, with a median size of 20mm compared to 15mm in women. They were less likely to have grade 1 tumours (16% vs 20.7% of women). They were also more likely to have lymph node metastasis (41.9% vs 33.2%; odds ratio 1.45) and distant metastasis (4% vs 3%; OR: 1.39).
There were also differences in treatment. Only 33% of men had a partial mastectomy compared to 62% of women (OR: 0.31), and 35.9% had radiation, compared to 50.4% of women (OR: 0.55). There were no statistical differences in chemotherapy rates, however, and only slight differences in rates of hormonal therapy, the study found.
"The data would indicate that a huge number of men are not getting the standard of treatment," Dr Greif said. Part of the discrepancy may lie in under-reporting by outpatients, but that shouldn't account for all of the difference, he said.
Characteristics of the cancers between gender
The data showed more similarity than difference in the characteristics of the cancers between men and women, the research team found. "Our recommendation that men be treated along similar guidelines as women is a good one," Dr Greif said.
Other differences noted include race and age. Compared to women, males with breast cancer were more often African American (11.7 vs 9.9%, OR 1.19) and less often Hispanic (3.6 vs 4.5%, OR 0.74). And men were older at 63 compared to 59 years old.
The differences in overall survival rates were highly statistically significant, but Dr. Greif and his team caution that because of the large number of patients included in the study, some comparisons that achieved significance may not be clinically relevant.
Dr Deanna Attai, Director of the Center for Breast Care, Inc. in Burbank, California, moderated the press conference. She said, "Even though we think of male breast cancer as a rare disease, I think we all see at least one or two male patients a year in our practises, so it is important to bring this to light."
(Reuters Health, Rob Goodier, May 2012)
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