ASCO issues first guideline for managing male breast cancer

  • Hassett MJ & al.
  • J Clin Oncol
  • 14 Feb 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • The American Society of Clinical Oncology (ASCO) delivered its first-ever guideline for male breast cancer.
  • The guideline focuses on care differing between men and women, because most care is the same.

Why this matters

  • No current guidelines exist for male breast cancer, which constitutes

Study design

  • An expert panel with 13 members conducted a 2-phase process:
    • A survey of the ASCO Breast Cancer Advisory Group to identify areas of strong agreement on care between men and women.
    • A Delphi process for consensus among the Expert Panel (≥75% agreement) on 26 observational studies addressing 10 areas of divergence between sexes.
  • Funding: Not disclosed.

Key recommendations

  • Areas not covered by recommendations because care is the same across sexes: gene expression profile testing (e.g., Oncotype DX), primary surgery, adjuvant chemotherapy, adjuvant radiation therapy, and chemotherapy for advanced/metastatic disease.
  • Most recommendations focus on estrogen receptor-positive cancers because 99% of male breast cancers display that subtype.
  • Tamoxifen should be offered for an initial duration of 5 years; patients for whom tamoxifen is contraindicated should be given a gonadotropin-releasing hormone agonist/antagonist in combination with an aromatase inhibitor.
  • MRI is not routinely recommended.
  • Germline testing should be offered to all men with breast cancer.