How is male breast cancer treated in the United States?

  • Yadav S & al.
  • Cancer
  • 7 Oct 2019

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

  • The most common treatment for male breast cancer is mastectomy, at 71.3%, a rate much higher than for women.
  • The 23.7% of males who get breast-conserving surgery (BCS) underuse radiotherapy (RT).

Why this matters

  • These are among the treatment patterns documented in an analysis of the largest US database.

Study design

  • Retrospective cohort (n=10,873) of patients entered into the US National Cancer Database, 2004-2014.
  • Funding: NIH.

Key results

  • Demographic factors:
    • Average age, 63.7 years.
    • Estrogen receptor positive (ER+) status, 88.7%.
    • Most diagnosed with stage II (43.4%) and stage I (37.9%).
    • Oncotype DX ordered, 34.9% of those with ER+, human epidermal growth factor receptor 2-negative tumors.
    • 5-year OS, 79.1%.
  • Treatment factors:
    • Mastectomy, 71.3%.
    • BCS, 23.7%.
    • Adjuvant RT after BCS, 70.2%.
    • Hormone therapy for ER+ tumors, 62.3%.
    • Chemotherapy, 44.5%.
  • Changes in treatment over time (2004-2014):
    • No change in OS.
    • Increases in the rate of total mastectomy, post-BCS RT, ordering of Oncotype DX testing, and use of endocrine therapy (all Ps<.05>
  • Prognostic factors (upon multivariate analysis):
    • Worse OS:
      • Older age (HR, 1.04; P<.001>
      • Black race (HR, 1.22; P=.003).
      • Higher Charlson comorbidity index (HR, 2.22; P<.001>
    • Better OS:
      • Having progesterone-positive tumor (HR, 0.82; P=.002).
      • Receipt of chemotherapy (HR, 0.67; P<.001>
      • Receipt of radiotherapy (HR, 0.82; P<.001>

Limitations

  • Retrospective design.
  • Lack of data on recurrence.