International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationManagement of Male Breast Cancer in the United States: A Surveillance, Epidemiology and End Results Analysis
Introduction
Male breast cancer (MBC) is uncommon and rarely studied prospectively. As such, therapy recommendations are generally extrapolated from the female breast cancer (FBC) literature.
A large population-based study conducted in Europe and Asia demonstrated that males with breast cancer (BC) were significantly less likely to receive surgery and radiation therapy (RT) than females with BC. However, rates of use of chemotherapy and hormonal therapy were similar (1). Little is known about how MBC is treated across the United States, specifically with regard to the use of RT.
The goals of this study were to evaluate the stage-specific surgical and radiotherapeutic management of males with BC in the United States and relate them to outcomes with comparisons to the management and outcomes in FBC. United States population-based data were extracted from the Surveillance, Epidemiology and End Results (SEER) registry.
Section snippets
Methods and Materials
The SEER database is a National Cancer Institute database that now incorporates 17 registries representing approximately 26% of the population of the United States. Before 2001, when Kentucky, Louisiana, New Jersey, and all of California were added, approximately 14% of the US population was represented. To identify cases of MBC and FBC, the SEER database [SEER 17 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973-2008)] was queried for all males and females
Incidence and patient characteristics
The original data set consisted of 848,940; after removing patients with unrecoverable or missing data, a total sample size of 722,863 remained and was used for this analysis. These represented 4276 cases of MBC and 718,587 cases of FBC. Male breast cancer constituted 0.6% of all BC, and FBC constituted 99.4%. Median follow-up for all patients was 66 months (range, 0-431 months).
Male breast cancer was diagnosed at an older median age than FBC: 65-69 years versus 60-64 years (P<.0001). The
Discussion
To our knowledge, this is the largest study of MBC to address the utilization and impact of surgery and RT. As demonstrated in this and other studies, MBC is rare, with an incidence of 0.6% in the United States; it has an older age of disease onset and a greater likelihood of advanced disease presentation than FBC 1, 4, 5.
The initial surgical management of MBC is dramatically different than that of FBC. In this analysis the overwhelming majority of males treated definitively received a
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Conflict of interest: none.