Background: Breast cancer is the leading malignancy in women, but it is relatively rare in men, accounting for 1% of all breast cancers. In Morocco, its incidence is 0.8/ 100,000 in men. This condition epidemiology, therapeutic and prognostic remains unknown given the scarcity of reported series. The objective of this work is to identify the epidemiological, clinical, pathological and therapeutic of this cancer in men. Results: Six patients were diagnosed with breast cancer with a ratio of 6/1277 cases. The mean age of patients was 63.3 ± 9.7 ans; the most common histological type was invasive ductal carcino ma (83.3%). The grade 2 SBR has a majority (66.7%), while that of SBR 3 is less represented (33.3%). A positive estrogen receptor (66.7% of cases) and progesterone (50.0% of cases) was noted. The HER2 receptor is overexpressed in 25% of cases. The treatment was essentially surgical (83.3%). Additional treatment included adjuvant chemotherapy (50.0%), radiotherapy (50.0%) and hormonal therapy (16.7%) was administered. Discussion/Conclusion: Breast cancer in men is rare and appears to have a very close clinical, histological characteristics and prognosis to those of elderly women. The diagnosis is usually late and tumors are treated in advanced stages. An improved prognosis requires better awareness for early detection.
Breast cancer is the most common cancer in women in both the developed and developing countries.
However, this typically “female” disease can also affect males. Male breast cancer is a rare disease. It represents approximately 1% of breast cancers and 0.6% of the malignant disease in humans [
In Morocco, according to the Cancer Register of the Region of Greater Casablanca (RCRC), its incidence is 0.8/100,000 in men [
Breast cancer in men is a little known pathology of the public and the discovery of a breast lump in a man does not raise the same concern as in women. Most studies show a more advanced stage at diagnosis and a poorer prognosis in men [
This is a cross-sectional study at the Mohammed VI center for the treatment of cancers Hospital IBN ROCHD (One of the two major centers for the care and treatment of cancers in Morocco treating 3000 - 3500 cases of cancers including breast cancer represents 20% of cases and breast cancer in men is 0.4% of cases).
We included in our study consecutively all cases of male breast cancer that has been treated at the Center from January first 2013 until 30 December 2014. Data collection was done retrospectively, from patient medical records.
The data collected focused on:
・ Socio-demographic data: Age at diagnosis, marital status, number of children and the concept of breast cancer family history.
・ Clinical data: The stage at diagnosis, tumor size, lymph node involvement, distant metastasis, histological type, histological grade, laterality with quadrant or tumor region, the hormone receptor status, HER2 receptor (Human Epidermal growth factor) and proliferation index Ki-67.
・ Therapeutic Data: Neoadjuvant chemotherapy, radiotherapy, adjuvant chemotherapy, hormone therapy and targeted therapy.
The variables studied were all well documented in all patients. Agreement of the ethics committee has been proven to this study. Data entry was conducted by Microsoft Office Excel (2007) and analysis of variables by the Epi Info software. The study association by crossing the variables between groups was evaluated by the test of chi-square. The test is considered significant when p < 0.05.
Between January 2013 to December 2014, six cases of male breast cancer have been supported in the Mohammed VI center for cancer treatment, CHU Ibn Rochd Casab- lanca. Epidemiological, clinical, histological and therapeutic patients are summarized in
The most common histological type was invasive ductal carcinoma, it was observed in 83.3% of cases and invasive carcinoma in 16.7% of cases. Tumors were localized in 50% of cases. Lymph node involvement was described in 33.3% of cases. In our series, male breast cancer was high grade (grade II and III). The SBR grade II was found in 66.7% of cases and grade III in 33.3% of cases. Hormone receptor positivity was found to estrogen in 66.7% of cases and progesterone in 50.0% of cases. Overexpression of HER2 was observed in 25.0% of cases over 66.7% of cases. The molecular profile of male breast cancer was essentially luminal; luminal A was found in 50.0% of cases while luminal B in 16.7% of cases.
Out of all of our series, 83.3% of patients underwent mastectomy and one patient had not undergone any surgery after the diagnosis of ductal carcinoma by biopsy. Of all mastectomies, 50.0% of cases were associated with axillary dissection and 16.7% of cases a simple mastectomy. Chemotherapy was performed in 50.0% of cases. The average age of patients in our series who received adjuvant chemotherapy was 59.0 ± 8.1 years. The additional irradiation was performed in 50.0% of cases. Of all irradiated patients, 55.5% of cases had lymph node involvement. Only one case (16.7%) had a tumor over 2 cm and 100% of the cases had grade II tumors (
Features | Number (N=6) | Percentage (%) |
---|---|---|
Average age Smoking Breast cancer antecedent BMI <25 25 - 30 >30 NP Call sign Nodule Isolated retraction Isolated flow Isolated ulceration TNM Stage T0 T1 T2 T3 T4 N0 N1 N2 N3 M0 M1 SBR grade SBR I SBR II SBR III Histological Type infiltrating ductal carcinoma Invasive carcinoma invasive lobular carcinoma Treatment Treatment Mastectomy lumpectomy No surgery Chemotherapy Hormonotherapy Radiotherapy | 63.3 years 2 0 4 0 1 1 2 1 1 2 0 0 4 0 2 3 1 1 1 5 1 0 4 2 5 1 0 2 3 1 3 1 3 | 33.3 0 66.6 0 16.6 16.6 33.3 16.6 16.6 33.3 0 0 66.6 0 33.3 50.0 16.6 16.6 16.6 83.3 16.6 0 66.6 33.3 83.3 16.6 0 33.3 50.0 16.6 50.0 16.6 50.0 |
Breast cancer is a rare condition in men. It represents less than 1% of cancers in men and only 0.6% of all breast cancer [
The etiology of breast cancer in men is not clearly established and the small number of cases does not allow the realization of a prospective study. However, some risk factors seem to be implicated.
Several studies have shown the involvement of direct family history of breast cancer [
The US network of cancer (National Comprehensive Cancer Network current) recommends providing education and encouragement to self-examination and conduct biannual clinical breast exams for men with gene mutations BRCA1 and BRCA2 [
Hyperoestrogenism could also have an exogenous origin, in connection with certain medications [
In our series, 16.7% of cases had severe obesity. As in women, overweight and obesity are risk factors implicated in breast cancer. Similar results have been observed by several authors [
A second cancer may be associated with breast cancer in humans. Moreover, Cutuli and al., by conducting a multicenter study found the association with various cancers, anteriorly, synchronous or Metachronous [
Breast Cancer diagnosis in men is usually done at later stages and tumor size is often superior to breast tumors in women [
In our series, invasive ductal carcinoma was found in 83.3% of cases, this is the most common histological type, as in women. Similar results have been observed by several authors [
Breast cancer in men rarely presents lobular carcinoma, unlike women where it occupies the second histology after invasive ductal carcinoma.
Male Breast cancer is characterized by a high expression of hormone receptors. In our study, we found positive hormone receptors in 80.0% of cases to estrogen and 60% to progesterone. HER2 overexpression is less common; our study showed that 25.0% of cases showed that overexpression. However, Giordano and al., in their study reported HER2 overexpression in 37% of cases [
We also noticed that in our study tumors were of high histological grade, 66.7% of grade II and 33.3% of grade III. Our results confirm those of Oger and al., which showed a high grade (grade II and III) in 72.0% of cases of breast cancer in men [
Breast cancer treatment in humans based on mastectomy associated with an ipsilateral axillary dissection [
Radical surgery is completed with adjuvant treatments. Adjuvant radiotherapy reduces the risk of local recurrence, but is controversial, as some studies have shown no benefit in overall survival [
Hormone therapy has an important place in the adjuvant treatment of breast cancer, given the high frequency of hormone receptor positivity [
Like any other study our study has its strengths and its limitations. This study presents the place of status the breast cancer in men is a particular entity at the center, but the information is limited and relates only to breast cancer in men cases in the public sector consultant and does not concerncases treated privately.
Male breast cancer is a rare disease and has its own characteristics. Considering all these observed differences, we cannot consider it as comparable to that of women.
The particularity of breast cancer in men is in its discovery at a late stage and high hormone receptor positivity. Besides, diagnosis and screening are the most important points to be developed to improve the prognosis. A large prospective study would improve knowledge regarding both diagnostic and therapeutic.
Ahmadaye Ibtrahim Khalil: data collection, data entry, data analysis, results interpretation, writing of the manuscript, Houriya Mestaghanmi: Data analysis, results interpretation, writing of the manuscript, Fadwa Qachach: interpretation of results, writing of the manuscript, Rachid Saile: interpretation of results, writing of the manuscript, Karima Bendahhou: data analysis, results interpretation, writing of the manuscript, Abdellatif Benider: therapeutic management of patients and the writing of the manuscript.
Khalil, A.I., Mestaghanmi, H., Qachach, F., Saile, R., Bendahhou, K. and Benider, A. (2016) Breast Cancer in Men: Characteristics Epide- miological, Clinicopathological and Thera- peutic. Open Access Library Journal, 3: e3166. http://dx.doi.org/10.4236/oalib.1103166