Male Breast Cancer

January 29, 2016

Breast cancer is usually associated with women as we think of the gear and pink ribbons which are sold to support awareness and research, but men get it too in rare cases.

The FDA doesn’t have good clinical trial date on treatments for make breast cancer since it’s so rare. Medical oncologist and breast cancer scientific lead at FDA’s Office of Hematology & Oncology Products Tatiana M. Prowell, MD says we treat men the same way as we do women for breast cancer.

In the historical sense, men are excluded from breast cancer trials. She stated that the FDA is encouraging drug companies to include men in their breast cancer trails unless they have some sort of scientific reason to exclude them. The number of men in any trial is always small because it’s a rare condition in men. There still needs to be information on the disease in men because it’s better than no information at all.

The Treatment of Male Breast Cancer

Treatment for male breast cancer is similar to that of women as there’s removal of the breast or mastectomy. In other cases there’s radiation, chemotherapy, lumpectomy, hormone therapy, and targeted therapies.

The treatment date for men is based largely on the trials that were conducted on women or are retrospective data from several men that were treated over time. There’s no high-level evidence or randomized trials for breast cancer treatment for males, says Prowell.

One drug called tamoxifen is a selective estrogen receptor modulator (SERM) and a hormonal drug treatment used. It inhibits aromatase inhibitors and estrogen receptors so the production of estrogen is blocked from testosterone and other androgens

For women that are postmenopausal aromatase inhibitors are used as a first-line treatment for any early stage breast cancers and tamoxifen is regarded as an alternative treatment. In men this is the opposite as aromatase inhibitors don’t work as well. In men tamoxifen is given first and aromatase inhibitors are the alternative treatment.

For men that have positive lymph nodes, cancer that has spread, or larger tumors, they receive chemotherapy as well as hormonal treatment just like women do. Men that have tumors which are HER2-positive usually get the antibody trastuzumab as it targets HER2 like it does in women. Men with breast cancer need genetic counseling according to Prowell.

Men also have another difference as they are not referred to a genetic counselor automatically if they have mutations like BRCA-1 or 2. These are “tumor suppressor genes” which allow breast cancer and other forms of cancer to develop when they don’t function normally. Women with certain characteristics or family history like having triple-negative breast cancer or being young are the only ones usually recommended for genetic testing.

In men African America men are more likely than white men to have tumors in the advanced stage or to get triple-negative cancers. They have tumors which have fewer treatment options or are likely to reoccur.

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