Male breast cancer in Chinese population - a ten year review

Abstract

Objective: Breast cancer is uncommon in men, occurring in 1% of the male population based on Western data. There is limited knowledge about the natural history and prognosis of male breast cancer in Chinese population. This study aims to be the first to perform a 10 year review of the clinical presentation and outcome of Chinese male breast patients. Methods: A retrospective study of patients with male breast cancer treated in Hong Kong from January 1995 to December 2005 was performed. Results: A total of 83/124 medical records of male breast cancers treated in 16 hospitals during this 10 year study period were available and reviewed. The mean age at diagnosis was 65 years old. Of those where family history was known, only 3% had a family history of breast cancer. Only 7 patients had gynaecomastia. The mean time of presentation from time of symptoms occurrence was 23.2 months (range 0.06- 216). The most common presentation was presence of a breast lump. 75 (97%) of these patients underwent mastectomy, half of whom also had axillary dissection. 4 patients had LD flap reconstruction in addition to the mastectomy. 67 (87%) of these were invasive carcinoma of which 1 was invasive lobular carcinoma, 2 were mucinous carcinoma, 8 were invasive papillary carcinoma and the rest were invasive ductal carcinoma. 9 (11.7%) were in-situ carcinomas, where 6 were intraductal papillary carcinoma and the rest were ductal carcinoma in-situ. One patient had breast sarcoma. Of the invasive tumors, 74% were classified as Grade II and above. 29.8% of the patients had nodal involvement and the most common stage of presentation were either Stage 1 (33) or Stage 2 (27%). Majority of the tumors were oestrogen (95.8%) and progesterone (81%) receptor positive and 50% were cerbB2 positive. Where treatment data was available, all patients with ER positive tumors except for 6 patients received tamoxifen. 2.7% received neoadjuvant chemotherapy, 19.2% adjuvant chemotherapy and 47.3% received radiation therapy. The mean follow up was 54.5 months (1-178) months. The 5-year disease free and overall survival were 88% and 71.2% respectively. Interestingly 15 patients also had a second primary cancer not of breast origin. Discussions: Male breast cancer in Chinese men is rare and present at an older age but at an early stage. Disease free survival was better than overall survival likely due to death cause by disease other than breast cancer due to the older age of presentation. Although a majority of our cohort did not have family history of breast cancer, there was a high incidence of second primary cancer not of breast origin. Further investigation with genetic study in this group of patients is likely to be of relevance.