Male breast cancer: an update in diagnosis, treatment and molecular profiling

Abstract

Significant advances have been made in the diagnosis and treatment of female breast cancer, resulting in a decline in incidence and a global improvement in clinical outcome. The statistics for male breast cancer (MBC) stand in sharp contrast-over the past several decades, there has been a steady rise in the incidence of this disease, and clinical outcome has improved at a much slower pace. In the current review, the clinicopathologic features of MBC are described in detail. An emphasis is placed on molecular profiling of MBC, which may identify candidate biomarkers and putative targets for pharmacologic intervention. The current role of cytotoxic chemotherapy and endocrine therapy (including tamoxifen, aromatase inhibitors and GnRH analogues) is defined in the context of currently available studies. Furthermore, the potential role of targeted agents, including HER2-directed therapies, PARP inhibitors, and angiogenesis inhibitors, is delineated.

Figure 1

A steady rise in the incidence of MBC has been documented in SEER registry analyses (a) and an evaluation of the UKACR (b). (Figures adapted from Stang A, Thomssen C: Decline in breast cancer incidence in the United States: what about male breast cancer? Breast Cancer Research and Treatment 112:595–596, 2008; and Speirs V, Shaaban A: The rising incidence of male breast cancer. Breast Cancer Research and Treatment 115:429–430, 2009).

Figure 2

A proposed schema for evaluation and management of MBC. (Adapted from Giordano SH, Buzdar AU, Hortobagyi GN: Breast Cancer in Men. Annals of Internal Medicine 137:678–687, 2002)