Breast cancer in male veteran population: an analysis from VA cancer registry

Abstract

Background: Male breast cancer is rare and makes up < 1% of all cases of breast cancers. Treatment and survival stage per stage is mainly based on what is known from female breast cancer.

Objectives: We determined the pathological features, stage, treatment of breast cancer in male veterans and their survival outcome.

Methods: Medical records of male patients diagnosed with breast cancer at the Veterans Affairs Medical Centers of Washington DC, Baltimore, Maryland, and Martinsburg, West Virginia, from 1992-2012 were reviewed after iInstitutional review board approval.

Results: From 1995-2012, 51 male patients with breast cancer were identifed from cancer registry. Of those, 57% were African American, 41% white, and 2% other race. Median age was 68 years (range, 44-86 years). Palpable mass was presenting symptoms in 80%, and gynecomastia or bloody nipple discharge in 16%. Family history of breast cancer in immediate family was positive in 11 patients without mention of BRCA genes except in one who was BRCA2-positve. ER/PR (estrogen-/progesterone-receptor) was positive in 71%, ER-positive/PR-negative in 2%, ER-positive/PR-positive /HER2-positive in 4%, ER-negative/PR-negative /HER2-triple negative in 4%. In all, 41% and 57% had right and left breast cancer, respectively; 80% had mastectomy, 36% had lymph node involvement (1-13 LN), 90% had invasive ductal carcinoma, 8% DCIS, and 2% sarcoma. Cancer in 26% was stage I, 38% stage II, 18% stage III and 8% stage IV. Twenty four percent of the patients had combination chemotherapy, and 66% were given tamoxifen. Eight percent had relapsed or recurrent disease within 1-5 years of their diagnosis and died within 2-12 years after the relapse. At median follow-up of 174 months (range, 4 months-19 years), 56% had died, 42% were alive, and 6% had been lost to follow-up.

Limitations: This is a very small retrospective chart review. Further large prospective studies are desired.

Conclusions: Median age at diagnosis of breast cancer seems to be higher in men (70 years) than it is in women (60 years). Invasive ductal carcinoma is the main pathology, and 73% of the tumors were ER-positive. The survival rate at more than 10 years of follow-up was about 40%. Stage versus survival revealed no difference in mortality.