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Medscape Conference Coverage, based on selected sessions at the:

American Society of Clinical Oncology 2006 Annual Meeting

,his acti*ity is not sanctioned by2 nor a part o%2 the American Society o% Clinical "ncology.
From Medscape Medical News
Male Breast Cancer Very Different From Female Disease
Allison Gandey
Authors and Disclosures
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INORMATION ROM IND!STRY
Op"i#n in a $ain"enance se""ing %#r pa"ien"s &i"' ad(anced n#ns)ua$#us n#n*s$all cell lung
cancer
See o*er*ie0 presentation o% data %rom a clinical trial in a maintenance setting o% patients 0ith locally
ad*anced or metastatic non!small cell lung cancer.
Learn $#re
August 72 8559 : A ne0 study suggests there are important di%%erences in the pathology2 presentation2
and sur*i*al bet0een men and 0omen 0ith breast cancer.
;Sur*i*al o% male breast!cancer patients appears in%erior in early!stage disease and node!negati*e
tumors2 suggesting gender di%%erences in the tumor pathogenesis and biology2; lead author <eina
'ahleh2 MD2 %rom the -ni*ersity o% Cincinnati in "hio2 stated during a poster session at the recent
78nd annual meeting o% the American Society o% Clinical "ncology. ;In hormone receptor=positi*e male
breast cancer2 sur*i*al 0as also in%erior2 despite similar hormonal treatment practices.;
,he researchers report that the incidence o% breast cancer in men continues to rise2 yet ;%e0 studies
ha*e addressed the di%%erences bet0een male and %emale breast cancer.; Elaborating in the April 8559
issue o% Cancer Treatment Reviews2 Dr. 'ahleh 0rites2 ;,he rarity o% male breast cancer has
precluded ma>or progress in the understanding and treatment o% this disease.; She points out that
treatment has o%ten been e?trapolated %rom %emale breast cancer despite distinct clinicopathologic
%eatures bet0een the 8 diseases2 ;especially2; she notes2 ;0ith regard to the role o% male hormones
and estrogens.;
Dr. 'ahleh e?plains that it is also not clear 0hether hormone receptor=positi*e tumors carry the same
prognostic implication in male breast cancer as in the %emale disease. ;ormonal therapy has been the
mainstay o% treatment in male breast cancer2 0ith tamo?i%en being the %ront!line drug. ,he role o% the
ne0er!generation aromatase inhibitors has not been 0ell de%ined but they are being used in clinical
practice %or the treatment o% male breast cancer based on accepted data %or 0omen 0ith the disease.;
In this analysis2 the researchers used the #eteran A%%airs 4#A6 cancer registry to conduct a
retrospecti*e analysis aimed at comparing the characteristics and outcome o% male and %emale breast
cancer patients. ,hey loo@ed at a total o% A58B patients %rom C85 #A medical centers.
,he in*estigators identi%ied 9C8 male and 87CA %emale breast cancer patients. Mean age at diagnosis
0as 9D years %or men and BD years %or 0omen 4P E .55B6. More male breast cancer patients 0ere
blac@. ,hey %ound that male patients presented 0ith a signi%icantly higher stage o% disease2 had larger
tumors2 and 0ere more o%ten node!positi*e.
Duc"al His"#l#g+ M#re C#$$#n in Male ,reas" Cancer
Dr. 'ahleh and colleagues also %ound that ductal histology 0as more common in male breast cancer
and lobular and ductal carcinoma in situ 0ere less common than in 0omen. ,hey also %ound that
estrogen receptor 4E+6=positi*e and progesterone receptor 4P+6=positi*e tumors 0ere signi%icantly
more common in men 495F *s B8F and BAF *s 7DF2 respecti*elyG P E .55B6. ,he researchers report
that male breast cancer patients recei*ed less chemotherapy but there 0as no statistical di%%erence in
hormonal treatment.
Median o*erall sur*i*al 0as lo0er %or male breast cancer 4D.5 *s H.I yearsG P E .55B6. "*erall sur*i*al
0as not signi%icantly di%%erent %or stage A and 72 but 0as in%erior %or stage C 4D years *s not reachedG P
J .55B6 and stage 8 49.5 *s I.9 years2 P J .55C6.
In node!negati*e tumors2 o*erall sur*i*al 0as in%erior %or men 49.C *s C7.9 yearsG P E .55B6 but not
statistically di%%erent %or node!positi*e tumors. In E+! and P+!positi*e tumors2 sur*i*al 0as in%erior %or
men 4D *s I years and D.A *s H.I years2 respecti*elyG P E .55B6. .ut the researchers obser*ed no
statistically signi%icant di%%erences in E+! or P+!negati*e tumors. -sing Co? regression analysis2 they
%ound that age2 se?2 clinical stage2 and nodal status 0ere statistically independent prognostic %actorsG
race2 histology2 and grade 0ere not.
Dr. 'ahleh and her team conclude there are di%%erences in the biology2 pathology2 presentation2 and
sur*i*al bet0een male and %emale breast cancer patients and they call %or additional research to de%ine
a di%%erent approach and appropriate treatment strategies %or men 0ith breast cancer.
ASC" 78nd Annual Meeting3 Abstract BID. Presented 1une A2 8559.

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Medscape Medical 'e0s L 8559
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From Medscape Hematology-Oncology > s! the "#perts > $reast Cancer
Treatment of Breast Cancer in a Man
arold 1. .urstein2 MD2 PhD
Authors and Disclosures
Posted3 5I$5H$855B
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INORMATION ROM IND!STRY
Op"i#n in a $ain"enance se""ing %#r ad(anced n#ns)ua$#us n#n*s$all cell lung cancer
See o*er*ie0 presentation o% data %rom a clinical trial in a maintenance setting o% locally ad*anced or
metastatic non!small cell lung cancer.
Learn $#re
Question
,he patient is a D5!year!old man2 treated 0ith mastectomy. e is node!positi*e 4A nodesM6 and
hormone receptor!positi*e 4estrogen receptor NE+OM and progesterone receptor NP+OM6. e is currently
recei*ing dose!dense do?orubicin!cyclophosphamide!paclita?el. ,he patient had a deep *ein
thrombosis 4D#,6 in his B5sG prior to initiation o% chemotherapy2 silent ischemia 0as seen on
echocardiogram 4EC"6. Family history re*eals 8 sisters 0ith o*arian cancer2 %ather)s sister 0ith
breast cancer2 and 1e0ish bac@ground on %ather)s side. BRCA1 and BRCA2 testing 0as delayed by
insurance issues. Due to the thrombogenicity o% tamo?i%en2 I 0ould pre%er not to use it. (hat do you
suggestP
Response From Expert

Har#ld 12 ,urs"ein3 MD3 P'D
Assistant Pro%essor2 ar*ard Medical School2 .oston2 MassachusettsG Dana Farber Cancer Institute2
.oston2 Massachusetts


Male breast cancer is a rare condition2 0ith C case %or e*ery C55!855 cases o% %emale breast cancer.
,he *ast ma>ority o% male breast cancers are E+!positi*e2 as in the case here. Families 0ith hereditary
breast cancer2 particularly 0hen it is associated 0ith a gene mutation o% BRCA22 ha*e a greater ris@ o%
male breast cancer. Gi*en this patient)s ethnic and %amily history2 it seems Quite possible that he has
an inherited breast cancer gene mutation. Such in%ormation 0ould not change our treatment %or him at
this time2 and o% course2 there is no consideration o% prophylactic oophorectomy here.
e is recei*ing intensi*e chemotherapy 0ith an anthracycline! and ta?ane!based regimen. Although
such treatment is commonly o%%ered to node!positi*e 0omen 0ith breast cancer2 and it is seemingly a
reasonable choice %or men2 there are no data %or its utility in men. Further2 such chemotherapy is not
0ithout ris@2 including cardiac ris@2 especially in older patients 0ith pree?isting coronary disease. ,he
bene%its o% any chemotherapy regimen in patients aged D5 or greater are not 0ell established2 and
probably are %airly modest2 in absolute terms.
,he practitioner)s Question relates to use o% ad>u*ant endocrine therapy in men. ,amo?i%en is the drug
o% choiceG there are no data %or use o% aromatase inhibitors 4AIs6 in men. Although the pharmacology
suggests that AI treatment may reduce testosterone con*ersion to estrogen in men2 as it does in
0omen2 it is not @no0n 0hether this is clinically e%%icacious. Gi*en the total lac@ o% data %or use o% AIs in
this setting2 tamo?i%en is the right choice.
I% you are concerned about thromboembolism2 then I 0ould consider lo0!dose prophylactic
anticoagulation or use o% aspirin therapy. E*en in patients 0ith a prior history o% D#,2 ho0e*er2 the ris@
o% *enous thromboembolism 0ith tamo?i%en is relati*ely lo0. 'eedless to say2 this patient)s silent
ischemia also merits treatment. I 0ould consult 0ith a cardiologist.

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3. 'e0 Senate +eport Puts A*andia Sa%ety in Spotlight Again %rom eart0ire
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