Surgery, radiation decisions differ between men and women, researchers say
FRIDAY, Nov. 15, 2013 (HealthDay News) -- Breast cancer in men occurs only rarely. But among men who have breast cancer, mastectomy rather than breast-conserving surgery is by far the more common choice, new research shows.
Scientists used a national database to compare treatment and outcomes between women and men with breast cancer. They found that males undergo mastectomy surgery far more often than females -- a whopping 87 percent of the time for men, compared with 38 percent for women.
Less than 5 percent of men diagnosed with early stage disease received a breast-conserving lumpectomy, according to the study. However, their survival rates didn't differ significantly from the 70 percent treated with mastectomy.
"I hope people will know there's a data set showing it's an appropriate [option] for select men with early stage breast cancer to undergo breast-conserving surgery," said study author Dr. Rachel Rabinovitch, a professor of radiation oncology at the University of Colorado School of Medicine. "That most men are treated with mastectomy for early stage breast cancer is not surprising, but this was a nice opportunity to compare outcomes and raise that issue."
The researchers said the study is among the largest to track how male breast cancer is treated in the United States. It was published in the November issue of the International Journal of Radiation Oncology, Biology and Physics.
About 0.6 percent of the 240,000 cases of breast cancer diagnosed each year in the United States occur in men, typically among those between 60 and 70 years old. Between 400 and 500 men die of the disease each year, according to the U.S. National Cancer Institute.
Breast cancer risk factors for men include radiation exposure, family history and unusually high estrogen levels.
For the study, Rabinovitch and her team used a National Cancer Institute database with treatment information from about 4,200 cases of male breast cancer and more than 700,000 cases of female breast cancer collected between 1973 and 2008.
The study also suggested that radiation therapy may be underused in men. Only 34 percent of the men in the study with locally advanced disease -- which had spread to the area surrounding the breast but not to distant organs -- were treated with radiation following mastectomy. However, 45 percent of women with similar disease received radiation.
Dr. Otis Brawley, chief medical officer at the American Cancer Society, said he thinks men are typically less concerned about losing their breast tissue, leading more male breast cancer patients to choose mastectomy over lumpectomy.
"If you do a mastectomy in a man, he still has the same shape and contour of his chest that most men have," Brawley said. "Many men have a little bit of breast tissue as they age, and it's undesirable. It's an opportunity to have that removed."
But Rabinovitch disagreed. Although most men are flat-chested, she said, "a mastectomy scar is typically an enormous scar" and can trigger psychological or sexual issues in men who are concerned about their appearance.
"I think we've also overlooked the medical issues," Rabinovitch said. "Mastectomy requires longer anesthesia times. Patients leave the hospital with a drain [from the surgical incision]."
Brawley said the study serves as a useful reminder that breast cancer isn't a female-only disease.
"We do need to realize that while it's a small percentage, men do get breast cancer," he said, adding that most men are diagnosed after finding a lump. "They do have nodules or masses that they feel in their breast and may ignore them when they should not."
Visit the U.S. National Cancer Institute to learn more about male breast cancer (http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/patient/ ).
SOURCES: Rachel Rabinovitch, M.D., professor, radiation oncology, University of Colorado School of Medicine, Aurora; Otis Brawley, M.D., chief medical officer, American Cancer Society; November 2013, International Journal of Radiation Oncology, Biology and Physics