male breast cancer thesis

• Search Menu
• Sign in through your institution
• Acute Care Surgery
• Breast Surgery
• Cardiothoracic Surgery
• Experimental Science
• General Surgery
• Hepato-Pancreato-Biliary Surgery
• Lower Gastrointestinal Surgery
• Orthopaedics
• Paediatric Surgery
• Plastic Surgery
• Transplantation
• Upper Gastrointestinal Surgery
• Vascular Surgery
• Abstract Supplements
• Scientific Surgery
• Author Videos
• Author Guidelines
• Submission Site
• Open Access Options
• Self-Archiving Policy
• Diversity, Equity, Inclusion, and Accessibility
• Editorial Board
• Advertising & Corporate Services
• Strategic Partners
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction, acknowledgements.

• < Previous

Treatment of male breast cancer: meta-analysis of real-world evidence

• Article contents
• Figures & tables
• Supplementary Data

A. P. Lin, T.-W. Huang, K.-W. Tam, Treatment of male breast cancer: meta-analysis of real-world evidence, British Journal of Surgery , Volume 108, Issue 9, September 2021, Pages 1034–1042, https://doi.org/10.1093/bjs/znab279

• Permissions Icon Permissions

Breast cancer is rare in men and managed by extrapolating from breast cancer in women. The clinicopathological features of male breast cancer, however, differ from those of female breast cancer. Because clinical trials are rare, the synthesis of real-world data is one method of integrating sufficient evidence on the optimal treatment for this patient population.

PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they evaluated the treatments of interest in male breast cancer; these evaluations included breast-conserving surgery (BCS) versus mastectomy, postmastectomy radiation therapy versus no radiation, the accuracy of sentinel lymph node biopsy (SLNB), and a comparison of various endocrine therapies.

Forty studies were retrieved. The pooled estimate of overall survival (OS) revealed no difference between BCS and mastectomy groups. Postmastectomy radiation to the chest wall significantly increased OS relative to no postmastectomy radiation (hazard ratio (HR) 0.67, 95 per cent confidence interval 0.54 to 0.84). The pooled estimates of identification and false-negative rates of SLNB were 97.4 and 7.4 per cent respectively. Tamoxifen treatment was associated with significantly increased OS compared with no tamoxifen intake (HR 0.62, 0.41 to 0.95).

Identification and false-negative rates for SLNB were comparable to those in female breast cancer. Breast-conserving surgery can be effective and safe; postmastectomy radiation to the chest wall and 5-year tamoxifen treatment improves survival.

Male breast cancer accounts for less than 1 per cent of all breast cancers 1 . Currently, this rare disease is treated by extrapolating from breast cancer treatment in women. The clinicopathological features of male breast cancer, however, differ from those of female breast cancer 2 , 3 . Furthermore, biological factors, such as anatomical differences and hormone regulation, may contribute to different responses to treatment. Therefore, a systematic approach dedicated to the optimal management of male breast cancer is required.

Breast cancer treatment in men faces unique challenges. Currently, the most common surgical management of breast cancer is total mastectomy; breast-conserving surgery (BCS) is performed in only a small proportion of men with breast cancer 4 . The low utilization rate of BCS may be due to the higher likelihood of recurrence in men. As men have smaller breasts, microscopic tumour foci are more likely to remain in the chest wall and overlying skin, potentially leading to locoregional recurrence 5–7 . Furthermore, because male breast cancer is most commonly located in the retroareolar area and frequently involves the nipple and skin at diagnosis 8 , close margins could pose a risk of recurrence.

Despite the use of postmastectomy radiation to the chest wall only in more advanced stages in women, some scholars have recommended the routine use of postmastectomy radiation therapy in all stages of breast cancer in men because of their smaller breast size 9 , 10 . The lack of breast tissue may result in small tumours having narrow resection margins, for which postmastectomy radiation therapy may confer significant survival benefits.

In addition, sentinel lymph node biopsy (SLNB) could pose challenges in men because of anatomical differences between the sexes. Although superficial lymphatic patterns are identical in women and men, women have additional lymph vessels that course through the breast tissue before draining radially into the axillary lymph node 11 . The absence of the axillary lymph node in men could result in different identification rates and false-negative rates because injected dyes and radioactive tracers travel via the lymphatics to the sentinel lymph nodes.

Tamoxifen may empirically exhibit an effective response toward male breast cancer because of the high prevalence of oestrogen receptor-positive tumours 12 . Men and women differ in endogenous oestradiol levels, oestrogen receptor distribution in the body, and drug metabolism 13 , 14 . Therefore, tamoxifen may have different responses in men.

Currently, comprehensive guidelines for the treatment of male breast cancer are scarce. The National Comprehensive Cancer Network 15 guidelines recommend clinicians to provide men with treatment similar to that provided to postmenopausal women. The relevant European Society for Medical Oncology 16 , 17 guidelines mainly cover recommendations for endocrine therapy. The American Society of Clinical Oncology (ASCO) 1 has developed recommendations for male breast cancer management, focusing on endocrine therapy, germline genetic testing, and survivorship care. Many attempted clinical trials focusing on breast cancer in men have closed owing to a lack of participants, and so real-world data are required to optimize clinical management of male breast cancer.

A meta-analysis of real-world studies on the management of male breast cancer was undertaken and the following four key questions were addressed: Is BCS oncologically safe in men who inherently have less breast tissue? Is radiation to the chest wall after total mastectomy effective at controlling local recurrence in men? Can the sentinel lymph node be successfully and accurately identified in men ? Does adjuvant endocrine therapy confer benefits in men similar to those in women?

Search strategy and selection criteria

PubMed, Embase, and Cochrane Library databases were searched without any date or language restrictions up to January 2021 using the broad search term ‘male breast cancer’. Additionally, separate search terms were applied to each of the four key questions. The broad search terms for the first question were ‘male breast cancer AND breast-conserving therapy OR lumpectomy OR partial mastectomy’; those for the second question were ‘male breast cancer AND sentinel lymph node’; those for the third question were ‘male breast cancer AND radiation therapy OR radiotherapy’; and those for the final question ‘were male breast cancer AND endocrine therapy OR hormone therapy OR tamoxifen OR aromatase inhibitor OR GnRH’. All relevant references were checked for additional and unpublished citations. All articles were then combined into a single list, and duplicates excluded.

Studies were included in this review if they evaluated the treatments of interest in male breast cancer; these evaluations included BCS versus mastectomy, postmastectomy radiation therapy versus no radiation, the identification rate and false-negative rate of SLNB, and a comparison of various endocrine therapies. All abstracts were reviewed and commentaries or opinion pieces were excluded. Other exclusions were review articles that reported on data present in references already identified by the search, and articles containing primary data duplicated in another included article. In the case of duplicate data, articles with the most complete baseline variables of treatment and non-treatment groups were selected. Studies that did not provide data on comparable confounding factors were excluded. With regard to BCS versus mastectomy and postmastectomy radiation therapy versus no radiation therapy, studies that did not provide data on tumour status for each group were excluded. For postmastectomy radiation therapy versus no radiation therapy, studies in which the type of surgery was missing or unknown were also excluded. For SLNB, studies were excluded if the identification rate was missing or unknown, or if patients did not undergo axillary lymph node dissection (ALND) after SLNB. For the evaluation of endocrine therapy, studies that did not provide hormone status data were excluded. All studies were screened with respect to inclusion criteria, and those to be subject to meta-analyses were reviewed by a second researcher. This project was registered in the PROSPERO online public database (CRD420202009315).

Data extraction

Data on the study design, patient characteristics, interventions, and outcomes were extracted from each paper by two independent reviewers. The data extracted by the two reviewers were compared, and disagreements resolved by a third reviewer.

Methodological quality appraisal

Study quality was judged by assessing the aspects of their research design that are likely to introduce bias, such as measures prone to measurement bias; confounding factors being insufficiently accounted for; and, in observational studies, loss to follow-up. Biases before, during and after the intervention, and overall biases were evaluated using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool 18 . Single-armed non-randomized studies were assessed using the modified Newcastle–Ottawa Scale 19 , in which stars are awarded in two broad categories: selection of groups, and discernment of the outcome of interest for the case–control or cohort. Each article is rated on six variables and can earn a maximum of six stars.

The main outcome investigated was the survival outcomes of BCS, postmastectomy radiation to the chest wall, and endocrine therapy. The main outcome for SLNB was the identification rate and false-negative rate in patients who had a planned, back-up, and completed ALND. Specifically, false-negative rate was calculated as [ n fp /( n fp + n tp )] × 100, where n fp is the number of false negatives and n tp the number of true positives.

Statistical analysis

Survival data were pooled for meta-analysis using Review Manager software 20 according to the PRISMA guidelines 21 . Overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) were reported as hazard ratios (HRs), calculated using the inverse-variance method and/or as odds ratios (ORs) using the dichotomous method. The precision of the effect sizes was reported in terms of 95 per cent confidence intervals. The DerSimonian and Laird random-effects model was used to compute the pooled estimates 22 . For SLNB, identification rates and/or false-negative rates from individual studies were pooled using OpenMeta[Analyst] software 23 . Cochrane Q tests and I 2 statistics were used to evaluate statistical heterogeneity and inconsistency in treatment effects respectively among the included studies. Statistical significance was set at P  <   0.1000 for the Cochrane Q tests. Statistical heterogeneity was assessed using the I 2 test , with I 2 quantifying the proportion of the total outcome variability attributable to variability among the studies. Subgroup analyses were also performed by pooling estimates for similar patient subsets among studies, as appropriate.

The searches yielded 91 902 entries, after duplicates had been removed. After excluding articles irrelevant to male breast cancer, 275 articles remained and were assessed; among these, 40 articles met the inclusion criteria and were selected for analysis ( Fig. 1 ).

PRISMA flow diagram showing selection of articles for review

*Four studies were included in two subgroups. PMRT, postmastectomy radiotherapy.

The quality of evidence varied between outcomes. High-quality evidence was rare ( Tables S1 and S2 ). Most studies were uncontrolled cohort studies or case series. If a single study was published in several outlets, only the study with the most complete set of data was analysed to avoid counting a study twice. Studies were organized into four categories, each corresponding to a research question of the present meta-analysis.

Breast-conserving surgery versus mastectomy

Seven studies 24–30 investigated the survival outcomes of BCS versus mastectomy, all of which were retrospective cohort studies. Because four studies 24–27 were based on the Surveillance, Epidemiology, and End Results (SEER) database with overlapping study periods, only those with the most complete set of data were analysed. One study 28 used the National Cancer Database (NCDB), and one 29 used the Swedish Cancer Registry. One study 30 collected data retrospectively from two medical centres. Of the 14 061 included patients, 2973 underwent BCS and 11 088 mastectomy. The majority of those receiving BCS had small tumours (less than 2 cm). Demographic, clinical, and molecular characteristics are listed in Table 1 .

Characteristics of studies comparing breast-conserving surgery and mastectomy in men with breast cancer

Values in parentheses are percentages unless indicated otherwise ; values are

mean(s.d.),

median (range), and ‡median (i.q.r.).

median (i.q.r.).

Men with T1a,b,c N0 M0 breast cancer diagnosed between 1988 and 2012 in Surveillance, Epidemiology, and End Results (SEER) database.

Men with stage I–II, T1–T2 N0 breast cancer diagnosed between 1998 and 2011 with required surgical and radiation treatment data in SEER database.

Men with breast cancer diagnosed between 1988 and 2010 in SEER database.

Radiotherapy defined as postoperative external beam radiation therapy to the breast and/or chest wall ± axilla.

All patients receiving adjuvant radiation therapy had invasive cancer. The median radiation dose was 53.2 (range 45–61) Gy, and the median dose per fraction was 2 Gy. Adjuvant radiation therapy included either breast conservation tangents with a tumour bed boost or chest wall and regional lymphatics when appropriate after mastectomy.

Treatments were with medium-energy X-rays (140–200 kV, half-value layer 0.5–1.2 mm Cu ). MBC, male breast cancer; NCDB, National Cancer Database; BMC, Boston Medical Center; MGH, Massachusetts General Hospital; B, breast-conserving surgery group; P, partial mastectomy group; M, mastectomy group; n.r., not reported; ER, oestrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2; BCS, breast-conserving surgery; MRM, modified radical mastectomy.

Survival outcomes

The meta-analysis revealed no difference in OS between BCS and mastectomy (HR 1.19, 95 per cent c.i. 0.69 to 2.04 ) ( Fig. S1 ). Furthermore, 5- and 10-year OS rates did not differ significantly between groups (at 5 years: OR 0.93, 0.73 to 1.19; at 10 years: OR 1.06, 0.93 to 1.21) ( Fig. 2 ). One study 29 reported comparable DFS and local control. Another study 30 reported lower incidences of breast oedema, fibrosis, arm oedema, and range of motion 1 year after surgery among patients who had undergone BCS compared with rates for patients who had undergone mastectomy.

Survival outcomes of breast conservative therapy versus mastectomy in terms of 5- and 10-year overall survival

A Mantel–Haenszel random-effects model was used for meta-analysis. Odds ratios are shown with 95 per cent confidence intervals.

Postmastectomy radiation therapy versus no radiation therapy

Fifteen retrospective cohort studies 25 , 27 , 28 , 31–42 evaluated the effects of postmastectomy radiation therapy. Because six studies 25 , 27 , 31–34 collected data from overlapping study periods from the SEER database and two studies 28 , 35 did so from the NCDB database, the most complete data sets were used for analysis. Six studies 36–41 collected data retrospectively from medical centres, and one study 42 did so from a national cancer registry in Germany. Of the 11 392 included patients, 3648 underwent postmastectomy radiation to the chest wall and/or node, and 7744 had surgery alone. The majority of patients in each study underwent mastectomy. The postmastectomy radiation group had more advanced overall stage and nodal status than the no-radiation group. Patient characteristics are summarized in Table S3 .

Postmastectomy radiation to the chest wall significantly increased OS compared with no radiation therapy (HR 0.67, 95 per cent c.i. 0.54 to 0.84) ( Fig. S2 ). Five-year OS, DFS, and LRFS all exhibited an (albeit non-significantly) increasing trend in the postmastectomy radiation group ( Fig. 3 and Fig. S2b ). One study 30 reported an association between postmastectomy radiation and improved OS for those with between one and three positive nodes (5-year OS: 79 versus 72 per cent; P  =   0.05) and those with four or more positive nodes (5-year OS: 73 versus 53 per cent; P  <   0.001). Another study 40 reported no grade 3–5 acute toxicities and 2 per cent grade 3 chronic toxicities associated with postmastectomy radiation. Almost all toxicities were skin-related reactions.

Survival outcomes of postmastectomy radiation therapy versus no radiation therapy in terms of 5-year overall survival

Sentinel lymph node biopsy

Eleven studies 43–53 with a total of 213 patients reported on the successful and/or accurate identification of sentinel lymph nodes in male breast cancer. All 11 studies reported identification rates, and seven 43 , 44 , 47 , 49 , 50 , 52 , 53 also had evaluable false-negative rates. Lymphoscintigraphy was performed in 81 per cent of patients. Most studies used dual mapping techniques for identifying sentinel lymph nodes. The most common injection site was peritumoral. The mean number of sentinel lymph nodes removed in each study is presented in Table S4 .

Pooled estimate of node identification rate and false-negative rate

The pooled estimate of the sentinel lymph node identification rate was 97.4 (95 per cent c.i. 95.3 to 99.5) per cent ( Fig. S3a ), ranging from 90.3 to 100 per cent. The pooled estimate of the false-negative rate was 7.4 (−0.9 to 15.8) per cent ( Fig. S3b ). With the exception of one study, the false-negative rate was 0 per cent. This one study 47 had a higher number of patients with negative sentinel lymph nodes who had additional non-sentinel lymph nodes removed but not complete ALND.

Endocrine therapies

Three prospective and seven retrospective cohort studies compared the efficacy of various endocrine therapies 12 , 37 , 54–61 . Seven studies 37 , 54–59 compared tamoxifen intake with no tamoxifen intake, two 12 , 60 compared tamoxifen with aromatase inhibitor, and one 61 compared aromatase inhibitor with gonadotrophin-releasing hormone (GnRH) against aromatase inhibitor alone. Two studies 58 , 59 with overlapping study intervals in the NCDB database evaluated the effect of endocrine therapy. Because tamoxifen was the most common endocrine therapy in male breast cancer during the these two studies, the data set of tamoxifen versus no tamoxifen groups was analysed. One study evaluating the risk of thromboembolism was an extension of a study on survival outcomes 54 , 55 . In total, 11 229 patients were analysed. Most patients were hormone receptor-positive and few were positive for human epidermal growth factor receptor 2. Patient characteristics are listed in Table S5 .

Survival outcomes of tamoxifen versus no tamoxifen

Seven cohort studies 37 , 54–59 reported the survival benefits of tamoxifen. A meta-analysis revealed significantly increased OS (HR 0.62, 95 per cent c.i. 0.41 to 0.95) ( Fig. S4a ) and DFS (HR 0.44, 0.28 to 0.69) ( Fig. S4b ) in the tamoxifen group. OS (at 5 years: OR 1.76, 1.60 to 1.94; at 10 years: OR 1.87, 0.98 to 3.54) ( Fig. 4 ), and DFS (at 5 years: OR 2.72, 1.57 to 4.70; at 10 years: OR 3.34, 1.95 to 5.71) ( Fig. S4c ) also favoured tamoxifen treatment. A subgroup analysis of treatment duration (5 years versus less than 5 years) favoured 5 years of treatment (DFS: OR 8.33, 0.35 to 198.09). Data comparing adverse effects were limited. One study 54 reported comparable risks of thromboembolism in the two groups.

Survival outcomes of tamoxifen versus no tamoxifen in terms of 5- and 10-year overall survival

Tamoxifen versus aromatase inhibitor

Tamoxifen had significantly increased 5-year OS compared with aromatase inhibitor (OR 2.35, 95 per cent c.i. 1.17 to 4.74) ( Fig. S4d ).

Aromatase inhibitor with gonadotrophin-releasing hormone versus aromatase inhibitor alone

The rationale for the use of GnRH with aromatase inhibitor is based on the theory of reduced aromatization rates through the inhibition of the hypothalamic–pituitary feedback loop 61 . One study 61 reported on survival outcomes of aromatase inhibitor with GnRH compared with aromatase inhibitor alone in men with metastatic breast cancer. The survival outcomes favoured aromatase inhibitor with GnRH (OS: OR 2.40, 95 per cent c.i. 0.83 to 6.97).

This systematic review of real-world data indicated that BCS is a feasible option for men with breast cancer, especially for tumours smaller than 2 cm. Postmastectomy radiation to the chest wall was associated with increased survival even though patients undergoing postmastectomy radiation were more likely to have the disease at a more advanced stage. The identification rates and false-negative rates of SLNB were comparable to those in women. Tamoxifen was associated with improved survival and was a superior option to aromatase inhibitor, especially if the duration of therapy was at least 5 years.

RCTs are unlikely in this distinct population; therefore, the synthesis of real-world data is one method of integrating a reasonable amount of evidence that allows clinicians to draw conclusions regarding the optimal treatment. Relative to previous narrative reviews, this study used a more comprehensive search method, focused on controversial issues, set well defined selection criteria, and made every effort to compare studies that contained two groups, each with sufficiently stratified confounding factors.

Although the paucity of male breast tissue has conventionally been considered a contraindication to lumpectomy, many men with breast cancer have some degree of breast enlargement that may permit wide local excision, making breast conservation feasible and safe in appropriately selected patients 24 , 62 . Many studies have reported on patients who insisted on having BCS, the majority of whom exhibited low recurrence risks, high survival rates, and good cosmetic outcomes 62–64 . Given the current shift in emphasis on self-image in men, BCS should be considered as an option in male breast cancer without overt nipple or areolar involvement. In this study, the recurrence and survival rates were comparable between patients who received BCS and those who underwent mastectomy, specifically if the tumour was smaller than 2 cm. Additionally, BCS is conventionally followed by radiation therapy, which was demonstrated to reduce the risk of recurrence 5 . Therefore, the available data support BCS as a feasible and safe approach in men with tumours less than 2 cm in size.

Contrary to current clinical guidelines, real-world data have indicated that a sizeable proportion of men with breast cancer opt to undergo radiation therapy to the chest wall despite a total mastectomy, a practice not followed in women except in advanced disease. The high utilization rates could be due to caution regarding not achieving negative surgical margins, especially in smaller breasts. Incidentally, this study found an increased survival rate in the radiation therapy group compared with the no-radiation therapy group, despite more advanced tumour stage and size 28 , 31 . Real-world evidence has revealed that, because breast tumours in men are located relatively close to the underlying muscle, the use of radiation therapy to the chest wall could reduce the risk of recurrence. These results demonstrate that men and women differ, which warrants the further development of male breast cancer guidelines.

Despite limited data for men, false-negative rate concerns must be addressed before generalizing evidence from female breast cancer to men because breast anatomy and lymphatic drainage patterns differ between the sexes 11 . In this review, whether the injection site was subareolar or peritumoral did not seem to affect the false-negative rate. Small breast sizes in men could have minimized the distinction between subareolar and peritumoral injection techniques 44 . Moreover, despite men having median tumour sizes of less than 2 cm, SLNB had low false-negative rates, supporting the belief that, as for women, the entire breast of men may drain the same few lymphatic channels to the axilla and that the site of injection may be of little importance 65 . Overall, this meta-analysis of the male SLNB literature had an identification rate of 97.4 per cent and a false-negative rate of 7.4 per cent, suggesting similar accuracies of SLNB in men and women.

Currently, ASCO guidelines 1 recommend, through formal consensus, the use of tamoxifen for men with hormone receptor-positive breast cancer for an initial duration of 5 years. Aromatase inhibitor and GnRH should be offered when tamoxifen is contraindicated. The results of this review of real-world data support these recommendations. Despite the survival benefits of tamoxifen, this study indicated that a large proportion of men discontinue treatment because of side-effects, including decreased libido and weight gain 36 , 66 , 67 . There were insufficient data on the effects of an additional 5 years of tamoxifen treatment. Further research on duration of tamoxifen treatment and the alleviation of adverse effects is urgently required.

This review has several limitations. Throughout, the level of evidence was of a low grade because of the rarity of breast cancer in men and lack of RCTs, limiting interpretation and conclusions. Most crucially, studies were limited by the lack of central findings, such as resection margins, which made it difficult to reliably determine treatment indications. Moreover, changes in techniques over the past four decades could have resulted in difficulty making comparisons across studies. Finally, many studies were subject to channelling bias. Despite these limitations, the assessment of treatments remains of crucial interest for oncologists because it contributes to the small amount of existing evidence on the potential roles of these treatments in male breast cancer.

This study reports comprehensive real-world data addressing the treatments of breast cancer in men as well as providing an opportunity to explore and develop clinical practice guidelines for this rare disease.

This manuscript was edited by Wallace Academic Editing. The authors thank J.-L. Chen who inspired this study.

Disclosure. The authors declare no conflict of interest.

Supplementary material

Supplementary material is available at BJS online.

Hassett MJ , Somerfield MR , Baker ER , Cardoso F , Kansal KJ , Kwait DC  et al.    Management of male breast cancer: ASCO guideline . J Clin Oncol   2020 ; 38 : 1849 – 1863 .

Google Scholar

Hong JH , Ha KS , Jung YH , Won HS , An HJ , Lee GJ  et al.    Clinical features of male breast cancer: experiences from seven institutions over 20 years . Cancer Res Treat   2016 ; 48 : 1389 – 1398 .

Cardoso F , Bartlett JMS , Slaets L , van Deurzen CHM , van Leeuwen-Stok E , Porter P  et al.    Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program . Ann Oncol   2018 ; 29 : 405 – 417 .

Fentiman IS.   Surgical options for male breast cancer . Breast Cancer Res Treat   2018 ; 172 : 539 – 544 .

Darby S , McGale P , Correa C , Taylor C , Arriagada R , Clarke M  et al. ; Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials . Lancet   2011 ; 378 : 1707 – 1716 .

Agrawal A , Ayantunde AA , Rampaul R , Robertson JFR.   Male breast cancer: a review of clinical management . Breast Cancer Res Treat   2007 ; 103 : 11 – 21 .

Harris J , Lippman M , Morrow M , Kent Osborne CK.   Disease of the Breast: Male Breast Cancer (5th edn). Philadelphia, PA : Lippincott Williams and Wilkins , 2014.

Google Preview

Yalaza M , İnan A , Bozer M.   Male breast cancer . J Breast Health   2016 ; 12 : 1 – 8 .

Robison R , Montague ED.   Treatment results in males with breast cancer . Cancer   1982 ; 49 : 403 – 406 .

Stranzl H , Mayer R , Quehenberger F , Prettenhofer U , Willfurth P , Stöger H  et al.    Adjuvant radiotherapy in male breast cancer . Radiother Oncol   1999 ; 53 : 29 – 35 .

Suami H , Pan WR , Mann GB , Taylor GI.   The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study . Ann Surg Oncol   2008 ; 15 : 863 – 871 .

Eggemann H , Ignatov A , Smith BJ , Altmann U , von Minckwitz G , Röhl FW  et al.    Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients . Breast Cancer Res Treat   2013 ; 137 : 465 – 470 .

Schmetzer O , Flörcken A.   Sex differences in the drug therapy for oncologic diseases . Handb Exp Pharmacol   2012 ; 214 : 411 – 442 .

Spoletini I , Vitale C , Malorni W , Rosano GM.   Sex differences in drug effects: interaction with sex hormones in adult life . Handb Exp Pharmacol   2012 ; 214 : 91 – 105 .

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology, Breast Cancer, Version 5 .   https://www2.tri-kobe.org/nccn/guideline/breast/english/breast.pdf (accessed 1 October 2020 ).

Cardoso F , Kyriakides S , Ohno S , Penault-Llorca F , Poortmans P , Rubio IT  et al. ; ESMO Guidelines Committee. Electronic address: [email protected]. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up . Ann Oncol   2019 ; 30 : 1194 – 1220 .

Cardoso F , Paluch-Shimon S , Senkus E , Curigliano G , Aapro MS , André F  et al.    5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) . Ann Oncol   2020 ; 31 : 1623 – 1649 .

Sterne JA , Hernán MA , Reeves BC , Savović J , Berkman ND , Viswanathan M  et al.    ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions . BMJ   2016 ; 355 : i4919 .

Wells GA , Shea B , O'Connell D , Robertson J , Peterson J , Welch V  et al.    The Newcastle–Ottawa Scale (NOS) for Assessing the Quality if Nonrandomized Studies in Meta-Analyses . http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed 1 October 2020 ).

Higgins JPT , Thomas J , Chandler J , Cumpston M , Li T , Page MJ  et al.    Cochrane Handbook for Systematic Reviews of Interventions (2nd edn). Chichester : John Wiley & Sons , 2019.

Moher D , Liberati A , Tetzlaff J , Altman DG ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . BMJ   2009 ; 339 : b2535 .

DerSimonian R , Laird N.   Meta-analysis in clinical trials . Control Clin Trials   1986 ; 7 : 177 – 188 .

Wallace BC , Dahabreh IJ , Trikalinos TA , Lau J , Trow P , Schmid CH.   Closing the gap between methodologists and end-users: R as a computational back-end . J Stat Softw   2012 ; 49 : 5 .

Cloyd JM , Hernandez-Boussard T , Wapnir IL.   Outcomes of partial mastectomy in male breast cancer patients: analysis of SEER, 1983–2009 . Ann Surg Oncol   2013 ; 20 : 1545 – 1550 .

Leone JP , Leone J , Zwenger AO , Iturbe J , Leone BA , Vallejo CT.   Locoregional treatment and overall survival of men with T1a,b,cN0M0 breast cancer: a population-based study . Eur J Cancer   2017 ; 71 : 7 – 14 .

Shin JY , Kachnic LA , Hirsch AE.   The impact of race in male breast cancer treatment and outcome in the United States: a population-based analysis of 4279 patients . Int J Breast Cancer   2014 ; 2014 : 1 .

Zaenger D , Rabatic BM , Dasher B , Mourad WF.   Is breast conserving therapy a safe modality for early-stage male breast cancer?   Clin Breast Cancer   2016 ; 16 : 101 – 104 .

Bateni SB , Davidson AJ , Arora M , Daly ME , Stewart SL , Bold RJ  et al.    Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis . Ann Surg Oncol   2019 ; 26 : 2144 – 2153 .

Hultborn R , Friberg S , Hultborn KA , Peterson LE , Ragnhult I.   Male breast carcinoma. II. A study of the total material reported to the Swedish Cancer Registry 1958–1967 with respect to treatment, prognostic factors and survival . Acta Oncol   1987 ; 26 : 327 – 341 .

Fogh S , Kachnic LA , Goldberg SI , Taghian AG , Powell SN , Hirsch AE.   Localized therapy for male breast cancer: functional advantages with comparable outcomes using breast conservation . Clin Breast Cancer   2013 ; 13 : 344 – 349 .

Abrams MJ , Koffer PP , Wazer DE , Hepel JT.   Postmastectomy radiation therapyis associated with improved survival in node-positive male breast cancer: a population analysis . Int J Radiat Oncol Biol Phys   2017 ; 98 : 384 – 391 .

Crew KD , Neugut AI , Wang X , Jacobson JS , Grann VR , Raptis G  et al.    Racial disparities in treatment and survival of male breast cancer . J Clin Oncol   2007 ; 25 : 1089 – 1098 .

Madden NA , Macdonald OK , Call JA , Schomas DA , Lee CM , Patel S.   Radiotherapy and male breast cancer: a population-based registry analysis . Am J Clin Oncol   2016 ; 39 : 458 – 462 .

Sroufe RL , Schwartz D , Rineer J , Choi K , Rotman M , Schreiber D.   A population-based study of the impact of post-mastectomy radiation on survival for male breast cancer . J Radiat Oncol   2012 ; 1 : 337 – 345 .

Weir J , Zhao YD , Herman T , Algan Ö.   Clinicopathologic features and radiation therapy utilization in patients with male breast cancer: a national cancer database study . Breast Cancer (Auckl)   2018 ; 12 : 117822341877068 .

Chakravarthy A , Kim CR.   Post-mastectomy radiation in male breast cancer . Radiother Oncol   2002 ; 65 : 99 – 103 .

Fogh S , Hirsch AE , Langmead JP , Goldberg SI , Rosenberg CL , Taghian AG  et al.    Use of tamoxifen with postsurgical irradiation may improve survival in estrogen and progesterone receptor-positive male breast cancer . Clin Breast Cancer   2011 ; 11 : 39 – 45 .

Macdonald G , Paltiel C , Olivotto IA , Tyldesley S.   A comparative analysis of radiotherapy use and patient outcome in males and females with breast cancer . Ann Oncol   2005 ; 16 : 1442 – 1448 .

Rogowski P , Schönecker S , Pazos M , Reitz D , Braun M , Pölcher M  et al.    Pattern of care of adjuvant radiotherapy in male breast cancer patients in clinical practice: an observational study . Strahlenther Onkol   2019 ; 195 : 289 – 296 .

Rolf D , Elsayad K , Meheissen MAM , Elkerm Y , Opitz C , Radke I  et al.    Impact of adjuvant radiation therapy in patients with male breast cancer: a multicenter international analysis . Adv Radiat Oncol   2020 ; 5 : 345 – 349 .

Yu E , Suzuki H , Younus J , Elfiki T , Stitt L , Yau G  et al.    The impact of post-mastectomy radiation therapy on male breast cancer patients—a case series . Int J Radiat Oncol Biol Phys   2012 ; 82 : 696 – 700 .

Eggemann H , Ignatov A , Stabenow R , von Minckwitz G , Röhl FW , Hass P  et al.    Male breast cancer: 20-year survival data for post-mastectomy radiotherapy . Breast Care (Basel)   2013 ; 8 : 270 – 275 .

Albo D , Ames FC , Hunt KK , Ross MI , Singletary SE , Kuerer HM.   Evaluation of lymph node status in male breast cancer patients: a role for sentinel lymph node biopsy . Breast Cancer Res Treat   2003 ; 77 : 9 – 14 .

Boughey JC , Bedrosian I , Meric-Bernstam F , Ross MI , Kuerer HM , Akins JS  et al.    Comparative analysis of sentinel lymph node operation in male and female breast cancer patients . J Am Coll Surg   2006 ; 203 : 475 – 480 .

Cimmino VM , Degnim AC , Sabel MS , Diehl KM , Newman LA , Chang AE.   Efficacy of sentinel lymph node biopsy in male breast cancer . J Surg Oncol   2004 ; 86 : 74 – 77 .

De Cicco C , Baio SM , Veronesi P , Trifirò G , Ciprian A , Vento A  et al.    Sentinel node biopsy in male breast cancer . Nucl Med Commun   2004 ; 25 : 139 – 143 .

Flynn LW , Park J , Patil SM , Cody HS III , Port ER.   Sentinel lymph node biopsy is successful and accurate in male breast carcinoma . J Am Coll Surg   2008 ; 206 : 616 – 621 .

Gentilini O , Chagas E , Zurrida S , Intra M , De Cicco C , Gatti G  et al.    Sentinel lymph node biopsy in male patients with early breast cancer . Oncologist   2007 ; 12 : 512 – 515 .

Goyal A , Horgan K , Kissin M , Yiangou C , Sibbering M , Lansdown M  et al. ; ALMANAC Trialists Group. Sentinel lymph node biopsy in male breast cancer patients . Eur J Surg Oncol   2004 ; 30 : 480 – 483 .

Koukouras D , Spyropoulos C , Zygomalas A , Tzoracoleftherakis E.   Sentinel node biopsy in male breast carcinoma: is the ‘female’ approach justified?   Eur J Gynaecol Oncol   2012 ; 33 : 255 – 256 .

Maráz R , Boross G , Pap-Szekeres J , Markó L , Rajtár M , Ambrózay É  et al.    The role of sentinel node biopsy in male breast cancer . Breast Cancer   2016 ; 23 : 85 – 91 .

Port ER , Fey JV , Cody HS III , Borgen PI.   Sentinel lymph node biopsy in patients with male breast carcinoma . Cancer   2001 ; 91 : 319 – 323 .

Rusby JE , Smith BL , Dominguez FJ , Golshan M.   Sentinel lymph node biopsy in men with breast cancer: a report of 31 consecutive procedures and review of the literature . Clin Breast Cancer   2006 ; 7 : 406 – 410 .

Eggemann H , Bernreiter AL , Reinisch M , Loibl S , Taran FA , Costa SD  et al.    Tamoxifen treatment for male breast cancer and risk of thromboembolism: prospective cohort analysis . Br J Cancer   2019 ; 120 : 301 – 305 .

Eggemann H , Brucker C , Schrauder M , Thill M , Flock F , Reinisch M  et al.    Survival benefit of tamoxifen in male breast cancer: prospective cohort analysis . Br J Cancer   2020 ; 123 : 33 – 37 .

Giordano SH , Perkins GH , Broglio K , Garcia SG , Middleton LP , Buzdar AU  et al.    Adjuvant systemic therapy for male breast carcinoma . Cancer   2005 ; 104 : 2359 – 2364 .

Ribeiro G , Swindell R.   Adjuvant tamoxifen for male breast cancer (MBC) . Br J Cancer   1992 ; 65 : 252 – 254 .

Venigalla S , Carmona R , Guttmann DM , Jain V , Freedman GM , Clark AS  et al.    Use and effectiveness of adjuvant endocrine therapy for hormone receptor-positive breast cancer in men . JAMA Oncol   2018 ; 4 : e181114 .

Sarmiento S , McColl M , Musavi L , Gani F , Canner JK , Jacobs L  et al.    Male breast cancer: a closer look at patient and tumor characteristics and factors that affect survival using the National Cancer Database . Breast Cancer Res Treat   2020 ; 180 : 471 – 479 .

Chen F , Qiu L.   Biological and clinical implications of aromatase inhibitors in early male breast cancer patients . Zhonghua Yi Xue Za Zhi   2014 ; 94 : 273 – 275 .

Di Lauro L , Pizzuti L , Barba M , Sergi D , Sperduti I , Mottolese M  et al.    Role of gonadotropin-releasing hormone analogues in metastatic male breast cancer: results from a pooled analysis . J Hematol Oncol   2015 ; 8 : 53 .

Golshan M , Rusby J , Dominguez F , Smith BL.   Breast conservation for male breast carcinoma . Breast   2007 ; 16 : 653 – 656 .

Gomberawalla A , Liou P , Martinez R , Rajpara R , Connolly E , Horowitz D  et al.    Breast conservation for male breast cancer: case report of intraoperative radiation . Breast J   2018 ; 24 : 74 – 77 .

Lanitis S , Filippakis G , Al Mufti R , Hadjiminas DJ.   Breast conserving surgery with preservation of the nipple–areola complex as a feasible and safe approach in male breast cancer: a case report . J Med Case Rep   2008 ; 2 : 126 .

Martin RC , Chagpar A , Scoggins CR , Edwards MJ , Hagendoorn L , Stromberg AJ  et al.    Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer . Ann Surg   2005 ; 241 : 1005 – 1012 .

Khan MH , Allerton R , Pettit L.   Hormone therapy for breast cancer in men . Clin Breast Cancer   2015 ; 15 : 245 – 250 .

Xu S , Yang Y , Tao W , Song Y , Chen Y , Ren Y  et al.    Tamoxifen adherence and its relationship to mortality in 116 men with breast cancer . Breast Cancer Res Treat   2012 ; 136 : 495 – 502 .

• aromatase inhibitors
• sentinel lymph node biopsy
• breast cancer, male
• breast cancer
• endocrine therapy
• breast conserving surgery
• cochrane collaboration
• false-negative results
• post-mastectomy radiation therapy

Supplementary data

Email alerts, citing articles via.

• Recommend to Your Librarian
• Advertising & Corporate Services
• Journals Career Network

Affiliations

• Online ISSN 1365-2168
• Copyright © 2024 BJS Foundation Ltd.
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Advertisement

Male Breast Cancer: a Review on Diagnosis, Treatment, and Survivorship

• Published: 02 January 2024
• Volume 26 , pages 34–45, ( 2024 )

Cite this article

• Prarthna V Bhardwaj 1 ,
• Shilpi Gupta 2 ,
• Alexa Elyash 3 &
• Eleonora Teplinsky   ORCID: orcid.org/0000-0001-8179-6079 3  

1013 Accesses

3 Altmetric

Explore all metrics

Purpose of Review

Male breast cancer is a relatively uncommon and rare disease that is often managed based on evidence adopted from trials pertaining to female breast cancer due to low accrual rates or exclusion of males. This is despite the known differences in the biology and epidemiology of this condition. This review provides an update regarding the management and surveillance of male breast cancer.

Recent Findings

Men with breast cancer tend to undergo more extensive surgery in the breast and axilla. The outcomes of male breast cancer compared to a similar subtype of female breast cancer appear worse when matched for stage. Systemic therapies remain predominantly based on recommendations for female breast cancer, although tamoxifen is the more optimal endocrine therapy for men than women. Surveillance with mammograms is recommended for patients harboring a breast cancer susceptibility gene but is otherwise not advised for men who have undergone a mastectomy. Notably, the role of other imaging modalities, including ultrasound and magnetic resonance imaging, is minimal. Although the focus on survivorship care among men is low, it is abundantly clear that this is a stigmatizing diagnosis for men, and they suffer from long-term physical and psychological sequelae following a diagnosis and treatment of breast cancer.

In summary, providing more gender-inclusive care and advocating for increased representation of men in prospective breast cancer studies and clinical trials may help improve outcomes and provide enhanced support for this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Data Availability

No new data was generated during the preparation of the manuscript.

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

Society AC. Key statistics for breast cancer in men. 2023 [Available from: https://www.cancer.org/cancer/types/breast-cancer-in-men/about/key-statistics.html .

Wang F, Shu X, Meszoely I, Pal T, Mayer IA, Yu Z, et al. Overall mortality after diagnosis of breast cancer in men vs women. JAMA Oncol. 2019;5(11):1589–96.

PubMed   PubMed Central   Google Scholar  

Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091.

PubMed   Google Scholar  

O’Malley C, Shema S, White E, Glaser S. Incidence of male breast cancer in California, 1988-2000: racial/ethnic variation in 1759 men. Breast Cancer Res Treat. 2005;93(2):145–50.

Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51–7.

Altiner S, Altiner OT, Buyukkasap C, Ugras Dikmen A, Pekcici MR, Erel S. Analysis of knowledge about male breast cancer among patients at Tertiary Medical Center. Am J Mens Health. 2023;17(2):15579883231165626.

Duma N, Hoversten KP, Ruddy KJ. Exclusion of male patients in breast cancer clinical trials. JNCI Cancer Spectr. 2018;2(2):pky018.

Gucalp A, Traina TA, Eisner JR, Parker JS, Selitsky SR, Park BH, et al. Male breast cancer: a disease distinct from female breast cancer. Breast Cancer Res Treat. 2019;173(1):37–48.

Senger JL, Adams SJ, Kanthan R. Invasive lobular carcinoma of the male breast - a systematic review with an illustrative case study. Breast Cancer (Dove Med Press). 2017;9:337–45.

CAS   PubMed   PubMed Central   Google Scholar  

Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen-Stok E, Porter P, et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol. 2018;29(2):405–17.

CAS   PubMed   Google Scholar  

Atlas CG, N. Comprehensive molecular portraits of human breast tumours. Nature. 2012;490(7418):61–70.

Google Scholar  

Ghani S, Sochat M, Luo J, Tao Y, Ademuyiwa F. Characteristics of male triple negative breast cancer: a population-based study. Breast J. 2020;26(9):1748–55.

Esposito A, Ablah E, Okut H, Tenofsky PL. Characteristics, treatment and outcomes of HER2 positive male breast cancer. Am J Surg. 2023;225(3):489–93.

Male breast cancer incidence and mortality, United States—2013–2017 U.S. Cancer Statistics Data Briefs, No. 192020 [Available from: https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm .

Liu N, Johnson KJ, Ma CX. Male breast cancer: an updated surveillance, epidemiology, and end results data analysis. Clin Breast Cancer. 2018;18(5):e997–e1002.

Jamy O, Rafiq A, Laghari A, Chawla T. Male breast cancer: a 24 year experience of a tertiary care hospital in Pakistan. Asian Pac J Cancer Prev. 2015;16(4):1559–63.

Albasri A, Hussainy AS, Sundkji I, Alhujaily A. Histopathological features of breast cancer in Al-Madinah region of Saudi Arabia. Saudi Med J. 2014;35(12):1489–93.

Salehi A, Zeraati H, Mohammad K, Mahmoudi M, Talei AR, Ghaderi A, et al. Survival of male breast cancer in fars, South of iran. Iran Red Crescent Med J. 2011;13(2):99–105.

Calip GS, Kidd J, Bernhisel R, Cox HC, Saam J, Rauscher GH, et al. Family history of breast cancer in men with non-BRCA male breast cancer: implications for cancer risk counseling. Breast Cancer Res Treat. 2021;185(1):195–204.

Brinton LA, Richesson DA, Gierach GL, Lacey JV Jr, Park Y, Hollenbeck AR, et al. Prospective evaluation of risk factors for male breast cancer. J Natl Cancer Inst. 2008;100(20):1477–81.

Ewertz M, Holmberg L, Tretli S, Pedersen BV, Kristensen A. Risk factors for male breast cancer--a case-control study from Scandinavia. Acta Oncol. 2001;40(4):467–71.

Abdelwahab Yousef AJ. Male breast cancer: epidemiology and risk factors. Semin Oncol. 2017;44(4):267–72.

Basham VM, Lipscombe JM, Ward JM, Gayther SA, Ponder BA, Easton DF, et al. BRCA1 and BRCA2 mutations in a population-based study of male breast cancer. Breast Cancer Res. 2002;4(1):R2.

Friedman LS, Gayther SA, Kurosaki T, Gordon D, Noble B, Casey G, et al. Mutation analysis of BRCA1 and BRCA2 in a male breast cancer population. Am J Hum Genet. 1997;60(2):313–9.

Ottini L, Masala G, D'Amico C, Mancini B, Saieva C, Aceto G, et al. BRCA1 and BRCA2 mutation status and tumor characteristics in male breast cancer: a population-based study in Italy. Cancer Res. 2003;63(2):342–7.

Ding YC, Steele L, Kuan CJ, Greilac S, Neuhausen SL. Mutations in BRCA2 and PALB2 in male breast cancer cases from the United States. Breast Cancer Res Treat. 2011;126(3):771–8.

Antoniou A, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL, et al. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72(5):1117–30.

Chamseddine RS, Wang C, Yin K, Wang J, Singh P, Zhou J, et al. Penetrance of male breast cancer susceptibility genes: a systematic review. Breast Cancer Res Treat. 2022;191(1):31–8.

Kwiatkowska E, Teresiak M, Filas V, Karczewska A, Breborowicz D, Mackiewicz A. BRCA2 mutations and androgen receptor expression as independent predictors of outcome of male breast cancer patients. Clin Cancer Res. 2003;9(12):4452–9.

Thorlacius S, Sigurdsson S, Bjarnadottir H, Olafsdottir G, Jonasson JG, Tryggvadottir L, et al. Study of a single BRCA2 mutation with high carrier frequency in a small population. Am J Hum Genet. 1997;60(5):1079–84.

Rizzolo P, Zelli V, Silvestri V, Valentini V, Zanna I, Bianchi S, et al. Insight into genetic susceptibility to male breast cancer by multigene panel testing: results from a multicenter study in Italy. Int J Cancer. 2019;145(2):390–400.

Vietri MT, Caliendo G, D’Elia G, Resse M, Casamassimi A, Minucci PB, et al. BRCA and PALB2 mutations in a cohort of male breast cancer with one bilateral case. Eur J Med Genet. 2020;63(6):103883.

Szwiec M, Tomiczek-Szwiec J, Kluzniak W, Wokolorczyk D, Osowiecka K, Sibilski R, et al. Genetic predisposition to male breast cancer in Poland. BMC Cancer. 2021;21(1):975.

Fackenthal JD, Marsh DJ, Richardson AL, Cummings SA, Eng C, Robinson BG, et al. Male breast cancer in Cowden syndrome patients with germline PTEN mutations. J Med Genet. 2001;38(3):159–64.

Pritzlaff M, Summerour P, McFarland R, Li S, Reineke P, Dolinsky JS, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575–86.

Hultborn R, Hanson C, Kopf I, Verbiene I, Warnhammar E, Weimarck A. Prevalence of Klinefelter’s syndrome in male breast cancer patients. Anticancer Res. 1997;17(6D):4293–7.

Swerdlow AJ, Schoemaker MJ, Higgins CD, Wright AF, Jacobs PA, Group UKCC. Cancer incidence and mortality in men with Klinefelter syndrome: a cohort study. J Natl Cancer Inst. 2005;97(16):1204–10.

Brinton LA, Cook MB, McCormack V, Johnson KC, Olsson H, Casagrande JT, et al. Anthropometric and hormonal risk factors for male breast cancer: male breast cancer pooling project results. J Natl Cancer Inst. 2014;106(3):djt465.

Thomas DB, Jimenez LM, McTiernan A, Rosenblatt K, Stalsberg H, Stemhagen A, et al. Breast cancer in men: risk factors with hormonal implications. Am J Epidemiol. 1992;135(7):734–48.

de Blok CJM, Wiepjes CM, Nota NM, van Engelen K, Adank MA, Dreijerink KMA, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652.

Hartley RL, Stone JP, Temple-Oberle C. Breast cancer in transgender patients: a systematic review. Part 1: Male to female. Eur J Surg Oncol. 2018;44(10):1455–62.

Krause W. Male breast cancer--an andrological disease: risk factors and diagnosis. Andrologia. 2004;36(6):346–54.

Ron E, Ikeda T, Preston DL, Tokuoka S. Male breast cancer incidence among atomic bomb survivors. J Natl Cancer Inst. 2005;97(8):603–5.

Little MP, McElvenny DM. Male breast cancer incidence and mortality risk in the Japanese atomic bomb survivors - differences in excess relative and absolute risk from female breast cancer. Environ Health Perspect. 2017;125(2):223–9.

Thomas DB, Rosenblatt K, Jimenez LM, McTiernan A, Stalsberg H, Stemhagen A, et al. Ionizing radiation and breast cancer in men (United States). Cancer Causes Control. 1994;5(1):9–14.

Network NCC. Genetic/familial high-risk assessment: breast, ovarian, and pancreatic 2023 [Available from: https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf .

Robson M, Im SA, Senkus E, Xu B, Domchek SM, Masuda N, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med. 2017;377(6):523–33.

Ludwig KK, Neuner J, Butler A, Geurts JL, Kong AL. Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review. Am J Surg. 2016;212(4):660–9.

Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967–75.

Hartmann LC, Sellers TA, Schaid DJ, Frank TS, Soderberg CL, Sitta DL, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst. 2001;93(21):1633–7.

Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, van’t Veer L, Garber JE, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22(6):1055–62.

Meijers-Heijboer H, van Geel B, van Putten WL, Henzen-Logmans SC, Seynaeve C, Menke-Pluymers MB, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345(3):159–64.

Gaddam S, Heller SL, Babb JS, Gao Y. Male breast cancer risk assessment and screening recommendations in high-risk men who undergo genetic counseling and multigene panel testing. Clin Breast Cancer. 2021;21(1):e74–e9.

Marino MA, Gucalp A, Leithner D, Keating D, Avendano D, Bernard-Davila B, et al. Mammographic screening in male patients at high risk for breast cancer: is it worth it? Breast Cancer Res Treat. 2019;177(3):705–11.

Gao Y, Goldberg JE, Young TK, Babb JS, Moy L, Heller SL. Breast cancer screening in high-risk men: a 12-year longitudinal observational study of male breast imaging utilization and outcomes. Radiology. 2019;293(2):282–91.

Bedrick BS, Fruhauf TF, Martin SJ, Ferriss JS. Creating breast and gynecologic cancer guidelines for transgender patients with BRCA mutations. Obstet Gynecol. 2021;138(6):911–7.

Mano R, Tamir S, Kedar I, Benjaminov O, Baniel J, Tabachnik T, et al. Malignant abnormalities in male BRCA mutation carriers: results from a prospectively screened cohort. JAMA Oncol. 2018;4(6):872–4.

Feng Z, Yang X, Tian M, Zeng N, Bai Z, Deng W, et al. BRCA genes as candidates for colorectal cancer genetic testing panel: systematic review and meta-analysis. BMC Cancer. 2023;23(1):807.

•• Hassett MJ, Somerfield MR, Baker ER, Cardoso F, Kansal KJ, Kwait DC, et al. Management of male breast cancer: ASCO guideline. J Clin Oncol. 2020;38(16):1849–63. This reference is of major importance as it is an article based on ASCO recommended guidelines for management of male breast cancer put together by an expert panel based on consensus and remains internationally recognized.

Auvinen A, Curtis RE, Ron E. Risk of subsequent cancer following breast cancer in men. J Natl Cancer Inst. 2002;94(17):1330–2.

Woods RW, Salkowski LR, Elezaby M, Burnside ES, Strigel RM, Fowler AM. Image-based screening for men at high risk for breast cancer: benefits and drawbacks. Clin Imaging. 2020;60(1):84–9.

Shin K, Martaindale S, Whitman GJ. Male breast magnetic resonance imaging: when is it helpful? Our experience over the last decade. Curr Probl Diagn Radiol. 2019;48(3):196–203.

•• Yadav S, Karam D, Bin Riaz I, Xie H, Durani U, Duma N, et al. Male breast cancer in the United States: treatment patterns and prognostic factors in the 21st century. Cancer. 2020;126(1):26–36. This reference is of major importance given this is one of the largest available studies from the United States detailing the real-world treatment patterns of male breast cancer in the absence of male breast cancer specific clinical trials.

Cloyd JM, Hernandez-Boussard T, Wapnir IL. Outcomes of partial mastectomy in male breast cancer patients: analysis of SEER, 1983-2009. Ann Surg Oncol. 2013;20(5):1545–50.

Bateni SB, Davidson AJ, Arora M, Daly ME, Stewart SL, Bold RJ, et al. Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis. Ann Surg Oncol. 2019;26(7):2144–53.

Zaenger D, Rabatic BM, Dasher B, Mourad WF. Is breast conserving therapy a safe modality for early-stage male breast cancer? Clin Breast Cancer. 2016;16(2):101–4.

Elmi M, Sequeira S, Azin A, Elnahas A, McCready DR, Cil TD. Evolving surgical treatment decisions for male breast cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database. Breast Cancer Res Treat. 2018;171(2):427–34.

Golshan M, Rusby J, Dominguez F, Smith BL. Breast conservation for male breast carcinoma. Breast. 2007;16(6):653–6.

Fogh S, Kachnic LA, Goldberg SI, Taghian AG, Powell SN, Hirsch AE. Localized therapy for male breast cancer: functional advantages with comparable outcomes using breast conservation. Clin Breast Cancer. 2013;13(5):344–9.

Lin AP, Huang TW, Tam KW. Treatment of male breast cancer: meta-analysis of real-world evidence. Br J Surg. 2021;108(9):1034–42.

Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10.

Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918–26.

Chung SH, de Geus SWL, Shewmaker G, Romatoski KS, Drake FT, Ko NY, et al. Axillary lymph node dissection is associated with improved survival among men with invasive breast cancer and sentinel node metastasis. Ann Surg Oncol. 2023;30(9):5610–8.

Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, et al. Neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer: ASCO Guideline. J Clin Oncol. 2021;39(13):1485–505.

Leone JP, Hassett MJ, Leone J, Tolaney SM, Vallejo CT, Leone BA, et al. Efficacy of neoadjuvant chemotherapy in male breast cancer compared with female breast cancer. Cancer. 2022;128(21):3796–803.

Cao L, Hue JJ, Freyvogel M, Li P, Rock L, Simpson A, et al. Despite equivalent outcomes, men receive neoadjuvant chemotherapy less often than women for lymph node-positive breast cancer. Ann Surg Oncol. 2021;28(11):6001–11.

Massarweh SA, Sledge GW, Miller DP, McCullough D, Petkov VI, Shak S. Molecular characterization and mortality from breast cancer in men. J Clin Oncol. 2018;36(14):1396–404.

Altman AM, Kizy S, Yuan J, Denbo JW, Jensen EH, Hui JYC, et al. Distribution of 21-gene recurrence scores in male breast cancer in the United States. Ann Surg Oncol. 2018;25(8):2296–302.

Grenader T, Yerushalmi R, Tokar M, Fried G, Kaufman B, Peretz T, et al. The 21-gene recurrence score assay (Oncotype DX) in estrogen receptor-positive male breast cancer: experience in an Israeli cohort. Oncology. 2014;87(1):1–6.

Giordano SH, Perkins GH, Broglio K, Garcia SG, Middleton LP, Buzdar AU, et al. Adjuvant systemic therapy for male breast carcinoma. Cancer. 2005;104(11):2359–64.

Goss PE, Reid C, Pintilie M, Lim R, Miller N. Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955-1996. Cancer. 1999;85(3):629–39.

Eggemann H, Altmann U, Costa SD, Ignatov A. Survival benefit of tamoxifen and aromatase inhibitor in male and female breast cancer. J Cancer Res Clin Oncol. 2018;144(2):337–41.

Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805–16.

Eggemann H, Bernreiter AL, Reinisch M, Loibl S, Taran FA, Costa SD, et al. Tamoxifen treatment for male breast cancer and risk of thromboembolism: prospective cohort analysis. Br J Cancer. 2019;120(3):301–5.

Hayes FJ, Seminara SB, Decruz S, Boepple PA, Crowley WF Jr. Aromatase inhibition in the human male reveals a hypothalamic site of estrogen feedback. J Clin Endocrinol Metab. 2000;85(9):3027–35.

Mauras N, O'Brien KO, Klein KO, Hayes V. Estrogen suppression in males: metabolic effects. J Clin Endocrinol Metab. 2000;85(7):2370–7.

Eggemann H, Ignatov A, Smith BJ, Altmann U, von Minckwitz G, Rohl FW, et al. Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients. Breast Cancer Res Treat. 2013;137(2):465–70.

Pemmaraju N, Munsell MF, Hortobagyi GN, Giordano SH. Retrospective review of male breast cancer patients: analysis of tamoxifen-related side-effects. Ann Oncol. 2012;23(6):1471–4.

Johnston SRD, Toi M, O'Shaughnessy J, Rastogi P, Campone M, Neven P, et al. Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 2023;24(1):77–90.

Dennis J. Slamon DS, Denise A. Yardley, Chiun-Sheng Huang, Peter A. Fasching, John Crown, Aditya Bardia, Stephen Chia, Seock-Ah Im, Miguel Martin, Sherene Loi, Binghe Xu, Sara A. Hurvitz, Carlos Barrios, Michael Untch, Rebecca L. Moroose, Fran Visco, Rodrigo Fresco, Tetiana Taran, and Gabriel N. Hortobagyi. Ribociclib and endocrine therapy as adjuvant treatment in patients with HR+/HER2- early breast cancer: primary results from the phase III NATALEE trial. J Clin Oncol. 2023;41;17_suppl_LBA500.

Tutt ANJ, Garber JE, Kaufman B, Viale G, Fumagalli D, Rastogi P, et al. Adjuvant olaparib for patients with BRCA1- or BRCA2-mutated breast cancer. N Engl J Med. 2021;384(25):2394–405.

Network NCC. Breast Cancer 2023 [Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf .

Early Breast Cancer Trialists’ Collaborative G. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015;386(10001):1353–61.

Jardel P, Vignot S, Cutuli B, Creisson A, Vass S, Barranger E, et al. Should adjuvant radiation therapy be systematically proposed for male breast cancer? A systematic review. Anticancer Res. 2018;38(1):23–31.

Di Lauro L, Vici P, Del Medico P, Laudadio L, Tomao S, Giannarelli D, et al. Letrozole combined with gonadotropin-releasing hormone analog for metastatic male breast cancer. Breast Cancer Res Treat. 2013;141(1):119–23.

Maugeri-Sacca M, Barba M, Vici P, Pizzuti L, Sergi D, De Maria R, et al. Aromatase inhibitors for metastatic male breast cancer: molecular, endocrine, and clinical considerations. Breast Cancer Res Treat. 2014;147(2):227–35.

Zagouri F, Sergentanis TN, Azim HA Jr, Chrysikos D, Dimopoulos MA, Psaltopoulou T. Aromatase inhibitors in male breast cancer: a pooled analysis. Breast Cancer Res Treat. 2015;151(1):141–7.

Ring A, Karuturi M, Smyth EN, Lokhandwala T, Sheffield KM, Willey J, et al. Characteristics and outcomes in cases of US male patients with metastatic breast cancer receiving abemaciclib in routine clinical practice. Adv Ther. 2023;40(5):2515–23.

• Campone M, De Laurentiis M, Zamagni C, Kudryavcev I, Agterof M, Brown-Glaberman U, et al. Ribociclib plus letrozole in male patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: subgroup analysis of the phase IIIb CompLEEment-1 trial. Breast Cancer Res Treat. 2022;193(1):95–103. This is of importance given this is one of the few male breast cancer specific clinical trials.

Kraus AL, Yu-Kite M, Mardekian J, Cotter MJ, Kim S, Decembrino J, et al. Real-world data of palbociclib in combination with endocrine therapy for the treatment of metastatic breast cancer in men. Clin Pharmacol Ther. 2022;111(1):302–9.

Siddhartha Yadav KVG. Jose Pablo Leone, Roberto A Leon-Ferre & Kathryn J Ruddy A practical guide to endocrine therapy in the management of estrogen receptor-positive male breast cancer. Future Medicine. 2021;10:3.

Zagouri F, Sergentanis TN, Chrysikos D, Dimopoulos MA, Psaltopoulou T. Fulvestrant and male breast cancer: a pooled analysis. Breast Cancer Res Treat. 2015;149(1):269–75.

Modi S, Jacot W, Yamashita T, Sohn J, Vidal M, Tokunaga E, et al. Trastuzumab deruxtecan in previously treated HER2-low advanced breast cancer. N Engl J Med. 2022;387(1):9–20.

Rugo HS, Bardia A, Marme F, Cortes J, Schmid P, Loirat D, et al. Overall survival with sacituzumab govitecan in hormone receptor-positive and human epidermal growth factor receptor 2-negative metastatic breast cancer (TROPiCS-02): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2023;402(10411):1423–33.

Bardia A, Hurvitz SA, Tolaney SM, Loirat D, Punie K, Oliveira M, et al. Sacituzumab govitecan in metastatic triple-negative breast cancer. N Engl J Med. 2021;384(16):1529–41.

Valentini V, Silvestri V, Bucalo A, Conti G, Karimi M, Di Francesco L, et al. Molecular profiling of male breast cancer by multigene panel testing: implications for precision oncology. Front Oncol. 2022;12:1092201.

Corrigan KL, Mainwaring W, Miller AB, Lin TA, Jethanandani A, Espinoza AF, et al. Exclusion of men from randomized phase III breast cancer clinical trials. Oncologist. 2020;25(6):e990–e2.

Treweek S, Pitkethly M, Cook J, Fraser C, Mitchell E, Sullivan F, et al. Strategies to improve recruitment to randomised trials. Cochrane Database Syst Rev. 2018;2(2):MR000013.

Shah NM, Scott DM, Kandagatla P, Moravek MB, Cobain EF, Burness ML, et al. Young women with breast cancer: fertility preservation options and management of pregnancy-associated breast cancer. Ann Surg Oncol. 2019;26(5):1214–24.

Hampe ME, Rhoton-Vlasak AS. Fertility preservation in breast cancer with case-based examples for guidance. J Assist Reprod Genet. 2020;37(3):717–29.

Osterberg EC, Ramasamy R, Masson P, Brannigan RE. Current practices in fertility preservation in male cancer patients. Urol Ann. 2014;6(1):13–7.

Thom B, Benedict C, Friedman DN, Kelvin JF. The intersection of financial toxicity and family building in young adult cancer survivors. Cancer. 2018;124(16):3284–9.

Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, et al. Medical egg freezing: how cost and lack of insurance cover impact women and their families. Reprod Biomed Soc Online. 2018;5:82–92.

Anelli TF, Anelli A, Tran KN, Lebwohl DE, Borgen PI. Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer. 1994;74(1):74–7.

Visram H, Kanji F, Dent SF. Endocrine therapy for male breast cancer: rates of toxicity and adherence. Curr Oncol. 2010;17(5):17–21.

Yadav S, Giridhar KV, Taraba J, Leon-Ferre R, Ruddy KJ. Safety, efficacy, and tolerability of systemic therapies in male breast cancer: are there sex-specific differences? Expert Opin Drug Saf. 2020;19(8):923–6.

Smith TJ, Loprinzi CL, Deville C. Oxybutynin for hot flashes due to androgen deprivation in men. N Engl J Med. 2018;378(18):1745–6.

• Younas A, Sundus A, Inayat S. Transitional experience of men with breast cancer from diagnosis to survivorship: an integrative review. Eur J Oncol Nurs. 2019;42:141–52. This is one of few studies that explores survivorship care of male breast cancer. Survivorship care remains an area that is understudied in men with breast cancer.

Barbor M. Preserving sexuality and restoring sexual function in male and female cancer survivor The ASCO Post. 2019 [Available from: https://ascopost.com/issues/august-10-2019/preserving-sexuality-and-restoring-sexual-function-in-male-and-female-cancer-survivors/ .

Vizza R, Capomolla EM, Tosetto L, Corrado G, Bruno V, Chiofalo B, et al. Sexual dysfunctions in breast cancer patients: evidence in context. Sex Med Rev. 2023;11(3):179–95.

Hass HG, Herzberger A, Wockel A, Stepien J. Male breast cancer: therapy-induced toxicities, psychological distress, and individual patient goals during oncological inpatient rehabilitation. Oncol Res Treat. 2022;45(12):736–43.

Andrykowski MA. Physical and mental health status and health behaviors in male breast cancer survivors: a national, population-based, case-control study. Psychooncology. 2012;21(9):927–34.

Potter AM, Bentz B, Crue L, Leiby S, Bashi S, Maguire K, et al. Men’s lived experiences of breast cancer and changes in occupation. Occup Ther Int. 2023;2023:9641922.

Dalton K, Waterman M, Wassersug R, Garland SN. Fear of cancer recurrence in males diagnosed with breast cancer. Support Care Cancer. 2021;29(11):6183–6.

Nguyen TS, Bauer M, Maass N, Kaduszkiewicz H. Living with male breast cancer: a qualitative study of men’s experiences and care needs. Breast Care (Basel). 2020;15(1):6–12.

Download references

Author information

Authors and affiliations.

Division of Hematology-Oncology, University of Massachusetts Chan School of Medicine, Baystate, MA, USA

Prarthna V Bhardwaj

Division of Medical Oncology, Atlantic Health System, Morristown Medical Center, Morristown, NJ, USA

Shilpi Gupta

Valley Health System, Paramus, NJ, USA

Alexa Elyash & Eleonora Teplinsky

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Eleonora Teplinsky .

Ethics declarations

Conflict of interest.

Prarthna V. Bhardwaj has received honoraria and stock options with Doximity. Alexa Elyash, Shilpi Gupta, and Eleonora Teplinsky; Consulting/Honoraria from Pfizer, Novartis, Astra Zeneca, and Daiichi-Sankyo. 

Human and Animal Rights and Informed Consent

This article contains no studies with human or animal subjects performed by authors.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Bhardwaj, P.V., Gupta, S., Elyash, A. et al. Male Breast Cancer: a Review on Diagnosis, Treatment, and Survivorship. Curr Oncol Rep 26 , 34–45 (2024). https://doi.org/10.1007/s11912-023-01489-z

Download citation

Accepted : 11 December 2023

Published : 02 January 2024

Issue Date : January 2024

DOI : https://doi.org/10.1007/s11912-023-01489-z

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Male breast cancer
• Hereditary breast cancer
• Breast neoplasm
• Male breast cancer genetics
• Male breast cancer treatment
• Find a journal
• Publish with us
• Track your research

• Open access
• Published: 06 February 2024

Experiences and perceptions of men following breast cancer diagnosis: a mixed method systematic review

• Mary Abboah-Offei 1 ,
• Jonathan Bayuo 2 ,
• Yakubu Salifu 3 ,
• Oladayo Afolabi 4 &
• Theophilus N. Akudjedu 5  

BMC Cancer volume  24 , Article number:  179 ( 2024 ) Cite this article

1539 Accesses

6 Altmetric

Metrics details

Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts.

All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines.

Of the studies screened ( n  = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1—Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3—Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures.

Conclusions

Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials.

Trial registration

PROSPERO Registration No. CRD42021228778.

Peer Review reports

Male breast cancer (MBC) is a rare condition, accounting for less than 1% of all breast cancers. About 2,710 men are estimated to be diagnosed with breast cancer, with approximately 530 men projected to die from breast cancer in 2022 and have about 1 in 833 lifetime risk of being diagnosed with the disease in the United States [ 1 ]. Data from the Global Burden of Disease 2017 database indicate that the incidence of MBC increased from 8.5 thousand in 1990 to 23.1 thousand in 2017 with 123 countries showing a significant increasing trend in MBC incidence rates [ 2 ]. There are variations in the incidence of MBC among countries for instance, in Thailand MBC incidence was lower than that in Israel, and the rate of variability has been attributed to population-specific factors [ 3 ]. Additionally, disparities have been noted in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions in specific population groups [ 4 ]. Some of these disparities have been noted in the United States, where black men are reported to have higher incidence and mortality rates compared to white men in the context of all cancer [ 4 , 5 , 6 ].

Evidence suggests that MBC is mostly diagnosed late (49%) when the disease is more advanced compared to women (33%) leading to relatively worse prognosis [ 7 , 8 , 9 , 10 , 11 ]. This has been attributed to delayed presentation, lack of screening, reduced awareness by treating providers and a lack of awareness of the disease among men [ 12 , 13 , 14 , 15 ]. Consequently, MBCs are mainly diagnosed with more severe clinical manifestations with relatively complex tumour characteristics (i.e., larger sizes and extensive lymph node involvement) [ 16 ], associated with higher proportions of positive hormone receptors, which mostly results in prolonged treatment delay, and metastasis of the disease at diagnosis compared to female breast cancer [ 17 ]. This has been influenced by issues with lower socioeconomic status, barriers to accessing healthcare and insurance cover issues in the context of the United States, adherence to treatment, post-treatment follow-up, and stigma [ 7 , 18 , 19 , 20 ]. MBC patients suffer from a triple stigma including stigma by healthcare professionals, society, and especially by themselves as they struggle to accept the disease which has been labelled as a woman's disease [ 20 ].

Treatment for MBC has mainly been informed by available evidence for female breast cancer [ 21 ], and no randomised data exists for optimal management strategies for men including surgery, systemic therapy, and radiation [ 22 ]. Some guidelines have been published for the management of MBC [ 23 , 24 , 25 ]; however, these guidelines are rarely based on clinical trials leading to a paucity of literature on the evaluation of outcomes for MBC. According to Corrigan et al. [ 26 ], of the 131 breast cancer clinical trials conducted, there was only 0.087% of male patients represented among study participants.

Moreover, MBC being widely described as a 'woman’s disease' has psychosocially impacted the experience of men in terms of their body image and appearance as well as masculinity [ 27 , 28 ]. A critical psychosocial problem for MBC patients is concerns with body image [ 29 ], because both the disease and its treatment can lead to significant alterations to their looks and how the body functions [ 30 ]. With masculinity often associated with chest rather than breast [ 31 , 32 , 33 ], being linked to a “woman’s disease” attributed to the body part that men do not relate to is probably threatening their masculinity [ 34 ]. Men with breast cancer also face unique physical and emotional challenges however, there is inconclusive understanding of men’s experiences of the psychosocial implications of MBC as well as the supportive care needs [ 35 , 36 ]. Therefore, in this review, we explored the experiences of MBC patients and the management approaches across different demographic contexts.

Review question

What are the experiences and perceptions of MBC patients following diagnosis?

We conducted a mixed method systematic review with an interpretive and inductive stance [ 37 ] and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [ 38 ].

Search strategy

We identified relevant studies through a search in six electronic databases: Global Health, CINAHL, Medline, PsycINFO, Embase, and Web of Science. Furthermore, we searched reference lists of included studies for additional studies. The search duration in these databases covered January 2000 to December 2023, and was updated in September 2023.

A combination of the following keywords was used for search strategy i) ‘Men’ OR ‘Male’ OR ‘Father’ OR ‘Husband’ AND ii) ‘Breast cancer’ OR ‘Breast carcinoma′ OR ‘Breast neoplasm’ OR ‘Breast tumour’ AND iii) ‘Experiences’ OR ‘Perceptions’ OR ‘Perspectives’ OR ‘Opinions’ AND iv) ‘Treatment’ OR ‘Approaches’ OR ‘Outcomes’. Multiple variations of the keywords were used including the truncations based on database requirements to broaden to capture all relevant studies.

Inclusion and exclusion criteria

This review included all primary studies of any design (qualitative, quantitative, or mixed methods) that report on MBC (included only men assigned male gender at birth); studies focussing on the experiences, perceptions, and treatment approaches for MBC; as well as studies conducted and reported in English (based on the resources available to the researchers). However, letters, editorials, commentaries, perspectives, case reports, opinion pieces, news reports and systematic reviews on MBC; studies reporting on cancers in men other than MBC; those that did not report on MBC experiences; as well as those reported in languages other than English were excluded.

Data extraction, quality assessment, synthesis and analysis

Search results were imported into Endnote reference manager (version 20) by the first reviewer (MA-O), duplicates removed and titles as well as abstracts were screened. The remaining studies were screened against the inclusion/ exclusion criteria, by three reviewers (MA-O, JB, OA), and any study for which inclusion was unclear was discussed and resolved by YS and TNA. Full texts studies were obtained if abstracts did not have enough information to determine the relevance of an article. Study variables such as authors, countries where studies were conducted, aims/objectives, study design, sample size and characteristics, experiences of MBC with verbatim quotes, MBC treatment approaches with outcomes and conclusions drawn were extracted to a common table (see Table  1 ).

We used a results-based convergent design [ 75 ] to guide data analysis, where we initially synthesised qualitative and quantitative findings separately, before integrating these findings from the two designs in the final analysis and synthesis (see Fig.  1 ). This allowed us to synthesise quantitative findings regarding treatment approaches of MBC and qualitative or mixed methods results on the experiences of MBC patients.

A flow diagram on the results-based convergent design

Descriptive statistics was used in reporting the number of published studies and presented in a PRISMA flow diagram in Fig.  2 . We synthesised the descriptions of MBC experiences and treatment approaches reported across studies. All studies were analysed descriptively. To synthesise the data regarding the experiences of men with breast cancer, verbatim quotes reported in the qualitative studies were extracted by two authors (JB & TNA). An interpretive and inductive stance was employed [ 37 ] by reviewing verbatim quotes to generate codes (see Table  2 ). Similar codes were aggregated to generate sub-themes followed by formulation of higher order themes. For the quantitative data regarding the treatment modalities, we focused on describing the main reported treatment modalities rather than their frequencies. At the end of the analysis, both the qualitative findings and descriptions from the quantitative studies converged as one dataset. The themes generated from the initial process and the descriptions obtained from the quantitative studies formed the basis of undertaking a narrative synthesis.

PRIMA flow chart of study search and selection process

The quality of included studies was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) tool [ 76 ], which is designed for use in mixed methods reviews and quality reporting in reviews that included qualitative, quantitative, mixed- and multi-methods research to ensure consistent and critical appraisal of relevant studies. In assessing study quality, studies were categorised as high quality if they achieved an aggregate score in excess of 70%, moderate quality were assigned to studies scoring between 50 and 70%, and those scoring less than 50% were assigned low quality (see Table  1 ). However, no study was excluded based on respective aggregate quality scores.

Study characteristics

Of the n  = 610 full-text articles assessed for eligibility. N  = 374 were excluded as these were letters, editorials, commentaries, perspectives, case reports, opinion pieces and news reports on MBC; including n  = 130 studies that did not report on MBC experiences and perceptions; and n  = 62 that were MBC related reviews (see Fig.  2 ). Following extensive search and screening, 44 studies were retained in the final synthesis and analysis, with publication years ranging from January 2000 to September 2023. Twenty-nine studies employed varied quantitative designs, 8 studies employed qualitative designs, and 6 studies employed mixed-method designs. Although most of the studies (n = 44) included only MBC, two retrospective studies compared males and females with breast cancer, and only the data reported on males were included in this review [ 58 , 68 ]. Study characteristics including quality assessment grading are reported in Table  1 .

Experiences and perceptions of males with breast cancer

As shown in Table  2 , three themes and nine sub themes emerged from the data which encapsulate the experiences of males with breast cancer.

Theme 1: Navigating through a threat to masculinity and one’s existence

This theme describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with the disease, and disclosure. The subthemes are 1) emergence and awareness of a foreign illness and threat to one’s existence 2) coming to terms with a gendered disease and 3) opening up/ coming out of the illness closet. All included nine qualitative studies highlighted how the affected men perceived breast cancer as a threat to their sense of masculinity.

Emergence and awareness of a foreign illness and threat to one’s existence

Males generally perceived breast cancer as a feminine illness which cannot affect their bodies [ 31 , 34 ]. In fact, although all the men in the included studies had heard about breast cancer, most of them had not previously heard about breast cancer in males which made them rule out any possibility of ever living with it and may have contributed to delay in seeking healthcare [ 31 , 49 ]. This perception and the emerging non-specific symptoms often delayed early health seeking as the symptoms were interpreted as irrelevant or not requiring urgent attention [ 49 ]. It is worth highlighting that most of the affected men presented with palpable lump in the breast or discharge from the nipple of the affected breast. Some men had to be ‘pushed’ by their wives or partners to seek medical attention to rule out the possibility of breast cancer; a condition they felt was out of their scope [ 49 , 71 ]. A breast cancer diagnosis was met with varied emotions including being dumbfounded, shocked, surprised, debilitating stress, and a feeling of housing a feminised illness in a masculine body which threatened their sense of masculinity and personhood [ 13 , 31 , 34 , 49 ].

“…there is no reason why I shouldn’t have cancer, I’m only the same as anyone else. I’m just a bit disappointed really about where it got me. it’s not right on a man, is it? [ 31 ] (p.467). “From others at work, I always (hear) ‘admit it, you’re just trying to find excuses. You’re not a real man, or you wouldn’t have such an illness’. [ 34 ] (p.8). ‘I suppose the fact that it was breast cancer surprised me. The fact that it was cancer I suppose was a shock . . . So, I suppose a combination of both. You know the fact that it was breast cancer which I do not think I had heard of and the fact that it was cancer’’ [ 13 ] (p.336).

Receiving the diagnosis was challenging which some men kept to themselves or only informed family/ close friends [ 71 ]. The notion of breast cancer being a feminine illness made men view the disease as foreign or exotic to their bodies [ 49 ]. The growing awareness of the disease made the men feel a sense of oddity and shame for having a feminine illness alongside a feeling of losing one’s manhood to an illness not considered masculine [ 31 , 49 ]. Worry, anxiety, and uncertainty also marked their increasing awareness of the disease particularly regarding how the disease could distort the shape of their ‘masculine chest’ [ 13 ]. Despite the varied emotions, some males felt extremely lucky that the cancer was located at a site not considered ‘vital’ in terms of masculinity [ 67 ].

My biggest problem was how to tell my wife that I have a woman’s disease? Because I thought maybe you’re not a real man, perhaps half woman?” [ 34 ] (p.8). “Now when I first knew that I had it, I thought to myself …well how did Dickens get breast cancer? I’m not a woman. I’m a man. I was surprised more than anything… Women, it's an ever-present threat … Men – never occur to them. ‘‘When I first knew I did not want everyone knowing, because I did not want everyone coming round sympathising’’ . [ 13 ] (p.336).

Further to the above, the diagnosis of breast cancer forced the affected men to come face to face with their own mortality. This is because they felt a diagnosis of breast cancer threatened their existence and equated to a death sentence. The realisation of death lurking close by pushed the affected men to increase their efforts in attaining their dream before they died. This experience helped them to be more appreciative of their present lives, increased their consciousness about their health, and helped them to redefine their values and beliefs [ 60 ]:

“I appreciate life a lot more. Before my cancer, I didn’t take life seriously. I took life for granted. I didn’t appreciate the people in my life and the things I see. So, after the cancer, it was a good kick in the butt. Just how much you appreciate it, and also made me realise to go after my dreams, chase it, and achieve it. Go after it and every day is a gift” [ 60 ] (p.3).

Coming to terms with a gendered disease

Through the journey of receiving a breast cancer diagnosis and living with the illness, the affected men expressed the insights and perceptions they gained regarding living with an uncommon illness that is believed to affect mostly women [ 60 ]. Following the breast cancer diagnosis, males were faced with the reality of living with a condition they did not expect to have. Coming to terms with a feminised disease was gradual and a lonely journey for the affected men. In fact, some wished they could give their condition another name instead of breast cancer. The fear of being stigmatised made some men keep their diagnosis to themselves [ 13 , 32 ]. Others also felt a sense of awkwardness discussing such sensitive issues and would avoid [ 13 ]. Taken together, men with breast cancer often concealed or attempted to re-label their diagnosis to manage their sense of stigma, shame, and oddity as they navigated through coming to terms with living with a “feminine disease” in their masculine bodies [ 13 , 32 , 66 ]:

‘‘I told the guys I played golf with that I’d got cancer; I do not think so. I necessarily told them it was breast cancer’’. [ 13 ] (p.337) “…but if I did, I would talk about it as chest cancer. I wouldn’t use breast cancer. So that would be the term I would use, and, in the conversation, I would say that it is the same as breast cancer. It’s exactly the same thing; it’s just in my chest.” [ 66 ] (p. 964). “I think among old men they almost consider it to be a stigma, they almost don’t want to tell people, you know, it’s some kind of, I don’t know, a black mark, but I never looked at it that way…I think people younger would just view it a little differently, you know it’s cancer, it’s something they have to deal with, it doesn’t really matter what type of cancer it is.” [ 67 ] (p.37)

Opening up/ coming out of the illness closet

As the men gradually came to terms with living with the “foreign or exotic disease”, they were able to talk to their families and close friends about their diagnosis [ 13 ]. This required a lot of courage to navigate through such a sensitive issue. Interestingly, the men noted that the process of openly discussing their diagnosis in social spheres and coming out to others offered them an opportunity to reassert the meaning of masculinity, particularly as they recognize how fragile their masculine bodies are [ 31 ]:

“When I spoke to people about it, they thought I was telling fairy tales … that was really the worst thing about it.” [ 34 ] (p.8). “I want to prove to everybody that MBC is not a women’s disease and that a normal man can have MBC.” [ 31 ] (p.468).

In two studies, however, the authors described the phenomenon of selective disclosure in which the men only disclosed their illness to selected persons only [ 20 , 60 ]. For some men, the selective disclosure also meant revealing just the diagnosis, but not going further to reveal how they are experiencing the treatment process or the aftermath of the illness:

“The children know and our closest friends know, the very closest. Why? Because I disappeared for a while. I don’t talk about it within the family, not at all. Nobody talks with me about it, but they know. It is only information, and that’s it, not about the experience and not about the surgery, and not about the treatment” [ 20 ] (p.5).

Theme 2: Navigating through treatment

The theme captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. The subthemes are 1) therapeutic interventions 2) navigating through feminised treatment pathways and 3) living with the effects of care/ ongoing treatment. All included qualitative, quantitative, and mixed method studies ( n  = 44) highlighted the treatment experiences and pathways respectively.

Therapeutic interventions

Several therapeutic interventions/ treatments were reported across the included studies. Five categories of treatments were ascertained across the included studies, and these are surgery, radiotherapy, chemotherapy, hormonal therapy, and palliative care. Surgical interventions included mastectomy with axillary dissection, mastectomy with sentinel node biopsy (both for men with late-stage breast cancer presentation), and lumpectomy [ 7 , 40 , 45 , 46 , 47 , 48 ]. Cronin et al., [ 46 ] noted that surgery and chemotherapy receipt were more likely among men up to age 65. In some studies, surgical interventions were the main forms of treatment with radiotherapy, chemotherapy, and hormone therapy playing adjuvant roles. For instance, in one study that included 37 men with breast cancer, radiotherapy (89.2%), hormonal therapy (56.7%), and chemotherapy (91.8%) were adjuvant therapies after surgery [ 48 ]. In one study, the authors reported several therapeutic regimens offered to men with breast cancer which included breast conserving surgeries, unilateral/ bilateral mastectomy, often with no reconstruction [ 44 ]. One third of the male breast cancer patients in the same study ( n  = 21) felt somewhat or very uncomfortable with their appearance after the surgery. Receipt of treatment was remarkably similar between blacks and whites in both age groups. Older black and white men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively). Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR, 1.76; 95% CI, 1.11 to 2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR, 1.37; 95% CI, 0.83 to 2.24). In those age 65 years, the excess risk of death in blacks versus whites was nonsignificant and not affected by adjustment for covariates.

Navigating through feminised treatment pathways

Despite the reality of breast cancer among males, the care pathways and healthcare payment frameworks across various healthcare systems are significantly tailored to the needs of females which reinforces the notion of the disease as a feminine in nature [ 31 , 71 ]. A study from Germany highlighted the difficulty that these men experience in finding a physician as the practitioners felt their breast care specialty targeted women and would lose on reimbursement [ 34 ]. Even in facilities where they were given satisfactory care, the men felt the services and procedures still failed to consider their unique needs as men with breast cancer [ 31 , 42 , 71 ]. Some men were mistakenly addressed as females on the assumption that only females experienced breast cancer [ 34 ]. Male-specific psychosocial support and information were generally lacking across the studies. Information leaflets mostly contained pictures of female breast cancer patients which made the men feel excluded [ 34 ]. In fact, they felt the service was not designed for them:

“My GP said: ‘I don’t know what to do any more, it’s not my specialty area. I’ll have to refer you to someone else’. And the other doctor said, ‘This is a women’s practice (…) and we can’t get reimbursed for men, we don’t want men here.’” [ 34 ] (p.9). ‘‘. . . but I think as a male the information that I was given was female orientated and it could have been better presented for me and . . .I know that every case is different, but it was lacking in that respect’’. [ 13 ] (p.336).

Further to the above, some men had several challenges in scheduling for therapeutic regimen such as mammography [ 67 ]. Interactions with healthcare providers were often considered awkward as the providers often did not know what to say to the men with breast cancer. Subsequently, most men with breast cancer undergoing treatment often felt like outsiders, out of place, marginalised, and alone:

‘No information. Nothing at all. It was like men; you are on your own. I daresay women aren’t left like that . . .On leaving after the first operation the nurse gave me a leaflet, a piece of paper with women on it doing exercises you have to do and that was it’’. [ 13 ] (p.336). “I find that dealing with the mammograms and the technical staff to kind of tiptoe around you and put you in certain places because they don’t expect a male to be there, right, so they got women walking around in their gowns, so they don’t want you in those areas… they kind of shunt you into an isolated, a more isolated area so you’re not seeing the women walking by.” [ 66 ] (p.967).

Living with the effects of care/ ongoing treatment

Men undergoing treatment for breast cancer felt their lives, roles, and occupations were impacted adversely by the treatment regimen [ 60 ]. The clinical management process of the disease, in fact, further heightened the gendered essence of the disease. For men who underwent surgical intervention, the mastectomy scar served as a permanent reminder of the disease impacted on their masculinity [ 66 ]. Others felt their chest had deformed due to the scar [ 71 ]. The typical exposure of the male chest at leisure activities such as the beach was considered a no-go area to conceal the scar from public view. The scars also evoked a sense of perceived stigma among these men [ 32 ]:

“I’ve been abroad and sunbathed. People do look, they do look” [ 71 ] (p.1835). “I don’t feel like a complete person either because I’ve got something missing, haven’t I? ... My nipples are not there anymore. Sometimes I look in the mirror . . . I don’t like doing that. It’s gone. . . There’s a scar across there. . .Doctor said I look like a patchwork quilt. So, I don’t bother taking my shirt off now. And something else … yes you ought to have a tattoo as a nipple’’. [ 13 ] (p.337).

For men who underwent hormone therapy, it was observed that the side effects of the various medications threatened their notion of being a male. Experiencing erectile dysfunction and loss of libido were really challenging for these men as they felt they had lost their sense of masculinity or what made them men [ 34 , 77 ]. Hair loss from chemotherapy was also challenging and frustrating for them [ 43 ]. These men felt as though they had been transformed to ‘menopausal women’ [ 34 ].

“We’re candid and honest with one another … male sexual potency has gone.” [ 34 ] (p.9). “This has killed my sex life; I can no longer get an erection. I’m on this Tamoxifen which I’ve got to take for 5 years. You know it’s driving me mad. I get free Viagra but there is nothing there. There are no feelings or anything like that and it’s terrible. I couldn’t get an erection or nothing. I don’t know what it was, I just felt so no, no (silence) I just felt so embarrassed.” [ 31 ] (p.467).

Further to the above, some men felt they were a burden to others as they had to rely on others to have their needs met. Younger males felt their traditional roles as providers of the family was threatened as their dependence increased with a slow return to work and had to be supported by their spouses [ 54 ]:

“You start to receive only sickness benefits and when all of a sudden, you have over 500 euro less, you have to first see how you manage with that. And for me [...] it was even more because I only have a 60% part-time job and work as a freelancer on the side. And that I couldn't do any longer either.” [ 54 ] (p.6).

Theme 3: Coping and support systems

The theme describes how men with breast cancer coped with the disease, treatment process, aftercare/ rehabilitative care, and the available support and it was reported across qualitative ( n  = 9), quantitative ( n  = 5) and mixed methods ( n  = 4) studies. The subthemes are 1) active coping strategies 2) family support and 3) support from healthcare providers and other support groups.

Active coping strategies

Although the breast cancer diagnosis was considered threatening with intense emotional stress, some affected men remained optimistic and hopeful of improved outcomes. Affected men often worked towards accepting the disease which made the navigation process less challenging [ 47 ]. The treatment process and aftercare phase offered the affected men an opportunity to amend or reformulate their notion of masculinity [ 66 ]. Although dealing with the disease was difficult, the men reportedly gained new insights in life which helped to reshape their worldviews and life priorities [ 14 ]. In addition, previous experience with breast cancer in the family was associated with use of non-repressing coping styles (X 2 [1, N  = 26] r  = 5.60, p  < 0.05). There was also a higher use of mature defence patterns (superior healthy neurotic functioning) in patients who use non-repressive coping [ 70 ]. Despite the identified active coping mechanisms, one study reported that majority (70%) of men with breast cancer used immature and neurotic defensive functioning and 53.8% used a repressive approach to bottle up their emotions and concerns and [ 70 ]:

“I was kind of self-conscious the first year or so but um, I’m in pretty good shape, I’m relatively muscular, not super muscular, but I’m toned, I’m in shape, and I think a lot of times unless I’m really up close to people, I think a lot of times they don’t even see it… I’m not self-conscious. I go on vacation or go swimming at the beach, I don’t feel like people are staring at me.” [ 67 ] (p.38) “Breast cancer, for me, means a whole complex of experiences, of realisations. It’s like being in the military, you know. You meet somebody who’s been in the military, you don’t have to say anything. But if you meet someone who hasn’t, there’s not a way in the world to describe what it’s like.” [ 67 ] (p.38)

Family support

Studies found that majority of patients (61.3–80%) disclosed and discussed their diagnosis with their spouses and close families while 4–21% refused to disclose or discuss with anyone [ 7 , 13 , 61 ]. This might be because less stigmatization was reported from close families and friends compared to broader social settings [ 32 ]. Such disclosure might also be protective as availability of marital support was found to influence treatment choice and outcomes. Men who were not currently married received chemotherapy significantly less often [ 52 ] and had significantly higher (in some cases up to 21%) mortality than married ones [ 52 , 53 ].

This was corroborated by included qualitative studies which reported on the family support that men affected with breast cancer received. Spousal support was identified as a significant resource to seeking healthcare in the first instances as some wives had to push their partners to seek medical care [ 31 , 57 ]. Spousal and family support also helped men to navigate through the breast cancer diagnosis, coming to terms with the disease [ 49 , 57 ]. Family support was also an essential resource during the treatment and aftercare phase as family members offered emotional and practical support [ 47 ]:

“My wife was my support – she and I talked about everything. At the beginning we talked about it and agreed that I would have her as my support and she would have her family to support her through. It worked well and I also got support from her family . . . mine were useless’’. [ 13 ] (p. 338).

Support from healthcare providers and other support groups

Studies reported the dimensions, contents and timing of information needs demonstrated by the patients. Men with breast cancer acknowledged the support received from healthcare providers regarding diagnosis, information, treatment options, and aftercare support [ 49 , 57 ] with the most common source of information being verbal (92%), leaflets or booklets (53–71%) and internet (20%) [ 61 ]. Yet, 36–65% of participants felt their needs were not always met and wanted more information on various contents (particularly sexuality related information) at different times in their treatment (early/acute effects, late effects and ongoing quality of life) and in a more male specific manner [ 42 ].

Men with Breast cancer faced challenges in accessing needed support from healthcare facilities. Included studies reported experience of embarrassment and stigmatization within healthcare facilities where male breast cancer patients were meant to get support. 51.6% of patients experienced "extreme" or "very" severe embarrassment while waiting in the clinic among other female patients [ 13 ]. The experience of stigmatization was found to be higher within the cancer care system than other social surroundings with significantly higher stigmatization incidences reported in rehabilitation settings (mean = 1.50) and during hospitalisations (mean = 1.20) [ 53 ].

A mixed finding was observed regarding usage of peer supports. For one-to-one peer support, Iredale et al. (2006) reported low utilisation of formal support services with only 19% of participants speaking to other men who had breast cancer and only 1 in 4 indicating they would have liked that opportunity after their diagnosis. However, Midding et al. [ 53 ] found that more men (63.2%) had a one-on-one peer support from a female Breast Cancer Patient compared to 24.2% from another male breast cancer patient. This is consistent with the qualitative data which showed some men appreciated the opportunity to talk to other men with breast cancer on one-to-one basis [ 34 , 71 ], other men did not prefer this and were satisfied with the support offered by the healthcare providers and their families [ 13 ]:

‘‘…none of the guys wanted to have self-help groups ... I don’t think they need the psychological support that perhaps women do, and women tend to congregate and talk about these things anyway. I think this is, of course ... research I know ... but actually quite therapeutic in a way’’. [ 13 ] (p.338). “To be honest, I don’t know how I would be managing if I had never had (the support group). They gave me back the will to live and I will always be grateful for that.” [ 43 ] (p. 9).

In terms of group peer support, studies reported that only 15.3% of the participants were part of a peer support group and majority (96.3%) of participants who were not currently part of a support group did not wish to be part of a support group whether male only or mixed sex [ 53 , 61 ].

Breast cancer is generally perceived to be a disease common among women albeit incidence among men is slowly rising, creating a need for health systems to be responsive to their needs. To this end, this review sought to develop a comparative understanding of the experiences of men with breast cancer and the treatment options available to them across different demographic settings. The review findings highlight the embodiment of breast cancer as a ‘feminine’ disease which is incongruent with what it means to be a ‘man’ and hegemonic masculinity discourses. Throughout the trajectory of the disease (that is, from diagnosis to aftercare), the review findings underscore the gendered nature of the disease with a lack of health system preparedness to support men who develop a disease perceived to be ‘feminine’. Though the treatment pathways were similar to those observed in the management of female breast cancer patients, they do not necessarily meet the unique needs of MBC across the disease trajectory warranting urgent attention considering the increasing prevalence of the disease among men. Male-specific treatment pathways, ongoing education, and professional support are also required.

The breast is seen as a symbol of femininity, and as incongruent with being male, together with the significant public health emphasis on the prevention of breast cancer among females [ 78 , 79 ] have further championed the perception that breast cancer is a feminine illness [ 56 , 67 ]. Thus, it was not surprising that the finding regarding being out of sync with one’s body resonated across the included studies. The breast cancer diagnosis which commenced the illness trajectory was really challenging for the men and filled with varied emotions. Despite the difficulty, the professional support available was often gendered and unsuitable to their needs. Thus, they mostly had to rely on their spouses and close families/ friends if they were able to open up to them, which may take some time. Coupled with the hegemonic masculinity ideology that a man must always be in charge and not demonstrate any emotions which can be perceived as weakness, it is likely that men will navigate through these on their own which can make the journey very lonely for them. Agreeing with a previous study, depressive symptoms, anxiety, and traumatic stress symptoms were common occurrences following the breast cancer diagnosis [ 43 ]. The culture of silence around the issue can lead to utilising avoidant coping mechanisms which may delay support seeking among men. Taken together, the findings highlight a need for tailor-made, individualised counselling support service for men before, during, and after breast cancer diagnosis. The need for healthcare professionals to consider the impact of the MBC on men cannot, therefore, be overemphasised.

Commencing treatment and aftercare/ rehabilitative support is an equally challenging phase for men living with breast cancer. A previous study has observed that gender impacts on the experience with breast cancer treatment [ 15 ]. The review findings highlighted the ‘feminised’’ nature of the treatment pathways with some practitioners not even knowing how to support the affected men. Information leaflets and other educational materials were generally noted to be filled with images of females which made the men feel out of place. Overall, these can serve as structural barriers which potentially deter men from seeking help even when required [ 34 ]. Undoubtedly, breast cancer affects more females than males. However, healthcare service delivery should be tailored to the unique needs of men to overcome the feeling of marginalisation or being left out. The impact of the therapeutic regimen should also be highlighted particularly as they can lead to loss of libido or erectile dysfunction which further diminishes one’s sense of being a man in relation to societal norms. Surgical procedures can lead to scars which serve as permanent reminders of the illness which can have life-long impact on men. Professional support should therefore not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare. There is also a need to raise awareness of male breast cancer among healthcare practitioners to improve their approach to individuals through person-centred and male-specific care strategies. It may be worth reiterating the recommendation by Nguyen et al., [ 34 ] suggesting a guideline targeting men with breast cancer to support healthcare practitioners in the health and social service delivery process.

The need for support was reiterated throughout the review, and this is corroborated in a previous study where family and spousal support was critically important for men with advanced prostate cancer [ 80 ]. Interestingly, mixed findings were observed regarding the need for male-specific support groups. Although this may be based on individual preferences, it may also emanate from the hegemonic masculinity ideology [ 80 , 81 ] or coping styles such as disengagement [ 20 ] as men may appear ‘stoic’ in the presence of such difficult moments and may not want to seek help [ 34 , 82 ]. A breast cancer diagnosis can profoundly impact masculinity, with men grappling with navigating a threat to masculinity which collectively challenges one's sense of self and traditional gender roles [ 82 , 83 , 84 ].

Recent research shows changing perceptions of breast cancer as a "feminine disease" due to awareness campaigns and shifts in societal attitudes [ 85 , 86 ]. Additionally, demographic factors like location of treatment, socioeconomic status, and age have been found to affect the quality of care and outcomes, while acknowledging the male breast cancer experience and its shared emotional aspects with women's experiences [ 87 , 88 ]. These highlights evolving healthcare practices and societal norms regarding breast cancer.

Despite this, it is still cogent to understand their lived experiences and advocate for men support groups, if they would like to join one, as they navigate through the diagnosis, treatment, and aftercare pathway. This study presents the synthesis of multicultural evidence to highlight the cross-cultural similarity in the reaction and lived experience of men when faced with the diagnosis of breast cancer.

Strengths and limitations

The strength of this mixed method is the inclusion of studies from different countries and settings in addition to including and synthesising studies on the experiences of patients with male breast cancer from diagnosis to aftercare. Notwithstanding, there are some limitations that need to be highlighted. Firstly, a real limitation of our review was including only studies published in English. Excluding studies that used a language other than English, potentially led to information loss that could come from relevant studies written in other languages and restricts this mixed methods review only to the views and perception of men living in English speaking countries or countries where practitioners write and publish in English. Secondly, we acknowledge that younger and older men may have unique experiences while navigating breast cancer diagnosis and treatment. These nuances were not captured in the current review and may be worth exploring in future studies.

Men experience a myriad of issues following a breast cancer diagnosis, underscored by their ideology of masculinity. Our findings suggest the need for healthcare professionals’ training and education on managing interactions with MBC patients in a way that does not propagate a sense of awkwardness and otherness in a feminised support structure. Additionally, policy must address the structural barriers to treatment access for MBC including healthcare finance reimbursements that limit access to gendered specialist breast cancer treatments. Awareness creation efforts of MBC among the public as well as healthcare practitioners are urgently required to explain to the public through television programmes and awareness meetings that breast cancer is a disease like any other that affects both men and women. Creating such awareness could lead to changing the perception of men and promote early diagnosis, adherence to treatments, post-treatment monitoring, oncological results, and a better quality of life. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare. Preserving sexual function is an important finding highlighted from this review. Research will be needed to develop and test testosterone-preserving treatment modalities or optimising existing therapies in a way that is relevant to the priorities of MBC. This will also require the development of specialised guidelines for healthcare practitioners on MBC to optimise care and treatment for MBCs in a person-centred manner as suggested by other studies. To develop such individualised support frameworks, it is imperative to understand the specific needs, priorities, and support preferences among MBC patients.

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Society AC. Key Statistics for Breast Cancer in Men 2022 [Available from: https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html .

Chen Z, Xu L, Shi W, Zeng F, Zhuo R, Hao X, et al. Trends of female and male breast cancer incidence at the global, regional, and national levels, 1990–2017. Breast Cancer Res Treat. 2020;180(2):481–90.

Article   PubMed   Google Scholar  

Health UDo, Services H. Making Cancer Health Disparities History: Report of the Trans-HHS Cancer Health Disparities Progress Review Group. Washington, DC: U.S. Department of Health and Human Services; 2004.

Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist. 2007;12(1):20–37.

Morris AM, Rhoads KF, Stain SC, Birkmeyer JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg. 2010;211(1):105–13.

Rhoads KF, Cullen J, Ngo JV, Wren SM. Racial and ethnic differences in lymph node examination after colon cancer resection do not completely explain disparities in mortality. Cancer. 2012;118(2):469–77.

Co M, Lee A, Kwong A. Delayed presentation, diagnosis, and psychosocial aspects of male breast cancer. Cancer Med. 2020;9(10):3305–9.

Article   PubMed   PubMed Central   Google Scholar  

Ndom P, Um G, Bell EMD, Eloundou A, Hossain NM, Huo D. A meta-analysis of male breast cancer in Africa. The Breast. 2012;21(3):237–41.

Fiala L, Coufal O, Fait V, Foretova L. Male breast cancer-our experience. Rozhledy v chirurgii: mesicnik Ceskoslovenske chirurgicke spolecnosti. 2010;89(10):612–8.

PubMed   CAS   Google Scholar  

Rudlowski C. Male breast cancer. Breast care. 2008;3(3):183–9.

Robinson JD, Metoyer KP, Bhayani N. Breast cancer in men: a need for psychological intervention. J Clin Psychol Med Settings. 2008;15(2):134–9.

Thomas E. Men’s awareness and knowledge of male breast cancer. AJN The American Journal of Nursing. 2010;110(10):32–7.

Iredale R, Brain K, Williams B, France E, Gray J. The experiences of men with breast cancer in the United Kingdom. Eur J Cancer. 2006;42(3):334–41.

Pituskin E, Williams B, Au H-J, Martin-McDonald K. Experiences of men with breast cancer: A qualitative study. Journal of Men’s Health and Gender. 2007;4(1):44–51.

Article   Google Scholar  

Naymark P. Male breast cancer: incompatible and incomparable. Journal Of Men’s Health And Gender. 2006;3(2):160–5.

Ottini L, Palli D, Rizzo S, Federico M, Bazan V, Russo A. Male breast cancer. Crit Rev Oncol Hematol. 2010;73(2):141–55.

Rudan I, Rudan N, Basić N, Basić V, Rudan D. Differences between male and female breast cancer. II. Clinicopathologic features. Acta Medica Croatica. 1997;51(3):129–33.

Sineshaw HM, Freedman RA, Ward EM, Flanders WD, Jemal A. Black/white disparities in receipt of treatment and survival among men with early-stage breast cancer. J Clin Oncol. 2015;33(21):2337–44.

DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69(3):211–33.

Levin-Dagan N, Baum N. Passing as normal: Negotiating boundaries and coping with male breast cancer. Soc Sci Med. 2021;1(284):114239.

Sousa B, Moser E, Cardoso F. An update on male breast cancer and future directions for research and treatment. Eur J Pharmacol. 2013;717(1–3):71–83.

Article   PubMed   CAS   Google Scholar  

Fentiman IS. Surgical options for male breast cancer. Breast Cancer Res Treat. 2018;172:539–44.

Cardoso F, Bartlett J, Slaets L, Van Deurzen C, van Leeuwen-Stok E, Porter P, et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol. 2018;29(2):405–17.

Korde LA, Zujewski JA, Kamin L, Giordano S, Domchek S, Anderson WF, et al. Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol. 2010;28(12):2114.

Miao H, Verkooijen H, Chia K-S, Bouchardy Magnin C, Pukkala E, Larønningen S, et al. Incidence and outcome of male breast cancer: an international population-based study. J Clin Oncol. 2011;29(33):4381–6.

Corrigan KL, Mainwaring W, Miller AB, Lin TA, Jethanandani A, Espinoza AF, Piotrowski M, Fuller CD, Stauder MC, Shaitelman SF, Perkins GH. Exclusion of men from randomized phase III breast cancer clinical trials. Oncologist. 2020;25(6):e990–2.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Manier KK, Rowe LS, Welsh J, Armstrong TS. The impact and incidence of altered body image in patients with head and neck tumors: a systematic review. Neuro-Oncology Practice. 2018;5(4):204–13.

Himmelstein MS, Sanchez DT. Masculinity impediments: Internalized masculinity contributes to healthcare avoidance in men and women. J Health Psychol. 2016;21(7):1283–92.

Paraskeva N, Clarke A, Harcourt D. Altered appearance from cancer. Body image care for cancer patients: Principles and practices. 2018;3:131–60.

Google Scholar  

Fingeret MC, Teo I, Epner DE. Managing body image difficulties of adult cancer patients: lessons from available research. Cancer. 2014;120(5):633–41.

Donovan T, Flynn M. What makes a man a man?: The lived experience of male breast cancer. Cancer Nurs. 2007;30(6):464–70.

Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman’s disease”: Stigmatization of male breast cancer patients—A mixed methods analysis. Am J Mens Health. 2018;12(6):2194–207.

Pituskin E, Williams B, Au HJ, Martin-McDonald K. Experiences of men with breast cancer: A qualitative study. Journal of Men’s Health and Gender. 2007;4(1):44–51.

Nguyen TS, Bauer M, Maass N, Kaduszkiewicz H. Living with male breast cancer: a qualitative study of men’s experiences and care needs. Breast Care. 2020;15(1):6–13.

Younas A. Epistemic injustice in health care professionals and male breast cancer patients encounters. Ethics Behav. 2021;31(6):451–61.

Article   MathSciNet   Google Scholar  

Ly D, Forman D, Ferlay J, Brinton LA, Cook MB. An international comparison of male and female breast cancer incidence rates. Int J Cancer. 2013;132(8):1918–26.

Elbardan H, Kholeif AO, Elbardan H, Kholeif AO. An interpretive approach for data collection and analysis. Enterprise Resource Planning, Corporate Governance and Internal Auditing: An Institutional Perspective. 2017:111–65. 

Moher D, Liberati A, Tetzlaff J, Altman DG, Group* P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann intern med. 2009;151(4):264–9.

Adekolujo OS, Tadisina S, Koduru U, Gernand J, Smith SJ, Kakarala RR. Impact of marital status on tumor stage at diagnosis and on survival in male breast cancer. Am J Mens Health. 2017;11(4):1190–9.

Ahmed A, Ukwenya Y, Abdullahi A, Muhammad I. Management and outcomes of male breast cancer in Zaria. Nigeria Int J Breast Cancer. 2012;2012:845143.

PubMed   Google Scholar  

Avila J, Herrick B, Attai DJ, Leone JP. Treatments for breast cancer in men: late effects and impact on quality of life. Breast Cancer Res Treat. 2023;201(3):489–98.

Bootsma TI, Duijveman P, Pijpe A, Scheelings PC, Witkamp AJ, Bleiker EM. Unmet information needs of men with breast cancer and health professionals. Psychooncology. 2020;29(5):851–60.

Brain K, Williams B, Iredale R, France L, Gray J. Psychological distress in men with breast cancer. J Clin Oncol. 2006;24(1):95–101.

Chichura A, Attai DJ, Kuchta K, Nicholson K, Kopkash K, Pesce C, Yao K. Male breast cancer patient and surgeon experience: the male WhySurg study. Ann Surg Oncol. 2022;29(10):6115–31.

Crew KD, Neugut AI, Wang X, Jacobson JS, Grann VR, Raptis G, et al. Racial disparities in treatment and survival of male breast cancer. J Clin Oncol. 2007;25(9):1089–98.

Cronin PA, Romanoff A, Zabor EC, Stempel M, Eaton A, Smyth LM, et al. Influence of age on the clinical outcome of breast cancer for men and the development of second primary cancers. Ann Surg Oncol. 2018;25(13):3858–66.

Duarte do Amaral DE, Manfrim Muniz R, Habekost Cardoso D, Tuerlinckx Noguez P, Ferreira Fagundes R, Costa Viegas A. Male breast cancer: the survivor's context. J Nurs UFPE/Revista de Enfermagem UFPE. 2017;11(5).

El-Beshbeshi W, Abo-Elnaga EM. Male breast cancer: 10-year experience at mansoura university hospital in Egypt. Cancer Biol Med. 2012;9(1):23.

PubMed   PubMed Central   Google Scholar  

France L, Michie S, Barrett-Lee P, Brain K, Harper P, Gray J. Male cancer: a qualitative study of male breast cancer. The Breast. 2000;9(6):343–8.

Giordano SH, Perkins GH, Broglio K, Garcia SG, Middleton LP, Buzdar AU, et al. Adjuvant systemic therapy for male breast carcinoma. Cancer. 2005;104(11):2359–64.

Halbach SM, Midding E, Ernstmann N, Würstlein R, Weber R, Christmann S, et al. Male breast cancer patients’ perspectives on their health care situation: a mixed-methods study. Breast Care. 2020;15(1):22–9.

Harlan LC, Zujewski JA, Goodman MT, Stevens JL. Breast cancer in men in the United States: a population-based study of diagnosis, treatment, and survival. Cancer. 2010;116(15):3558–68.

Hill TD, Khamis HJ, Tyczynski JE. Comparison of male and female breast cancer incidence trends, tumor characteristics, and survival. Ann Epidemiol. 2005;15(10):773–80.

Hiltrop K, Heidkamp P, Halbach S, Brock-Midding E, Kowalski C, Holmberg C, et al. Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications—A qualitative study. Eur J Cancer Care. 2021;30(4): e13402.

Hoffman A, Horesh N, Shabtai M, Forschmidt E, Rosin D, Gutman M, et al. Breast Cancer in Men: A Single Center Experience Over a Period of 22 years. The Israel Medical Association Journal: IMAJ. 2020;22(3):160–3.

Kowalski C, Steffen P, Ernstmann N, Wuerstlein R, Harbeck N, Pfaff H. Health-related quality of life in male breast cancer patients. Breast Cancer Res Treat. 2012;133(2):753–7.

Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Social support of male breast cancer patients—a mixed-methods analysis. Am J Mens Health. 2019;13(4):1557988319870001.

Nahleh ZA, Srikantiah R, Safa M, Jazieh AR, Muhleman A, Komrokji R. Male breast cancer in the veterans affairs population: a comparative analysis. Cancer. 2007;109(8):1471–7.

Özkurt E, Tükenmez M, Yılmaz R, Cabioğlu N, Müslümanoğlu M, Dinççağ AS, et al. Favorable long-term outcome in male breast cancer. European Journal of Breast Health. 2018;14(3):180.

Potter AM, Bentz B, Crue L, Leiby S, Bashi S, Maguire K, Meyers J, Mieczkowski K. Men’s Lived Experiences of Breast Cancer and Changes in Occupation. Occup Ther Int. 2023;13:2023.

Rayne S, Schnippel K, Thomson J, Reid J, Benn C. Male breast cancer has limited effect on survivor’s perceptions of their own masculinity: a record review and telephone survey of patients in Johannesburg, South Africa. Am J Mens Health. 2017;11(2):246–52.

Sanguinetti A, Polistena A, Lucchini R, Monacelli M, Galasse S, Avenia S, et al. Male breast cancer, clinical presentation, diagnosis and treatment: Twenty years of experience in our Breast Unit. Int J Surg Case Rep. 2016;20:8–11.

Article   PubMed Central   Google Scholar  

Sarmiento S, McColl M, Musavi L, Gani F, Canner JK, Jacobs L, et al. Male breast cancer: a closer look at patient and tumor characteristics and factors that affect survival using the National Cancer Database. Breast Cancer Res Treat. 2020;180(2):471–9.

Shah S, Bhattacharyya S, Gupta A, Ghosh A, Basak S. Male breast cancer: a clinicopathologic study of 42 patients in eastern India. Indian J Surg Oncol. 2012;3(3):245–9.

Shin JY, Kachnic LA, Hirsch AE. The impact of race in male breast cancer treatment and outcome in the United States: a population-based analysis of 4,279 patients. Int J Breast Cancer. 2014;2014:685842.

Skop M, Lorentz J, Jassi M, Vesprini D, Einstein G. “Guys don’t have breasts”: The lived experience of men who have BRCA gene mutations and are at risk for male breast cancer. Am J Mens Health. 2018;12(4):961–72.

Thompson EH Jr, Haydock AS. Men’s lived experiences with breast cancer: The double consciousness of marginal men. Sex Roles. 2020;82(1–2):28–43.

Visram H, Kanji F, Dent S. Endocrine therapy for male breast cancer: rates of toxicity and adherence. Curr Oncol. 2010;17(5):17–21.

Wang Y, Chen K, Yang Y, Tan L, Chen L, Zhu L, et al. Incidence and survival outcomes of early male breast cancer: a population-based comparison with early female breast cancer. Ann transl med. 2019;7(20):536.

Weber R, Ehrenthal JC, Brock-Midding E, Halbach S, Würstlein R, Kowalski C, Ernstmann N. Defense mechanisms and repressive coping among male breast cancer patients. Front Psych. 2021;10(12): 718076.

Williams B, Iredale R, Brain K, France E, Barrett-Lee P, Gray J. Experiences of men with breast cancer: an exploratory focus group study. Br J Cancer. 2003;89(10):1834–6.

Yadav BS, Sharma SC, Singh R, Dahiya D, Ghoshal S. Male breast cancer: Outcome with adjuvant treatment. J Cancer Res Ther. 2020;16(6):1287.

Yoney A, Kucuk A, Unsal M. Male breast cancer: a retrospective analysis. Cancer/Radiothérapie. 2009;13(2):103–7.

Zongo N, Ouédraogo S, Korsaga-Somé N, Somé OR, Go N, Ouangré E, et al. Male breast cancer: diagnosis stages, treatment and survival in a country with limited resources (Burkina Faso). World journal of surgical oncology. 2018;16(1):1–7.

Hong QN, Pluye P, Bujold M, Wassef M. Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence. Syst Rev. 2017;6(1):1–14.

Sirriyeh R, Lawton R, Gardner P, Armitage G. Reviewing studies with diverse designs: the development and evaluation of a new tool. J Eval Clin Pract. 2012;18(4):746–52.

Ruddy KJ, Giobbie-Hurder A, Giordano SH, Goldfarb S, Kereakoglow S, Winer EP, et al. Quality of life and symptoms in male breast cancer survivors. The Breast. 2013;22(2):197–9.

Dozier R. Beards, breasts, and bodies: Doing sex in a gendered world. Gend Soc. 2005;19(3):297–316.

Sulik GA. Pink ribbon blues: How breast cancer culture undermines women’s health. Walton Street, Oxford: Oxford University Press; 2010.

Salifu Y, Almack K, Caswell G. ‘My wife is my doctor at home’: A qualitative study exploring the challenges of home-based palliative care in a resource-poor setting. Palliat Med. 2021;35(1):97–108.

Connell RW, Messerschmidt JW. Hegemonic masculinity: Rethinking the concept. Gend Soc. 2005;19(6):829–59.

Salifu Y, Almack K, Caswell G. ‘Out of the frying pan into the fire’: a qualitative study of the impact on masculinity for men living with advanced prostate cancer. Palliative Care and Social Practice. 2023;17:26323524231176828.

Quincey K, Williamson I, Wildbur D. Men with breast cancer and their encounters with masculinity: An interpretative phenomenological analysis using photography. Psychology of Men & Masculinities. 2021;22(4):690.

Quincey K, Williamson I, Winstanley S. ‘Marginalised malignancies’: A qualitative synthesis of men’s accounts of living with breast cancer. Soc Sci Med. 2016;149:17–25.

Yadav S, Karam D, Bin Riaz I, Xie H, Durani U, Duma N, Ruddy KJ. Male breast cancer in the United States: treatment patterns and prognostic factors in the 21st century. Cancer. 2020;126(1):26–36.

Wang F, Shu X, Meszoely I, Pal T, Mayer IA, Yu Z, Shu XO. Overall mortality after diagnosis of breast cancer in men vs women. JAMA oncol. 2019;5(11):1589–96.

Download references

Acknowledgements

Not applicable.

Author information

Authors and affiliations.

School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Sighthill Campus, Edinburgh, UK

Mary Abboah-Offei

School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, Hongkong, China

Jonathan Bayuo

International Observatory On End of Life Care (IOELC), Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4AT, UK

Yakubu Salifu

Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, WC2R 2LS, UK

Oladayo Afolabi

Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Science, Bournemouth University, Bournemouth, UK

Theophilus N. Akudjedu

You can also search for this author in PubMed   Google Scholar

Contributions

This review was conceived and designed by JB, MA-O, YS, OA, and TNA. The first reviewer imported all search results to Endnote reference manager version X9, de-duplicated, then all authors screened titles and abstracts of all identified studies, any article for which inclusion was unclear were discussed and if necessary adjudicated by YS and TNA. All authors critically appraised and contributed to the manuscript.

Corresponding author

Correspondence to Yakubu Salifu .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Abboah-Offei, M., Bayuo, J., Salifu, Y. et al. Experiences and perceptions of men following breast cancer diagnosis: a mixed method systematic review. BMC Cancer 24 , 179 (2024). https://doi.org/10.1186/s12885-024-11911-9

Download citation

Received : 28 September 2022

Accepted : 22 January 2024

Published : 06 February 2024

DOI : https://doi.org/10.1186/s12885-024-11911-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Male breast cancer
• Experiences
• Perceptions
• Treatment approaches
• Systematic review
• Masculinity

ISSN: 1471-2407

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Male Breast Cancer: A Comparative Analysis from the National Cancer Database

Affiliations.

• 1 Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA. [email protected].
• 2 Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA.
• 3 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
• 4 Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
• PMID: 33474851
• PMCID: PMC8255393
• DOI: 10.5534/wjmh.200164

Purpose: Breast cancer (BC) in males accounts for <0.5% of all male cancer diagnoses and ~1% of all BCs in the United States. We sought to describe clinicopathologic characteristics among male and female BC patients and differences in overall survival (OS) through the National Cancer Database over 13 years (2004-2016).

Materials and methods: Secondary to the 1:99 ratio of male to female BC cases, we randomly selected female cases for equal comparison to males cases by diagnosis year. Chi-square and t-tests compared demographic and tumor characteristics. OS was examined using Kaplan-Meier survival analysis.

Results: Among the ~2.7 million BC patients, 9 per 1,000 BCs were in males, the rate remained similar over time. The mean (SD) age was 64.9±13.0 years for males and 60.7±13.6 years for females. Most of the male BC cases were white (non-Hispanic) (n=19,015 [80.2%]), clinical stage I (n=7,353 [32.1%]) or stage II disease (n=7,923 [34.6%]), and tumors were moderate or poorly differentiated (84.5%). Males exhibited more comorbidities, presented with a larger proportion of disease, and decreased OS (p<0.005) than females. Male OS was >10% lower at 5-years and nearly 20% lower at 10-years for males. More males had primary BC tumors under the nipple; the 10-year OS rate for this site was 48.8%.

Conclusions: This study reports clinicopathologic characteristics of a large cohort of male BC. Males present at older age, with a greater comorbidity index, at later stages of disease. Increased education regarding the continued risks of male breast cancer may be warranted.

Keywords: Breast neoplasms, male; Epidemiology; Neoplasms; Patient-relative outcomes.

Copyright © 2021 Korean Society for Sexual Medicine and Andrology.

Downloadable Content

Male breast cancer: Still separate and unequal in 2020 - an ethical dilemma for medical social work advocacy in the United States. A review of the literature

• Masters Thesis
• Lynn, Jakki
• Decker, James
• Ashley, Wendy
• Willner, Lauren
• Social Work
• California State University, Northridge
• holding environment
• bio-psycho-social needs of men with breast cancer
• Dissertations, Academic -- CSUN -- Social Work.
• professional ethics
• Male breast cancer
• medical social work
• marginalization of men
• medical system
• 2020-05-27T18:46:58Z
• http://hdl.handle.net/10211.3/216018
• by Jakki Lynn
• California State University, Northridge. Department of Social Work.

Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.

File(s) under embargo

until file(s) become available

A Co-design Approach to Support Oral Anticancer Medication Use in Breast Cancer

Recent developments in cancer therapeutics have allowed increased use of Oral Anticancer Medications (OAMs), including in the treatment of breast cancer. Breast cancer is the most common cancer among women in the United States. Patients with breast cancer may face key barriers in managing their OAMs at home. These challenges can lead to sub-optimal adherence and lower the overall quality of life. Designing interventions that enhance the patient experience with use of OAMs requires a deeper understanding of barriers faced by patients as they navigate their cancer care journey. The objective of this study was to identify the unmet medication management needs of patients with breast cancer who are receiving OAMs and co-design an early prototype intervention with patients to support medication management needs of patients with breast cancer.

Two phases comprise this study. Phase 1 involved patient-journey mapping to characterize the longitudinal experience of OAMs use among patients diagnosed with breast cancer. In phase 2, we conducted participatory design (PD) workshops to develop a prototype tool to address OAM needs identified in phase 1. All participants were recruited from an outpatient breast cancer clinic in Indianapolis. Eligible participants were: 18 years of age or older, diagnosed with breast cancer, and currently receiving an OAM. All participants completed a brief sociodemographic and health information questionnaire. In phase 1, enrolled persons participated in a journey mapping exercise through semi-structured interviews. Interviews were conducted either in-person or remotely via Zoom, based on participant preference. For each interview, two researchers and the participant collaborated to create individual patient journey maps to generate a concise visual storyboard focused on medication use experiences related to OAMs. The journey maps helped capture treatment timelines, key markers of medication use, and specific barriers faced by patients. Individual journey maps were consolidated to generate personas representing groups of patients with related characteristics, treatment types, goals, and unmet needs. In phase 2, three rounds of PD workshops were conducted using the focus group format to develop an early prototype intervention. In round one (inspiration stage), participants defined the problem space and prioritized a list of challenges amenable to solutions; in round two (ideation stage), participants generated multiple possible solutions and design ideas; and in round three (convergence stage), two design concepts were selected and evaluated by participants.

In phase 1, 12 interviews (11 females and 1 male) were completed. The median age of participants was 65.5 years (range, 37-75). Participants were divided into two groups based on their prescribed medication types: (1) specialty medication (palbociclib or ribociclib; n=4 patients) and (2) traditional medication (tamoxifen, anastrozole, or exemestane; n=8 patients). We defined ‘Specialty’ medications as those that require specialty pharmacies and ‘traditional’ medications as those obtainable in local community pharmacies. To represent participants across these two broad categories of medications, two personas were created. Participants who had been prescribed specialty medication reported difficulty navigating the insurance process during medication fills, while participants who prescribed traditional medication did not. Notably, the word “prior authorization” was not used by participants to explain the issues they experienced. While all participants reported having side effects from their medications, sub-optimal adherence (n=2) was reported among the traditional medication group only. Other participants taking traditional medications either found their own ways to manage side effects or simply reported: “dealing with side effects as I don’t want cancer.” Participants expressed coping with side effects by enduring them. Participants had few strategies to manage their side effects, often stating that “they didn’t think of reaching out to the doctor,” when asked. Additionally, participants mentioned needing more financial and emotional support during their treatment journey. In phase 2, each PD session was conducted with 4-5 participants and 2 researchers (the design panel). Participants identified key challenges including difficulties navigating resources and information as well as managing medication side effects. The design panel prioritized two design concepts, which were subsequently developed into two prototypes: 1) a physical breast cancer handbook; and 2) an interactive treatment navigation app for use on tablet and smartphone devices. Our team plans to consolidate, further develop, and evaluate these prototypes in subsequent work as a follow up to this pilot study.

This study provides insight into the patient experience with OAMs. The personas created can be applied in designing interventions tailored to breast cancer patients’ needs and goals, while the consolidated journey maps identify potential areas for improvement. Adequate patient education and enhanced tools and processes are necessary to manage medication side effects effectively, ultimately leading to improved medication outcomes and assisting patients in navigating their treatment. The two design concepts require further revision prior to implementation and pilot testing.

Degree Type

• Master of Science
• Pharmacy Practice

Campus location

• West Lafayette

Advisor/Supervisor/Committee Chair

Additional committee member 2, additional committee member 3, additional committee member 4, usage metrics.

• Implementation science and evaluation
• Clinical pharmacy and pharmacy practice
• Health services and systems not elsewhere classified

Meet the 2024 Presidential Scholars

June 3, 2024

Seven WWU graduates will be recognized at the upcoming June commencement as recipients of the Presidential Scholar Award. 

The award honors the high achievements of students for exceptional scholarship, success in furthering multicultural programs and activities, and other service to the university and community. Presidential Scholars are nominated by faculty members, recommended by deans and formally selected by the president. Presidential Scholars will also wear their award medallions and be recognized during their commencement ceremonies.

The 2024 Presidential Scholars are: 

Kyana Renee Grayer

College of science and engineering.

Kyana Grayer’s significant academic accomplishments complement her engagement in community service and her work to promote diversity and inclusion in STEM fields.

A manufacturing engineering major with a minor in mathematics, Grayer has exceptional analytical skills that have enabled her to collaborate on significant research with faculty and industry partners.

Associate Professor of Engineering and Design Sura Al-Qudah writes that Grayer is “a model student and an inspiring figure in the Engineering and Design community.” And Grayer’s involvement in the community is immense.

She supports her fellow students’ academic success as a math tutor. She also served as president of the Society of Women Engineers, which under her leadership saw a significant increase in engagement among STEM students outside of Engineering and Design, contributing to a more connected and collaborative academic environment.

Grayer also served as a lead member of the Formula SAE team, most recently as Breaks, Pedals and Steering Lead, mentoring fellow students in designing and building these essential systems. She also worked to foster a culture of respect and understanding among team members.

“Her leadership, empathy, and dedication to fostering diversity and inclusion have had a lasting impact on the community,” Al-Qudah writes, “shaping a more inclusive and supportive academic and social environment.”

Gabrielle Laipenieks

College of humanities and social sciences, social sciences division.

Presidential Scholar Gabby Laipenieks is capping off her WWU experience by planning and teaching a quarter-length class on climate storytelling and community building with a guiding ethos of climate hope.

The class, Laipenieks’ honors senior capstone project guided by Sustainability Engagement Institute Director Grace Wang, aims to build resilience among young people facing climate challenges.

“Most of Ms. Laipenieks’ endeavors center on making the world a more just place,” writes Political Science Professor Debra Salazar. “Whether in classes on queer or Black politics or on how inequality shapes our politics, she focuses laser like on how institutions and practices can be remade to make the world one in which all kinds of people can thrive.”

Laipenieks majored in political science, minored in both environmental science and honors interdisciplinary studies, and earned a climate leadership certificate. Part of that climate leadership work involved a deep dive into campus signage related to sustainable waste disposal and proposals for improvement.

Her service work at Western is just as varied.

As the local issues coordinator for the AS Office of Civic Engagement, Laipenieks serves as the WWU student liaison to local governments. She’s also a voting member of the President’s Sustainability Council and worked with RE Sources to plan their first youth climate summit.

On top of all that, Laipenieks lends her voice to the WWU Concert Choir.

Ian Schaefer Lorenz

College of the environment.

During his time at Western Ian Schaefer Lorenz has become an integral part of the Institute for Watershed Studies.

Schaefer Lorenz, who is completing a major in environmental sciences with a toxicology emphasis and a minor in chemistry, worked on several of the institute’s long-term research projects on regional water quality. He spent last summer sampling lakes in Whatcom, Skagit, Island and Snohomish counties with the Northwest Lakes Monitoring Program. This summer, thanks to his knowledge and leadership skills, he’ll be leading that program.

“His contributions extend far beyond the classic laboratory and field sampling skills,” writes Angela Strecker, the institute’s director. “He has quickly become a leader among our student employees and is regarded as someone everyone can look to for emotional support and acceptance.”

Schaefer Lorenz, who returned to college after several years away, is also committed to community service and organization and was recognized with the 2024 WWU Student Civic Leadership Award. He’s a long-term volunteer with the Bellingham Food Bank and is a communications leader with the Washington Poor People’s Campaign, which works to raise awareness of systemic racism, poverty and ecological devastation. He also works to support the Bellingham Tenants Union, Community to Community Development and the Coalition to Transform Safety.

Levi Franklin-Montes

College of business and economics.

Accounting major Levi Franklin-Montes learned the power of mentorship early in life. Since then, he has never been satisfied to excel alone.

As a kid, Franklin-Montes found guidance and support at the Everett Boys and Girls Club, where he began as a participant, eventually became an employee and continues to serve as a volunteer, playing sports, helping with homework and mentoring younger members.

At Western, Franklin-Montes is known for his keen understanding and mastery of accounting principles. In his classes, he played a pivotal role in enhancing the learning environment.

“He had a deep calling to help his fellow students to succeed,” writes Accounting Professor Audrey Taylor, “staying after class and tutoring others who were struggling with the material.”

Franklin-Montes was also selected for internships with prestigious firms such as KPMG and Falco Sult.

Outside of class, he’s a volunteer with Smile Samoa, a nonprofit that provides dental care to low-income communities with limited access.

College of Humanities and Social Sciences, Humanities Division

Max Stone accomplished an extraordinary amount during his three years at Western.

He completed two majors (history and philosophy) and two minors (holocaust and genocide studies. and honors interdisciplinary studies). He served on the WWU Board of Trustees as its student trustee, captained the men’s rugby team, and helped revive the Philosophy Club as its president.

“Max Stone is one of the most remarkable students that I have worked with in my 19 years at Western,” writes Professor Ryan Wasserman.

A first-rate student, Stone impressed faculty with his history thesis, which deftly applied his understanding of philosophy to the discipline of history to explore the history of antinatalist philosophy.

Rugby is another passion of Stone’s. He has twice been recognized as an American Collegiate Rugby All-American, served as both captain and president of Western’s Men’s Rugby Club and coordinated annual free rugby camps on campus. He also organized free rugby camps for kids in British Columbia through the BC Grassroots Rugby Foundation.

“In all his endeavors, he demonstrates leadership well beyond what we expect from students,” writes History Professor Susan Costanzo, “and his pursuits have benefited both Western and the diverse communities of lower British Columbia.”

Amalia Voiss

College of fine and performing arts.

After Amalia Voiss survived breast cancer, she enrolled at Western to pursue her passion in costume design.

She’ll graduate this month with not only a major in theatre, but regional and national honors for her design work and a reputation for academic excellence and artistic prowess.

Voiss sets high standards for herself in the costuming studio, and her collaborative style elevates the work of her fellow student designers. A creative, versatile designer, Voiss’ work seamlessly blends traditional theatrical techniques with contemporary influences.

Her designs for WWU’s production of “Hay Fever” won accolades at the regional and national Kennedy Center American College Theater Festival.

Voiss’ costume design work is also inspired by her own experiences as a burlesque dancer and her commitment to creating a community where bodies of all shapes, genders and ethnicities are seen and valued.

“Having recovered from cancer, but still bearing the scars of that battle, Amalia’s work as a performer, artist and designer reflects an important and invaluably diverse voice in the larger artistic community,” writes Assistant Theatre Professor Sarah Jo Monaghan.

Meilani Wilson

Woodring college of education.

Mei Wilson, who graduated in fall 2023 with a degree in early childhood education and early childhood special education, is dedicated to providing high quality experiences for children with disabilities and from culturally and linguistically diverse backgrounds.

She excelled throughout her time in the program even while working long hours to support herself financially, bringing her warm, engaging, authentic perspective to her work.

During her teaching internship, Wilson was known for communicating high expectations for all students while skillfully accommodating student needs in the classroom. She is a consistent voice for the perspectives of students from diverse backgrounds.

As an assistant teacher in the AS Child Development Center, Wilson advocated for the inclusion of more representative books for youngsters, and more support for young students with disabilities.

She also served as an officer in the Pacific Islander Student Association, coordinating campus events and helping to provide a community hub for students of Pacific Islander descent.

“Meilani’s work, service, and scholarship are all exemplary” writes assistant professor Lindsay Foreman-Murray, “as is her commitment to supporting diverse populations of students and relationship building across stakeholders in the university.”

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.54; 2020 Dec

Epidemiology of male breast cancer

Santhi konduri.

a Advocate Aurora Health, Advocate Aurora Research Institute, Milwaukee, WI, USA

b Advocate Aurora Health, Aurora Neuroscience Innovation Institute, Milwaukee, WI, USA

Maharaj Singh

c School of Dentistry, Marquette University, Milwaukee, WI, USA

George Bobustuc

Richard rovin, amin kassam.

Due to its rarity, few studies have characterized the epidemiology of male breast cancer. The purpose of this study was to determine survival and risk factors for male breast cancer in a large U.S. population.

In this study, 19,795 male patients with breast cancer were identified from the National Cancer Database (2004–2014). Patient demographics, tumor characteristics and treatments were analyzed by using descriptive statistics. We used multivariate Cox regression and Kaplan Meier analysis.

Over 10 years, the incidence of male breast cancer increased from 7.2% to 10.3%, while mortality decreased from 11% to 3.8%. Socioeconomic factors predicting mortality included income medium, and high vs low (HR = 0.78; 0.68), private vs no insurance (HR = 0.73) and the academic research facility vs community cancer center (HR = 0.79). Significant predictors of all-cause mortality included age (HR = 1.04), tumor size (HR = 1.01), hormone receptor expression (HR = 0.8) and cancer stage I vs II, III, and IV at the time of diagnosis (HR = 1.5, 2.7, 4.4, 9.9 respectively). Other predictors of mortality include surgery (HR = 0.4), chemotherapy (HR = 0.8), radiation (HR = 0.8), and hormonal therapy (HR-0.8).

Conclusions

Socioeconomic factors, cancer stage, tumor characteristics (size and grade), and high Charlson-Dayo score contributed to higher mortality among male patients diagnosed with breast cancer. Surgery was most effective, followed by radiation, chemotherapy, and hormonal therapy. Patients with positive ER or PR expression demonstrated better survival. Adjusting for socioeconomic factors, biomarker identification and timely, appropriately chosen treatment are likely to reduce the risk for mortality.

• 1 Mortality was higher among patients with Low income and with no insurance.
• 2 Patients with positive ER or PR expression demonstrated better survival.
• 3 Surgery, chemotherapy, radiation, and hormonal therapy improved survival.

Introduction

Breast cancer is a common cancer in women but relatively rare in men, with male breast cancers accounting for less than 1% of all diagnosed cases [ 1 ]. According to Surveillance, Epidemiology, and End Results (SEER) data, male breast cancer incidence rose by 40% from 1975 to 2015, exceeding that of women by 25% [ 2 ]. The American Cancer Society estimated that in 2019, 2670 new cases of male breast cancer would be diagnosed in the United States, with 18% mortality [ 3 ].

Male breast cancer is not well understood. There is some evidence that male breast cancers are more likely to express the estrogen (ER) or androgen receptors than female and less likely to overexpress HER2 [4] , [5] . However, studies to characterize male breast cancers or correlate prognostic factors with treatment outcomes are limited and, when available, underpowered [ [5] , [6] , [7] ]. Therefore, there is an urgent need to understand the risk factors associated with the disease. Here, we report the results of a retrospective study of NCDB data from 2004 to 2014. The purpose of this study was to determine risk and survival factors in men with breast cancer in a large U.S. population.

The data used in the study was derived from a de-identified National Cancer Database (NCDB) file. NCDB is an oncology outcomes database with more than 1500 U S. cancer programs accredited by the Commission on Cancer, a joint program of the American College of Surgeons and American Cancer Society.

The NCDB file consisted of 2,211,245 patients diagnosed with breast cancer from 2004 to 2014. Female patients (2,191,450; 99.1%) and any male patients for whom follow-up data or mortality status was missing were excluded from the analysis, leaving a study population of male breast cancer to be 19,795 (0.9%). All categorical and continuous variables were described using appropriate descriptive statistics, ie. frequency and percentage for categorical variables, mean with standard deviation for continuous numeric variables. For survival analysis, Kaplan Meier was used to show comparative survival between 2 or more groups. Multivariate Cox regression was used to determine hazard ratios (HR) predicting mortality. For all statistical tests, an alpha of 0.05 was used for statistical comparison, and statistical analysis was performed using SAS software (Version 9.4, SAS Institute Inc., Cary, NC). Information with relation to tumor recurrence and cause of the death was not available in this dataset. Therefore, only all-cause and not cancer-related mortality was analyzed. Detailed pathologic and treatment information and lifestyle/comorbidity information is not available through the database.

Results and discussion

In general, male patients account for less than 1% of all patients with breast cancer [ [8] , [9] , [10] ], which is consistent with the SEER data base [ 4 ], suggesting that there is no bias in the selection process (19,795 or 0.9%). In the NCDB dataset, a little over seven percent (7.2%) of the cases were diagnosed in 2004 increasing steadily to reach 10.3% by 2014 ( Fig. 1 orange line ). The rate of all-cause mortality across the same time frame dropped from 11% in 2004 to 3.8% by 2014 ( Fig. 1 blue line ). However, overall mortality rate in same period remained significantly higher for men (27.2%) than women (17.4%) diagnosed with breast cancer (p < 0.001).

Percentage of the cases for male breast cancer per year out of total patients diagnosed with breast cancer from 2004 through 2014 (N = 19,795). Rates of diagnosis and mortality in male breast cancer. Orange line: Total cases of male breast cancer were graphed from 2004 to 2014. Blue line: Mortality rates for male breast cancer was calculated for the same time frame.

Patient demographics

Most of the cases self-identified as non-Hispanic white (75% as NHW), 12% as non-Hispanic black race (NHB), and 0.5% as Hispanic ( Table 1 Patient Characteristics ). The remaining 12% of patients were classified as Asian, Pacific Islander, American Indian, Aleutian or Eskimo. Mortality rates were highest in NHB (29%), then NHW (27%), Hispanic men (21%) and 25% among other races. The mean age was 64.6 ± 13.1 years. The distribution of mortality rates for median income, insurance status, location, health facility type, cancer stage and Charlson-Deyo score are all described in Table 1 . Most patients lived in a metro area and had access to insurance.

Table 1

Descriptive statistics for the incidences of male breast cancer from national cancer database.

Tumor characteristics

Tumor data including size, stage at diagnosis, tumor grade, site of the tumor and invasiveness were collected ( Table 1 Tumor Characteristics ). Mean tumor size was 42.8 ± 135.7 mm, with most tumors falling into the moderately differentiated category (49.4%). Most tumors were primary (75.1%) lesions and invasive (87.2%). In addition, estrogen receptor (ER) and progesterone receptor (PR), HER2 status was reported, with most patients expressing ER and (or) PR (91.7% and 82.9%, respectively).

Data was available for patients who received surgery, chemotherapy, radiation, hormonal therapy or immunotherapy ( Table 1 Treatment Modalities ). The vast majority of patients underwent surgery (90.6%) but did not receive chemotherapy (63.4%) or radiation (65.9%). The rate of patients which received hormonal therapy was 26.7% while the rate of patients who received immunotherapy was 1.1%.

The comparison of survival probability showed that overall survival probability was lower for male patients compared to female patients (log rank p < 0.001). The 5 and 10-year survival percentage was 85% and 71% for female patients and 75% and 56% for male patients, respectively. Similarly, in the matched cohort (13,011 male and 13,011 female) five-year and 10-year survival for female patients was 79% and 60% whereas in male patients it was 73% and 54% respectively (p < 0.001). Overall median survival for female was 13.2 years vs 11.4 years for male patients.

Multivariate Cox regression & Kaplan Meier analysis

Multivariate Cox regression was performed, and the data is shown in Table 2 . In addition, Kaplan Meier survival probabilities were calculated. In our study, increasing age and tumor size were among the independent factors affecting mortality. Patients who were diagnosed at an older age had reduced survival (HR = 1.04, p  < 0.0001) as well as those whose tumors were larger at diagnosis (HR = 1.01, p  < 0.001). These findings are similar to those of previously reported, albeit smaller studies [ 11 ].

Table 2

Multivariate Cox Regression: Predictors of mortality for male patients diagnosed with breast cancer.

Five and 10-year survival rates.

Tumor stage carried the highest risk of mortality in this dataset, with HRs of 1.54, 2.734, 4.481, 9.893 ( p  < 0.001) for patients diagnosed with cancers at stages I, II, III and IV, respectively, compared to stage 0. Similarly, mortality increased with increasing Charlson-Deyo scores. HRs of 1.582 for a score of 1, 2.672 for score 2, and an HR of 2.833 for patients with scores of ≤3 ( p  < 0.001; Table 2 ).

On the other hand, primary cancers carried an HR of 0.816 ( p  < 0.0001) compared with breast cancers in a secondary site. Patients with poorly, moderately, or well-differentiated tumors also showed decreasing mortality compared with undifferentiated tumors (HR = 0.539, 0.398, 0.341, respectively; p  < 0.001).

A higher proportion of ER and PR positivity was detected in male (91.8%, 83.2%) compared to female (81.2%, 70.7%) patients (p < 0.001) in this dataset and for male patients expression of either resulted in lower all-cause mortality than patients diagnosed with tumors which did not express ER or PR (HR = 0.82 for both, p  < 0.05) ( Table 2 Tumor Characteristics ). Kaplan Meier survival curves demonstrated that patients with either ER ( Fig. 3 a) or PR expression ( Fig. 3 b) had higher probabilities of survival ( p  < 0.0001). Fig. 3 a show the difference in survival probability of ER positive vs ER negative (p < 0.0001). Similarly, Fig. 3 b shows the difference in survival probability of PR positive vs PR negative p < 0.0001). Fig. 3 c shows the difference in survival of patients who received hormonal therapy vs who did not receive it (p = 0.0126).

Survival probabilities for male breast cancer patients whose tumors expressed ER or PR and for those who received hormonal therapy. (a) Patients whose tumors were ER positive (red line) compared with those who tumors were ER negative (blue line). (b) Patients whose tumors expressed PR (red line) compared with those whose tumors were PR negative (blue line). Dx, diagnosis. (c) Patients who received hormonal therapy were compared with those who did not receive hormonal therapy. Dx: diagnosis. p -values are shown in the upper, right-hand corner of each graph.

When we stratified ER positive and negative by the presence of hormonal therapy. The results show that there are no survival differences with hormonal therapy for ER positive (p = 0.0826) as well as for ER negative (p = 0.3923). In a similar patient population from M.D. Anderson Cancer Center (Houston, TX), ER- and PR-positive tumors comprised 85% and 71% of male cases [ 12 ]. Despite the high proportion of ER- and PR-positive disease in male breast cancer patients, fewer men than women (ER: 31.5% vs 34.4%; p < 0.001; PR: 31.8% vs 34.8%, p < 0.001) received adjuvant endocrine therapy, suggesting that either there is poor compliance or male patients are not exposed to currently available treatments. Several studies have reported that males are also less likely to overexpress HER2 [ 13 , 14 ]. HER2 expression data from the NCDB was only available from 2010 through 2014 and in this study HER2 was used from breast cancer specific factor 15.

However, when this was analyzed, the results showed that HER2 expression on tumors was indeed associated with higher mortality. For example, there were 9.8% male and 13.3% female patients with HER2 positive expression and within this population mortality rate was 20.8% among male and 11.8% among female patients.

Previous studies using national databases showed that race, insurance, income, and facility type were all independent factors for mortality among male breast cancer patients [ 9 , 15 ]. In our study, using stepwise Cox regression, we found income, insurance and facility type to be independently associated with mortality. All-cause mortality was lower among patients in medium- ($48,000-$67,999) or high-income (>$68,000) groups as well as those with private insurance (HR = 0.733, p  = 0.0038). Patients with Medicare or Medicaid insurance had an HR of 0.936, but this did not reach statistical significance ( p  = 0.5326). In addition, patients treated in academic/research facilities showed lower all-cause mortality compared with Community Cancer facilities (HR = 0.791, p  = 0.006).

Previous studies have reported improved survival in male patients with breast cancer who receive surgery, chemotherapy, radiation and hormonal therapy [ 16 , 17 ]. We investigated survival rates using multivariate Cox regression and Kaplan Meier survival probabilities. All-cause mortality was lower for patients who underwent surgery, with an HR of 0.415 ( p  < 0.0001) and there was a significant increase in Kaplan Meier survival ( p  < 0.001, Fig. 2 a). Chemotherapy and radiation treatments reduced all-cause mortality, with HRs of 0.77 and 0.79, respectively ( p  < 0.0001). Kaplan Meier survival curves showed that both chemotherapy and radiation treatment increased survivals up to 150 months. In our study population, radiation was part of the treatment for approximately 65% of the cases and was found to be an independent predictor for survival, thus radiation remains an important treatment strategy for male breast cancer [ 18 ].

Kaplan Meier survival probability of male breast cancer patients who received either surgery, chemotherapy or radiation following initial diagnosis. The numbers of patients in each category are shown on the bottom of each graph. (a) Survival probabilities for patients who underwent surgery were calculated. The solid blue line is survival of patients who did not receive surgery and the red, dashed line is of the patients who underwent surgery. (b) Survival curves for patients who received chemotherapy treatment (red line) vs. those who did not receive chemotherapy (blue line). (c) Survival curves for patients who received radiation treatment (red line) comparing those who did not (blue line). Dx: diagnosis. p -values are shown in the upper, right-hand corner of each graph.

The number of diagnosed cases of male breast cancer increased over the past 2 decades, which highlights the need for raising awareness of this disease in the community. Diagnosis of biomarkers such as ER, PR, and HER2 through early screening could guide clinicians for better prognosis and outcomes. In fact, some studies have suggested that more male breast cancer patients are diagnosed with advanced disease compared to women due to lack of awareness of screening for breast cancer in men [ 12 , 19 ]. In addition, there is a lack of randomized trials aimed at patients with male breast cancer. Though male breast cancer is different than female breast cancer, some of the molecular markers are present in both sexes. Large multicenter trials are required to understand the disease and determine the most effective therapies. Additional information related to treatment, biological attributes, and lifestyle (e.g., smoking, drinking, body mass index) could be assessed to develop treatment tailored for men with breast cancer. Early detection along with a comprehensive treatment strategy consisting of surgery, hormonal therapy or combination therapies would improve survival of male patients with breast cancer.

The data from present study suggests disparity among male and female patients. Male breast cancer is relatively rare but had lower survival and higher mortality. While the rate of mortality has been falling, there is still more work to be done to adequately provide early screening and treatment to improve prognosis. Socioeconomic status may be one of the reasons that men with breast cancer do less well than women. However, even after matching for the income level, insurance status and for facility type we found that survival was better for female compared to male patients. However, there is also a possibility of late detection of biomarkers for male patients compared to female patients.

In this study we identified factors for both risk and survival for male breast cancer patients. Most patients underwent surgery positively impacted survival, and mortality is reduced in men who received chemotherapy, radiation, or hormonal therapy, compared to men who did not receive either of these treatments. All-cause mortality was significantly lower in men whose tumors expressed ER or PR, but these men often did not receive treatment beyond surgery, even though hormonal therapy for treatment demonstrated a reduced probability of mortality. Further studies need to be done to determine specific reasons for the disparity in care.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Advocate Aurora Healthcare Foundation partially funded this project.

Declaration of competing interest

Acknowledgement.

The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB files. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. The authors are indebted to Dr Jennifer Jacob for her editorial assistance and for formatting the final manuscript.

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
• Inflammatory disorders
• Medical economics
• Medical research
• Medications
• Neuroscience
• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
• Radiology & Imaging
• Sleep disorders
• Sports medicine & Kinesiology
• Vaccination
• Breast cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
• Lung cancer
• Multiple sclerosis
• Myocardial infarction
• Ovarian cancer
• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
• Skin cancer
• Type 2 diabetes
• Full List »

share this!

May 30, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

Drugs can reduce recurrence after bowel cancer surgery, new thesis suggests

by Claes Björnberg, Umea University

A thesis at Umeå University shows that certain non-steroidal anti-inflammatory drugs, known as NSAIDs, can help patients who have undergone surgery for colorectal cancer. These patients suffer fewer recurrences of cancer and fewer leaks at the surgical site, so-called anastomotic leakage.

The researchers investigated whether NSAIDs, if taken in the first week after surgery for rectal cancer, could reduce the risk of recurrence-free survival. No conclusive effect were seen. This may be because there is no effect, that there were too few patients in the study, that different NSAIDs were used, or that a longer treatment with NSAIDs may be needed to see an effect.

"When we included a larger group of patients in the study, we saw positive effects in those treated with NSAIDs. These patients had a reduced rate of cancer recurrence, especially for left-sided colon cancer, and a reduced rate of anastomotic leakage," says the study's author Oskar Grahn, Department of Diagnostics and Intervention.

Furthermore, the biological processes that can explain why anastomotic leakage negatively affect long-term cancer outcomes were investigated. They discovered that even though patients who suffered anastomotic leakage or intra-abdominal abscess had normal levels of a protein called C-reactive protein (CRP) 41 days after surgery, there were 72 proteins that were upregulated and five that were downregulated still. This suggests that there may still be harmful processes going on in the body, even though one might think that the negative effects already have passed.

Finally, it was studied how common a certain mutation of the gene for the enzyme cyclooxygenase (COX-2) is among patients with colorectal cancer in Sweden. COX-2 is one of the enzymes that NSAIDs inhibit. However, it was not possible to confirm a previous finding showing that this mutation could be linked to an increased risk of anastomotic leakage.

In conclusion, research suggests that NSAIDs may have beneficial effects on cancer recurrence and anastomotic leakage in patients with colorectal cancer , depending on the location of the tumor and the anastomosis. This is especially the case for left-sided colon cancer, as these tumors often overexpress COX-2.

"Further research is needed to confirm these results and to investigate whether a longer treatment with NSAIDs could have an even greater effect," says Oskar Grahn.

Explore further

Feedback to editors

Facial thermal imaging and AI can accurately predict presence of coronary artery disease

7 minutes ago

Study: High excess death rates in the West for 3 years running since start of pandemic despite containment and vaccines

Inflight alcohol plus cabin pressure can lower blood oxygen and raise heart rate, even in the young and healthy

Personalized oxygenation could improve outcomes for patients on ventilators

Molecule produced in gut can have protective effect against flu, study shows

Genetic changes identified as key to childhood lupus

New method offers faster, more accurate pathogen identification, even in complex DNA sequences

2 hours ago

Oral nucleoside antiviral is progressing toward future pandemic preparedness

New machine learning method can better predict spine surgery outcomes

Airplane noise exposure may increase risk of chronic disease

Related stories.

Colorectal cancer surgery: Modifying gut microbiota could reduce postoperative complications

Jan 31, 2023

New research may explain unexpected effects of common painkillers

May 23, 2022

How does aspirin help prevent colorectal cancer development and progression?

Apr 22, 2024

Antibiotics use in relation to colorectal cancer risk, survival and postoperative complications

Mar 19, 2024

Soy lecithin NSAID combo drug protects against cancer with fewer side effects

May 30, 2018

Use of ibuprofen and similar NSAIDs may shorten life of patients

May 1, 2018

Recommended for you

Two-pronged attack strategy boosts immunotherapy in preclinical studies

3 hours ago

New study shows vitamin C boosts DNA damage and cell death in melanoma cells

Scientists develop AI tool to predict how cancer patients will respond to immunotherapy

5 hours ago

Study finds semaglutide associated with reduction in incidence and recurrence of alcohol-use disorder

7 hours ago

Chromatin openness sheds new light on prostate cancer plasticity

4 hours ago

Let us know if there is a problem with our content

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter