Highlights
- •Men continue to undergo more extensive surgery for T1-T2 breast cancer than women.
- •Unilateral mastectomy rates for men have increased from 2004 to 2016.
- •Males had inferior survival after adjustment for patient, tumor, and treatment factors.
- •Partial mastectomy was associated with a 42% reduction in mortality risk for men.
- •Surgical de-escalation could be considered in MBC and may improve outcomes.
Abstract
Background
Despite evidence that early-stage male breast cancer (MBC) can be treated the same
as in females, we hypothesized that men undergo more extensive surgery.
Methods
Patients with clinical T1-2 breast cancer were identified in the National Cancer Database
2004–2016. Trends in surgery type and overall survival were compared between sexes.
Results
Of 9,782 males and 1,078,105 females, most were cN0 with AJCC stage I/II disease.
Unilateral mastectomy was most common in men (67.1% vs. 24.1%, p < 0.001) and partial
mastectomy in women (64.7% vs. 26.4%, p < 0.001), with no significant change over
time. Over 1/3 of men received ALND in 2016. While overall survival was superior in
females (HR 0.83, 95% CI 0.73–0.94, p = 0.003), partial mastectomy was associated
with a 42% reduction in mortality risk for males (HR 0.58, 95% CI 0.4–0.8, p = 0.003).
Conclusions
De-escalation of surgery could be considered for MBC to improve survival and align
with current standards of care.
Keywords
Abbreviations:
MBC (male breast cancer), BCS (breast-conserving surgery), MRM (modified radical mastectomy), SLNB (sentinel lymph node biopsy), ALND (axillary lymph node dissection)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 24, 2022
Accepted:
September 20,
2022
Received in revised form:
August 14,
2022
Received:
April 17,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
