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Trends in surgery and survival for T1-T2 male breast cancer: A study from the National Cancer Database

  • Rashi Singh
    Affiliations
    Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
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  • Lifen Cao
    Affiliations
    Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
    Search for articles by this author
  • Anuja L. Sarode
    Affiliations
    Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
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  • Michael Kharouta
    Affiliations
    Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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  • Robert Shenk
    Affiliations
    Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
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  • Megan E. Miller
    Correspondence
    Corresponding author. Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA.
    Affiliations
    Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), USA
    Search for articles by this author
Published:September 24, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.043

      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)
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