title: Management of male breast cancer in the United States: a surveillance, epidemiology and end results analysis.
abstract: OBJECTIVE
  To analyze the stage-specific management of male breast cancer (MBC) with surgery and radiation therapy (RT) and relate them to outcomes and to female breast cancer (FBC).
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was queried for all primary invasive MBC and FBC diagnosed from 1973 to 2008. Analyzable data included age, race, registry, grade, stage, estrogen and progesterone receptor status, type of surgery, and use of RT. Stage was defined as localized (LocD): confined to the breast; regional (RegD): involving skin, chest wall, and/or regional lymph nodes; and distant: M1. The primary endpoint was cause-specific survival (CSS).
  
  
  RESULTS
  A total of 4276 cases of MBC and 718,587 cases of FBC were identified. Male breast cancer constituted 0.6% of all breast cancer. Comparing MBC with FBC, mastectomy (M) was used in 87.4% versus 38.3%, and breast-conserving surgery in 12.6% versus 52.6% (P<10(-4)). For males with LocD, CSS was not significantly different for the 4.6% treated with lumpectomy/RT versus the 70% treated with M alone (hazard ratio [HR] 1.33; 95% confidence interval [CI] 0.49-3.61; P=.57). Postmastectomy RT was delivered in 33% of males with RegD and was not associated with an improvement in CSS (HR 1.11; 95% CI 0.88-1.41; P=.37). There was a significant increase in the use of postmastectomy RT in MBC over time: 24.3%, 27.2%, and 36.8% for 1973-1987, 1988-1997, and 1998-2008, respectively (P<.0001). Cause-specific survival for MBC has improved: the largest significant change was identified for men diagnosed in 1998-2008 compared with 1973-1987 (HR 0.73; 95% CI 0.60-0.88; P=.0004).
  
  
  CONCLUSIONS
  Surgical management of MBC is dramatically different than for FBC. The majority of males with LocD receive M despite equivalent CSS with lumpectomy/RT. Postmastectomy RT is greatly underutilized in MBC with RegD, although a CSS benefit was not demonstrated. Outcomes for MBC are improving, attributable to improved therapy and its use in this unscreened population.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: emma.fields@ucdenver.edu.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Fields
authors.forename: Peter
authors.initials: P
authors.lastname: DeWitt
authors.forename: Christine M
authors.initials: CM
authors.lastname: Fisher
authors.forename: Rachel
authors.initials: R
authors.lastname: Rabinovitch
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery; D018567:Breast Neoplasms, Male / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000706:statistics & numerical data; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D018426:SEER Program; D017678:Sex Distribution; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone