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JWNF hired Medical Writers Group, LLC, New York, January, 2008. Made possible through a grant provided by Cancer Research and Prevention Foundation. Compared to female breast cancer, male breast cancer (MBC) is relatively rare.
In the past, MBC was considered an aggressive disease with a considerably worse prognosis than in women. Some recent data have challenged these assumptions. Although MBC shares many similarities with cancer of the female breast, there are also important differences. Incidence and Prevalence—
In the United States, approximately 2030 new cases of MBC are diagnosed annually, and 450 deaths occur; this represents less than 0.5 percent of all cancer deaths in men annually. By contrast, in Tanzania and areas of central Africa, breast cancer accounts for up to 6 percent of cancers in men.
In the United States, the ratio of female to male breast cancer is approximately 100:1 in whites, but lower (70:1) in blacks. Blacks also have a poorer prognosis, even after adjustment for clinical, demographic, and treatment factors.
The median age of onset of MBC is 65 to 67, approximately 5 to 10 years older than in women. Like female breast cancer, the incidence of MBC has been increasing; one report suggests that incidence has increased 26 percent over the past 25 years.Risk Factors — Although the majority of men with breast cancer have no identifiable risk factors, several have been identified, many related to hormone levels.
In a meta-analysis of published case-control studies, the risk of developing MBC was increased in men with the following characteristics: never married, Jewish ancestry, previous benign breast disease, gynecomastia, history of testicular or liver pathology, family history of breast cancer, or prior chest wall irradiation. Gynecomastia, which is most often drug-related is probably not a precursor for MBC, but may be associated with it because of shared hormonal risk factors.
Testicular conditions associated with an increased risk of MBC include orchitis, undescended testes (cryptorchidism) and testicular injury. Among the chronic liver diseases that are associated with MBC are cirrhosis, alcoholic liver disease, and schistosomiasis.
Risk factors for male breast cancer:
•Testicular abnormalities: Undescended testes, Congenital inguinal hernia, Orchitis, Testicular injury.
•Postive family history
•Benign breast conditions: Nipple discharge, Breast cysts, Breast trauma.
•Radiation exposure•Increasing age
•Jewish ancestry Hormonal
Imbalance — Several of the risk factors for MBC involve imbalance in estrogenic versus androgenic influences (ie, relative estrogen excess or lack of androgen). As an example, men with liver disease have increased production of androstenedione from the adrenal glands, enhanced aromatization of androstenedione to estrone, and increased conversion of estrone to estradiol. On the other hand, androgens may convey a protective effect on breast tissue by inhibiting cell proliferation. The association of MBC with prolactinoma, a condition often associated with low plasma testosterone levels, is consistent with this hypothesis. It is hypothesized that relative changes in endogenous hormones may play a causative role in MBC. However, abnormalities in peripherally detectable hormone levels have not been detected in affected men.
Furthermore, other conditions associated with an increased estrogen-to-testosterone ratio such as obesity, thyroid disease, use of marijuana, and exogenous estrogen use (eg, transsexuals, treatment of prostate cancer) have a less certain relationship to MBC. Klinefelter syndrome — The strongest risk factor for developing MBC is Klinefelter syndrome, a rare condition resulting from the inheritance of an additional X chromosome. The Klinefelter syndrome consists of atrophic testes, gynecomastia, high serum concentrations of gonadotropins (follicle-stimulating hormone, luteinizing hormone), and low serum testosterone levels; the net effect is a high ratio of estrogen-to-testosterone. The risk of MBC is 20 to 50-fold higher in men with Klinefelter syndrome as compared to those with a normal genotype; breast cancer-related mortality may be particularly high in those with 47,XXY mosaicism.
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