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Breast Cancer in Men: a 10-Year Experience © Permanyer 2019 © Permanyer 2019 of an Oncology Reference Center in Northeast

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Breast Cancer in Men: a 10-Year Experience © Permanyer 2019 © Permanyer 2019 of an Oncology Reference Center in Northeast www.journalofcancerology.com PERMANYER J Cancerol. 2019;6:21-7 www.permanyer.com JOURNAL OF CANCEROLOGY HOT TOPIC Breast cancer in men: A 10-year experience © Permanyer 2019 © Permanyer 2019 of an oncology reference center in Northeast . Mexico CARLOS EDUARDO SALAZAR-MEJÍA*, ALAN BURGUETE-TORRES, JUAN FRANCISCO GONZÁLEZ-GUERRERO, DANIEL ALbeRTO GALLEGOS-ARGUIJO, BLANCA OTILIA WImeR-CASTILLO, BRENDA ALEJANDRA SAMANIEGO-SÁENZ, LOURDES PAOLA CHAPA-MONTALVO AND OSCAR VIDAL-GUTIÉRREZ of the publisher Centro Universitario Contra el Cáncer, University Hospital “Dr. José Eleuterio González” and Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México ABSTRACT Introduction: Breast cancer in men (BCM) accounts for approximately 1% of all breast cancer cases. The present study aimed at describing the clinical and demographic characteristics of BCM in Mexican population. Methods: We performed a retrospective analysis of the men with newly diagnosed breast cancer treated in an oncology referral center in Northeast Mexico from 2007 to 2017. Results: Fifteen patients were included in the analysis. Mean age at diagnosis was 60.7 years and median time from diagnosis to the start of treatment was 2 months. About 73% of patients presented with locoregional disease (clinical stage [CS] I-III) and 26.7% were classified as Stage IV disease on their first assessment. All patients had invasive ductal carcinoma and 60.0% were Grade II tumors. Twelve cases were positive for hormone receptors and none showed overexpression of human epidermal growth factor receptor 2. Regarding primary treatment, 12 patients underwent a modified radical mastectomy and two underwent breast-conserving surgery. The majority of patients received chemotherapy and radiotherapy in the adjuvant setting and tamoxifen was the drug of choice in all patients considered as candidates for hor- monal therapy. Conclusion: While most of the data presented matches that reported by other authors, some interesting differences unique to our population were observed. Key words: Breast Cancer. Men. Mexico. Latin America. No part of this publication may be reproduced or photocopying without the prior written permission Sin contar con el consentimiento previo por escrito del editor, no podrá reproducirse ni fotocopiarse ninguna parte de esta publicación. Sin contar con el consentimiento previo por escrito del editor, Corresponding author: *Carlos Eduardo Salazar-Mejía Received for publication: 11-03-2019 E-mail: [email protected] Accepted for publication: 17-04-2019 21 Journal of Cancerology. 2019;6 RESUMEN Introducción: El cáncer de mama en hombres (CMH) representa aproximadamente el 1% de todos los casos de cáncer de mama. El presente estudio tuvo como objetivo describir las características clínicas © Permanyer 2019 Métodos: y demográficas del CMH en población mexicana. Realizamos un análisis retrospectivo de los © Permanyer 2019 hombres con cáncer de mama recién diagnosticado tratados en un centro de referencia oncológica del noreste de México de 2007 a 2017. Resultados: Quince pacientes fueron incluidos en el análisis. La . edad media al diagnóstico fue de 60,7 años, la mediana de tiempo desde el diagnóstico hasta el inicio del tratamiento fue de dos meses. El 73% de los pacientes presentaron enfermedad locorregional (EC I-III) y el 26.7% se clasificó como enfermedad en etapa clínica (EC) IV en su primera evaluación. Todos los pacientes tenían carcinoma ductal infiltrante y el 60% eran tumores de grado II. Doce casos fueron of the publisher positivos para receptores hormonales y ninguno mostró sobreexpresión de HER2. Debido a limitaciones económicas, ninguno de los pacientes fue evaluado para determinación de mutaciones germinales o somáticas. Respecto al tratamiento primario, 12 pacientes se sometieron a mastectomía radical modifi- cada y dos a cirugía conservadora. La mayoría de los pacientes recibieron quimioterapia y radioterapia en el escenario adyuvante y el tamoxifeno fue el fármaco de elección en todos los pacientes conside- rados candidatos a terapia hormonal. Conclusión: Si bien la mayoría de los datos presentados coinci- den con lo reportado mundialmente por otros autores, se observaron algunas diferencias, tal vez únicas para nuestra población. (J CANCEROL. 2019;6:21-7) Corresponding author: Carlos Eduardo Salazar-Mejía, [email protected] Palabras clave: Cáncer de mama. Hombre. México. América Latina. in Austria to 0.93 cases per 100,000 men in Ice- INTRODUCTION land. In the United States, the incidence was 0.79 cases per 100,000 men. For Latin-American Breast cancer in men (BCM) is an uncommon en- countries, incidence was lower than that reported tity. It accounts for approximately 1% of all breast by European countries or the United States. Among cancer cases, with a lifetime risk for men to devel- Latin-American countries, Colombia reported the op breast cancer of 1:10001. In the United States, lowest incidence with 0.23 cases, whereas Brazil SEER data estimate that 2550 men will be diag- reported the highest rates with 0.48 cases per nosed with breast cancer in 2018, with 480 ac- 100,000 men. In Mexico, the reported incidence countable deaths from this disease2. of male breast cancer in 2014 was 0.64 cases per 100,000 men4. There are important geographical variations re- garding the incidence of this disease. A retrospec- Large retrospective series of the clinical-patholog- tive study compared the incidence of male breast ical characteristics of female breast cancer in Mex- cancer among several countries from five conti- ican patients have been recently published5-7. How- nents3. Israel reported the highest incidence with ever, there are limited data on this regard for male 1.24 cases per 100,000 men, while the Philippines breast cancer8. The aim of this study is to describe No part of this publication may be reproduced or photocopying without the prior written permission and Japan reported the lowest rates with 0.16 and the clinical and demographic characteristics of no podrá reproducirse ni fotocopiarse ninguna parte de esta publicación. Sin contar con el consentimiento previo por escrito del editor, 0.18 cases, respectively. For countries in the Eu- men with breast cancer treated at a referral center ropean Union, the incidence rate ranged from 0.45 in Northeast Mexico within a 10-year period. 22 C.E. Salazar-Mejía, et al.: Breast cancer in Mexican men Table 1. Patient characteristics METHODS Patients n = 15 Age at diagnosis (years); mean ± SD 60.7 ± 13.0 A retrospective, observational study was designed, BMI (kg/m2); median (IQR) 26.5 (25.0-30.4) in which medical records of male patients diag- © Permanyer 2019 st Performance status; n (%) nosed with breast cancer attending for the 1 time © Permanyer 2019 ECOG 0-1 11 (73.3) to the breast tumor unit of the “Centro Universitar- ECOG 2-3 4 (26.7) io Contra el Cáncer – Hospital Universitario – . Risk factors; n (%) UANL” in Monterrey, Mexico, were reviewed. Smoking 9 (60.0) Alcohol consumption 11 (73.3) After the ethics committee approval, medical re- Diabetes mellitus 6 (40.0) cords of patients older than 18 years diagnosed SAH 8 (53.3) of the publisher with breast cancer from January 2007 to Decem- Dyslipidemia 1 (6.7) ber 2017 were reviewed and included in the anal- Hepatopathy 1 (6.7) ysis. Family history 6 (40.0) SD: standard deviation; IQR: interquartile range; BMI: body mass index; ECOG: Eastern Cooperative Oncology Group; SAH: systemic arterial hypertension; ICS: inherited cancer The study variables included: age at initial diag- syndromes. nosis, body mass index, Eastern Cooperative On- cology Group performance scale (ECOG), comor- bidities, risk factors, employment and marital was 60.7 ± 13.0 years. Socioeconomic character- status, primary tumor location, time from initial istics were as follows: eight patients reported to diagnosis to treatment, histologic type/grade, and be employed at the time of their first evaluation initial clinical stage (CS) at diagnosis. Estrogen and two had a higher education grade. Twelve receptor (ER), progesterone receptor (PR), andro- patients (80.0%) had government-issued medical gen receptor (AR), and human epidermal growth insurance. factor receptor 2 (HER2) status, as well as treat- ment received, were also included in the study. About 73.3% of patients had an ECOG of 0-1, while 26.7% were classified as having a score of For data analysis, SPSS v20 software was used. 2-3. Risk factors for BCM such as smoking, alco- The normality of the variables was determined us- hol consumption, diabetes mellitus, and systemic ing the Shapiro–Wilk test. Variables with normal arterial hypertension were present in 60.0, 73.3, distribution were described using mean and stan- 40.0, and 53.3% of patients, respectively. A total dard deviation values. Variables with non-normal of six patients reported having a family history of distribution were described with median and inter- cancer. None of the patients were evaluated for quartile range (IQR) of percentiles 25 and 75. Cat- germline or somatic mutations. Epidemiological egorical values were expressed in absolute num- and clinical characteristics of patients are de- bers and percentages. scribed in Table 1. About 86.7% of patients presented with a retroare- RESULTS olar lump as their initial symptom. Median time from diagnosis to treatment was 2.0 months (IQR A total of 15 cases of male breast cancer were 1.75-7.5). Locoregional disease (CS I-III) at diag- No part of this publication may be reproduced or photocopying without the prior written permission obtained and included in the analysis, which cor- nosis was found in 73.3% of patients, while 26.7% no podrá reproducirse ni fotocopiarse ninguna parte de esta publicación. Sin contar con el consentimiento previo por escrito del editor, responds to 0.5% of all cases of breast cancer of patients were considered to have Stage IV dis- diagnosed in our center. Mean age at diagnosis ease at initial presentation.
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