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Is Breast-Conserving Therapy Appropriate for Male Breast Cancer Patients? A National Cancer Database Analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Current treatment guidelines for male breast cancer are predominantly guided by female-only clinical trials. With scarce research, it is unclear whether breast-conserving therapy (BCT) is equivalent to mastectomy in men. We sought to compare overall survival (OS) among male breast cancer patients who underwent BCT versus mastectomy.

Methods

We performed a retrospective analysis of 8445 stage I–II (T1–2 N0–1 M0) male breast cancer patients from the National Cancer Database (2004–2014). Patients were grouped according to surgical and radiation therapy (RT). BCT was defined as partial mastectomy followed by RT. Multivariable and inverse probability of treatment-weighted (IPTW) Cox proportional hazards models were used to compare OS between treatment groups, controlling for demographic and clinicopathologic characteristics.

Results

Most patients underwent total mastectomy (61.2%), whereas 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. In multivariable and IPTW models, partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse OS compared with BCT (p < 0.001 all). Ten-year OS was 73.8% for BCT and 56.3, 58.0 and 56.3% for other treatment approaches. Older age, higher T/N stage, histological grade, and triple-negative receptor status were associated with poorer OS (p < 0.05). Subgroup analysis by stage demonstrated similar results.

Conclusions

In this national sample of male breast cancer patients, BCT was associated with greater survival. The underlying mechanisms of this association warrant further study, because more routine adoption of BCT in male breast cancer appears to translate into clinically meaningful improvements in survival.

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Funding

The National Center for Advancing Translational Sciences, NIH (UL1TR001860) and the Agency for Healthcare Research and Quality (T32HS022236).

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Authors and Affiliations

  1. Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA

    Sarah B. Bateni MD, Anders J. Davidson MD, Richard J. Bold MD, Robert J. Canter MD & Candice A. M. Sauder MD

  2. Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, USA

    Mili Arora MD

  3. Department of Radiation Oncology, University of California, Davis Medical Center, Sacramento, CA, USA

    Megan E. Daly MD

  4. Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento, CA, USA

    Susan L. Stewart PhD

  5. Division of Surgical Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA

    Richard J. Bold MD, Robert J. Canter MD & Candice A. M. Sauder MD

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  1. Sarah B. Bateni MD
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Correspondence to Candice A. M. Sauder MD.

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Bateni, S.B., Davidson, A.J., Arora, M. et al. Is Breast-Conserving Therapy Appropriate for Male Breast Cancer Patients? A National Cancer Database Analysis. Ann Surg Oncol 26, 2144–2153 (2019). https://doi.org/10.1245/s10434-019-07159-4

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  • DOI: https://doi.org/10.1245/s10434-019-07159-4

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