Evolving surgical treatment decisions for male breast cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database

Abstract

Background

Male breast cancer (MBC) is a rare malignancy, and gender-specific treatment outcomes are currently lacking. The use of a large, multi-national surgical-outcomes database may provide a better understanding of treatment patterns and postoperative morbidity in men who undergo oncological breast surgery.

Methods

A retrospective cohort analysis was conducted between 2007 and 2016 using the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP), examining MBC treatment patterns and postoperative complication rates. All men undergoing surgery for the treatment of invasive or in situ carcinoma of the breast were identified. Clinical characteristics, demographics, and surgical treatment options most frequently used for this population were described. In addition, the 30-day postoperative complication rates in the surgical treatment of male breast cancer were evaluated.

Results

A total of 1773 MBC patients with a median age of 65 years (IQR 56–74 years) were included in this analysis. Mean body mass index (BMI) was 29.1 (IQR 25.4–33.8). In this study population, 177 (10.0%) had a diagnosis of in situ breast cancer, while the remaining 1596 (90.0%) had invasive disease. While most men underwent mastectomy, 282 (15.9%) had breast-conserving surgery. There were 74 (4.2%) patients who underwent immediate breast reconstruction. In addition, 118 (6.7%) patients elected to have a contralateral prophylactic mastectomy. Overall, the rate of morbidity was 4.6%, comprising mostly of wound complications (3.2%).

Conclusion

Analysis of this large, prospective multi-institutional cohort revealed that complication rates are low and comparable to reported rates in the female breast cancer population. What is also significant about this analysis is that the cohort demonstrated the importance of cosmetic considerations in MBC patients, as some men decide to undergo breast-conserving surgery or immediate breast reconstruction. Contralateral prophylactic mastectomy in the treatment of MBC is also performed.

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Author information

Affiliations

Authors

Contributions

Conception and design: ME, SS, AA, AE, DRM, TDC. Acquisition of data: AE, AA. Analysis and interpretation of data: ME, SS, AA, AE, DRM, TDl. Drafting of manuscript: ME, AA, SS, AE, DRM, TDC. Critical revision and final approval: ME, SS, AA, AE, DRM, TDC.

Corresponding author

Correspondence to Maryam Elmi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Poster Presentation: Annual Scientific Meeting, American Society of Breast Surgeons, Orlando, Florida, USA, May 2–8 2018.

Appendix

Appendix

See Tables 5, 6, 7, and 8.

Table 5 International classification of diseases (ICD) codes used to query the National Surgical Quality Improvement Program (NSQIP) database (2007–2016) for male breast cancer and in situ malignancy of the male breast
Table 6 Common procedural terminology (CPT) codes used to query the National Surgical Quality Improvement Program (NSQIP) database (2007–2016) for mastectomy- partial or total- and breast reconstruction-type procedures
Table 7 Common procedural terminology (CPT) codes describing the 30-day reoperation procedures in the National Surgical Quality Improvement Program (NSQIP) database (2007–2016) male breast cancer cohort
Table 8 International classification of diseases (ICD) codes describing the diagnostic reason behind 30-day readmissions in the National Surgical Quality Improvement Program (NSQIP) database (2007–2016) male breast cancer cohort

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Elmi, M., Sequeira, S., Azin, A. et al. Evolving surgical treatment decisions for male breast cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database. Breast Cancer Res Treat 171, 427–434 (2018). https://doi.org/10.1007/s10549-018-4830-y

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Keywords

  • Male breast cancer
  • National Surgical Quality Improvement Program
  • Surgical management of cancer
  • Male breast reconstruction
  • Male breast-conserving surgery