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Surgery for Men with Breast Cancer: Do the Same Data Still Apply?

Annals of Surgical Oncology volume 27, pages 4720–4729 (2020)Cite this article

Abstract

Background

Men represent a small proportion of breast cancer diagnoses, and they are often excluded from clinical trials. Current treatments are largely extrapolated from evidence in women. We compare practice patterns between men and women with breast cancer following the publication of several landmark clinical trials in surgery.

Patients and Methods

Patients with invasive breast cancer (2004–2015) from the National Cancer Data Base were identified; subcohorts were created based on eligibility for NSABP-B06, CALGB 9343, and ACOSOG Z0011. Practice patterns were stratified by gender and compared. Cox proportional hazards regression analyses were utilized to estimate the association between OS and gender.

Results

Of the 1,664,746 patients identified, 99% were women and 1% were men. Among NSABP-B06 eligible men, mastectomy rates did not change (consistently ~ 80%), and their adjusted OS was minimally worse compared with women (HR 1.19, 95% CI 1.11–1.28). Following publication of CALGB 9343, omission of radiation after lumpectomy was less likely in men and lagged behind that of women, despite similar OS (male HR 0.92, 95% CI 0.59–1.44). Application of ACOSOG Z0011 findings resulted in deescalation of axillary surgery for men and women with comparable OS (male HR 0.69, 95% CI 0.33–1.45).

Conclusions

Uptake of clinical trial results for men with breast cancer often mirrors that for women, despite exclusion from these studies. Furthermore, when study findings were applied to eligible patients, men and women demonstrated similar survival. Observational studies can help inform the potential application of study findings to this unique population and improve patient enrollment in clinical trials.

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Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the deidentified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

Dr. O. Fayanju is supported by the National Institutes of Health (NIH) under Award Number 1K08CA241390 (PI: Fayanju). This work was in part supported by Duke Cancer Institute through NIH grant P30CA014236 (PI: Kastan) for the Biostatistics Core.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Jennifer K. Plichta MD, MS, FACS, Caitlin E. Marks BS, Rachel A. Greenup MD, MPH, Laura H. Rosenberger MD, MS, Oluwadamilola M. Fayanju MD, MA, MPHS & E. Shelley Hwang MD, MPH

  2. Duke Cancer Institute, Durham, NC, USA

    Jennifer K. Plichta MD, MS, FACS, Yi Ren MS, Samantha M. Thomas MS, Rachel A. Greenup MD, MPH, Laura H. Rosenberger MD, MS, Oluwadamilola M. Fayanju MD, MA, MPHS, Susan G. R. McDuff MD, PhD, E. Shelley Hwang MD, MPH & Jeremy Force DO

  3. Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA

    Samantha M. Thomas MS

  4. Department of Surgery, Durham VA Medical Center, Durham, NC, USA

    Oluwadamilola M. Fayanju MD, MA, MPHS

  5. Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA

    Susan G. R. McDuff MD, PhD

  6. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Jeremy Force DO

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  1. Jennifer K. Plichta MD, MS, FACS
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Correspondence to Jennifer K. Plichta MD, MS, FACS.

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Disclosures

:The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. J. Plichta is a recipient of research funding by the Color Foundation (PI: Plichta). She serves on the NCCN Breast Cancer Screening Committee and the ASCO Clinical Practice Guideline Committee for the Management of Male Breast Cancer. Dr. E.S. Hwang serves on the NCI Breast Cancer Steering Committee and the NCCN Breast Cancer Prevention Committee. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Samantha Thomas: Consulting work with Abbvie, Inc, on biosimilar/bioequivalence. Unrelated to this work. Relationship complete effective January 2019. Jeremy Force: METAVIVOR Early Career Investigator Award.

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Plichta, J.K., Ren, Y., Marks, C.E. et al. Surgery for Men with Breast Cancer: Do the Same Data Still Apply?. Ann Surg Oncol 27, 4720–4729 (2020). https://doi.org/10.1245/s10434-020-08901-z

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Keywords

  • Male breast cancer
  • Breast surgery
  • Breast radiation
  • Local–regional therapy