Male Breast Diseases

Chapter

Abstract

• No cause is found in 25 % of patients who develop gynaecomastia. • After persistent pubertal gynaecomastia, medication use and substance use are the most common causes of non-physiologic gynaecomastia. • In adult males gynaecomastia is often multifactorial, due to increased aromatisation of testosterone to oestradiol and the gradual decrease of testosterone production. • In men symptomatic or at high risk, the presence of gynaecomastia or obesity may mask early symptoms of MBC. • Core biopsy should be performed following imaging in those patients with uncertain or suspicious clinical or radiological findings. FNA is not recommended.

Future directions. Treatment for men with BC is the same as for women with the disease, but, according to new research, differences have been found that may change the way men will be treated in the future. Superficially, both genders appeared similar, but using more detailed analysis, subtle variations were observed specifically in relation to the hormone receptors, which influence the growth of most BCs. These findings highlight the need to understand more about how anti-hormone treatments can be optimised.

Keywords

Androgen Receptor Male Breast Male Breast Cancer Nipple Discharge Male Breast Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Braunstein GD. Clinical practise. Gynecomastia. N Engl J Med. 2007;20(357):1229–37.CrossRefGoogle Scholar
  2. 2.
    Rahmani S, Turton P, Shaaban A, Dall B. Overview of gynecomastia in the modern era and the Leeds Gynaecomastia Investigation algorithm. Breast J. 2011;17:246–55.CrossRefPubMedGoogle Scholar
  3. 3.
    Handschin AE, Bietry D, Hüsler R, Banic A, Constantinescu M. Surgical management of gynecomastia- a 10 year analysis. World J Surg. 2008;32:38–44.CrossRefPubMedGoogle Scholar
  4. 4.
    Gikas P, Mokbel K. Management of gynaecomastia: an update. Int J Clin Pract. 2007;61:1209–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Carlson HE. Approach to the patient with gynecomastia. J Clin Endocrinol Metab. 2011;96:15–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009;84:1010–5.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Dobs A, Darkes MJ. Incidence and management of gynecomastia in men treated for prostate cancer. J Urol. 2005;174:1737–42.CrossRefPubMedGoogle Scholar
  8. 8.
    Deepinder F, Braunstein GD. Drug-induced gynecomastia: an evidence-based review. Expert Opin Drug Saf. 2012;11:779–95.CrossRefPubMedGoogle Scholar
  9. 9.
    Mieritz MG, Sorensen K, Aksglaede L, et al. Elevated serum IGFI, but unaltered sex steroid levels, in healthy boys with pubertal gynaecomastia. Clin Endocrinol (Oxf). 2014;80:691–8.CrossRefGoogle Scholar
  10. 10.
    Bowman JD, Kim H, Bustamante JJ. Drug-induced gynecomastia. Pharmacotherapy. 2012;32:1123–40.CrossRefPubMedGoogle Scholar
  11. 11.
    Boccardo F, et al. Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol. 2005;23:808–15.CrossRefPubMedGoogle Scholar
  12. 12.
    Perdonà S, et al. Efficacy of tamoxifen and radiotherapy for prevention and treatment of gynaecomastia and breast pain caused by bicalutamide in prostate cancer: a randomised controlled trial. Lancet Oncol. 2005;6:295–300.CrossRefPubMedGoogle Scholar
  13. 13.
    Plourde PV, Reiter EO, Jou HC, et al. Safety and efficacy of anastrozole for the treatment of pubertal gynecomastia: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:4428–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Petty PM, Solomon M, Buchel EW, et al. Gynecomastia: evolving paradigm of management and comparison of techniques. Plast Reconstr Surg. 2010;125:1301–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Cordova A, Moschella F. Algorithm for clinical evaluation and surgical treatment of gynaecomastia. J Plast Reconstr Aesthet Surg. 2008;61:41–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101:51–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Korde LA, Zujewski JA, Kamin L, et al. Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol. 2010;28:2114–22.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Thomas DB, Jimenez LM, McTiernan A, et al. Breast cancer in men: risk factors with hormonal implications. Am J Epidemiol. 1992;135:734–8.PubMedGoogle Scholar
  19. 19.
    Gómez-Raposo C, Zambrana-Tévar F, Sereno-Moyano M, López-Gómez M, Casado E. Male breast cancer. Cancer Treat Rev. 2010;36:451–7.CrossRefPubMedGoogle Scholar
  20. 20.
    D’Avanzo B, LaVecchia C. Risk factors for male breast cancer. Br J Cancer. 1995;71:1359–62.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Okada K, Kajiwara S, Tanaka H, Sakamoto G. Synchronous bilateral non- invasive ductal carcinoma of the male breast: a case report. Breast Cancer. 2003;10:163–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Anderson WF, Jatoi I, Tse J, Rosenberg PS. Male breast cancer: a population-based comparison with female breast cancer. J Clin Oncol. 2009;28:232–9.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Sasco AJ, Lowenfels AB, Pasker-deJong J. Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected etiological factors. Int J Cancer. 1993;53:538–49.CrossRefPubMedGoogle Scholar
  24. 24.
    Giordano SH, Valero V, Buzdar AU, Hortobagyi GN. Efficacy of anastrozole in male breast cancer. Am J Clin Oncol. 2002;25:235–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006;367:595–604.CrossRefPubMedGoogle Scholar
  26. 26.
    Shaaban AM, et al. A comparative biomarker study of 514 matched cases of male and female breast cancer reveals gender-specific biological differences. Breast Cancer Res Treat. 2012;133:949–95.CrossRefPubMedGoogle Scholar
  27. 27.
    Cutuli B. Strategies in treating male breast cancer. Expert Opin Pharmacother. 2007;8:193–202.CrossRefPubMedGoogle Scholar
  28. 28.
    Gentilini O, Chagas E, Zurrida S, et al. Sentinel lymph node biopsy in male patients with early breast cancer. Oncologist. 2007;12:512.CrossRefPubMedGoogle Scholar
  29. 29.
    Katz A, Buchholz TA, Thames H, et al. Recursive partitioning analysis of locoregional recurrence patterns following mastectomy: implications for adjuvant irradiation. Int J Radiat Oncol Biol Phys. 2001;50:397–403.CrossRefPubMedGoogle Scholar
  30. 30.
    Giordano SH, Perkins GH, Broglio K, et al. Adjuvant systemic therapy for male breast carcinoma. Cancer. 2005;104:2359–64.CrossRefPubMedGoogle Scholar
  31. 31.
    Doyen J, Italiano A, Largillier R, Ferrero JM, Fontana X, Thyss A. Aromatase inhibition in male breast cancer patients: biological and clinical implications. Ann Oncol. 2010;21:1243–5.CrossRefPubMedGoogle Scholar

Further Reading

  1. ASPS. Gynecomastia, Practice Parameters. www.plasticsurgery.org/Documents/Gynecomastia-PP.pdf. Accessed 30 Jan 2015.
  2. Cloyd JM, Hernandez-Boussard T, Wapnir IL. Outcomes of partial mastectomy in male breast cancer patients: analysis of SEER, 1983-2009. Ann Surg Oncol. 2013;20:1545–50.CrossRefPubMedGoogle Scholar
  3. Doyen J, Italiano A, Largillier R, et al. Aromatase inhibition in male breast cancer patients: biological and clinical implications. Ann Oncol. 2010;21:1243–5.CrossRefPubMedGoogle Scholar
  4. Giordano SH, Hortobagyi GN. Leuprolide acetate plus aromatase inhibition for male breast cancer. J Clin Oncol. 2006;24:e42–3.CrossRefPubMedGoogle Scholar
  5. Greif JM, Pezzi CM, Klimberg VS. Gender differences in breast cancer: analysis of 13,000 breast cancers in men from the National Cancer Data Base. Ann Surg Oncol. 2012;19:3199–204.CrossRefPubMedGoogle Scholar
  6. Hurwitz DJ. Boomerang pattern correction of gynaecomastia. Plast Reconstr Surg. 2015;135:433–6.CrossRefPubMedGoogle Scholar
  7. Ruddy KJ, Winer EP. Male breast cancer: risk factors, biology, diagnosis, treatment and survivorship. Ann Oncol. 2013;24:1434–43.CrossRefPubMedGoogle Scholar
  8. Websites in Appendix: Male BC, A-4.14.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Breast SurgeryEuropean Institute of Oncology (IEO)MilanoItaly

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