Major differences between male and female breast cancers found

Traveltext

Report by ECCO - European Cancer Organisation. Reported HERE

Major differences between male and female breast cancers uncovered but male patients still disadvantaged by lack of research, say investigators

Male breast cancer (Male BC) has important biological differences that distinguish it from female breast cancer, but to date these have been little studied and Male BC patients have been excluded from many clinical trials in breast cancer. Male patients are also usually diagnosed later when their cancers are more advanced, leading to a worse outcome. New research has now uncovered some of the differences between the two types of breast cancer, and the researchers hope that this will help doctors to make better treatment choices for Male BC patients.

Speaking at the 10th European Breast Cancer Conference (EBCC-10) today (Thursday), Dr Carolien van Deurzen, MD, a pathologist specialising in breast cancer at the Erasmus Medical Centre, Rotterdam, The Netherlands, reported results from a study [1] of the relationship between the pathology of different types of Male BC and their prognosis. The study forms part of the International Male Breast Cancer Program, led by the European Organisation for Research and Treatment of Cancer (EORTC) in Europe and the Translational Breast Cancer Research Consortium (TBCRC) in the USA. The team of researchers examined 1203 tumour samples from Male BC patients who made up part of the largest series of this disease ever collected linked to outcome data -- 1483 patients from 23 centres in nine countries.

"Besides conventional tumour tissue characteristics, such as subtype and grade, we also examined additional features, such as the development of fibrotic connective tissue, and the density of tumour infiltrating lymphocytes, a type of white blood cell often found in tumours and implicated in killing tumour cells," she said. "Interestingly, we found that these two last factors were strongly associated with outcomes in Male BC, whereas tumour grade, a commonly used prognostic measure in female breast cancer was not."

Grading examines the similarity of breast cancer cells to normal breast tissue in order to classify severity and prognosis of the disease. A potential explanation for the lack of association between grading and outcome in men is the different distribution of breast cancer subtypes in male patients, say the researchers. For example, lobular tumours [2] are relatively common in women but rare in men. The researchers also found that a large proportion of male cancers were luminal, or oestrogen-receptor positive (tumours sensitive to oestrogen-deprivation as a treatment strategy), whereas HER2 positive and triple negative [3] subtypes are more common in women.

"However, this sub-typing of breast tumours does not seem to result in an optimal risk classification for Male BC patients. Additional tests that are well established in women, including gene-expression profiling, may result in the identification of more accurate prognostic and predictive markers. These could enable us to take better treatment choices, individualised for each patient, particularly in regard to the use of chemotherapy and new targeted agents," said Dr van Deurzen.

Male BC is rare, accounting for less than 1% of all breast cancer cases and 1% of all cancer cases in men. The ratio of female to male breast cancer is approximately 100:1 and this means that there is little awareness among men, and even among physicians, regarding the occurrence of breast cancer in males. This has major implications for these patients, leading to their often being diagnosed late and therefore affecting prognosis.

The researchers hope to begin a clinical trial soon using a new agent that blocks the androgen receptor, a protein that is frequently present in Male BC, for the patients in the programme.

"This will only be possible with a worldwide collaboration, but it is also important that Male BC patients should take part in general breast cancer trials, since trials for them alone are difficult to run due to the rarity of the disease. In the past, male patients have been persistently excluded, with no scientific rationale for doing so. It is also essential to find independent sources of funding to study Male BC; once again, it is its rarity that makes this difficult.

"In the meantime, we believe that our findings will help focus research in the field, since they indicate that we should be focusing on improving the management of luminal cancers as opposed to other subtypes in these patients," Dr van Deurzen concluded.

David Cameron, Professor of Oncology at the University of Edinburgh, UK, who was not directly involved in the research, said: "These are important conclusions from this international project. It has always been assumed, based on limited information, that men with breast cancer should be treated in the same way as women; for the first time, by studying over 1000 cases, it is becoming clear that that this is not so."

Abstract no. 7, "Pathologic prognostic factors of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABG International Male Breast Cancer Program", Thursday 11.00 hrs, Best oral abstract session, Elicium.

Notes:

[1] EORTC 10085/TBRC/BIG/NABG International Male Breast Cancer Program

[2] Lobular cancer is a subtype of breast cancer with a poorly-defined margin, which can make it difficult to visualise and excise completely.

[3] HER-2 positive breast cancers are those where there is an amplification in the HER-2 gene, involved in regulating cell growth. This leads to cancer cells reproducing more rapidly than normal. Triple negative breast cancer is where tumour cells are negative for oestrogen receptors, progesterone receptors, and HER-2.

oddducklady

Traveltext- Thanks for posting this. Very interesting. The conclusion that there may need to be a difference in treatment for men then women is important. When my husband was first diagnosed the Dr. had never seen a case of male BC and he didn't think anyone in our town had ever seen a case either. If he thought he was being reassuring by telling us "the treatment is the same for men as women", he was not, so we went out of state for treatment. I wonder if any of my husband's tissue samples were in the study. Also, on a visit to the oncologist a few months ago my husband saw a notice about a clinical study on BC chemo and mental status changes, chemo brain, etc. He asked about the study and was told it was just for women. He didn't think that was right and I didn't either.

Traveltext

odducklady. This is a European study, so it's unlikely any of your husband's tissue was used. It's so hard to get male-specific info and it doesn't help when men are excluded from studies such as, for goodness sake, BC chemo and mental status changes!

It's very unlucky for your husband to have a recurrence in the other breast and I'm sorry that he (and you) are going through it all again. The docetaxol is an especially strong chemo and will likely do the job. Is there to be a right mastectomy?

You are welcome to PM me if you or your husband would like another pair of ears. I'm trained as a cancer counsellor, have contact with several guys going through treatment, and do hospital visits to oncology patients.

steelrose

Traveltext… Interesting post. I come back to this forum just to check that it still has a pulse! As I mentioned before, my dad died of the disease in '97… truly the dark ages of male bc. My dad was initially treated with Tamoxifen, as I was, followed by chemo. Taxol, I believe. It was difficult because like in oddducklady's husband's situation, my dad's doctor had never dealt with male bc. Anyway, glad you're still here, speaking up, speaking out, and helping to move things along in this neglected group of male bc patients.

Oddducklady… I'm so sorry that you and your husband are battling this. Very wise of you to go out of state to find the help and treatment you need. Second opinions, and sometimes third opinions are always good if you're at all in doubt. I've been stage iv for over six years now, and there is hope. Wishing you the best!

Rose.

ShetlandPony

It's great that a study such as this has finally been done.

A note about this part: "The researchers hope to begin a clinical trial soon using a new agent that blocks the androgen receptor, a protein that is frequently present in Male BC, for the patients in the programme." If anyone is interested in this approach, look up the drug Xtandi, discussed elsewhere on these discussion boards. It is an anti-androgen drug. I don't know if it is the agent for this clinical trial, but my point is that it may be possible to access such a drug without waiting for a trial.

Traveltext

steelrose...Thanks for looking in. Not much happens under this topic, so I spend most of my time learning about the disease by reading appropriate topics posted by all the helpful women on BCO.

Your dad certainly had basic treatment in '97, but my mum was treated in '62 before even chemo and hormone blockers became widely available. She survived for two years post diagnosis. We live in a more advanced medical era, but a cure is still as remote as ever. I can see from your post history that you are strong supporter of Stage IV members, so good on you and I wish you well.

Traveltext

ShetlandPony. Thanks for that tipoff on Xtandi, I'll follow it up.

pops

I just learned something. This is why Lucretia Borgia, my chemo oncologist has me on Tamoxifen.  It is an estrogen blocker.    Diagnosed 7/24/ 09 radical right mastectomy most of the  lymph nodes gone 7/29/09 stage 2 B. Then AZT chemo for 16 weeks.  I rested up over  the holidays,then 33 doses of  radiation in 35 days. Cut, poisoned and nuked. A chance question to  my NP at the end of a physical and I was diagnosed  earlier than  I would have  left  to  my own devices.  I got a prescription for Celexa and considered the whole thing an adventure. Everyone will tell you to stay positive. Stay positive. You'll  have a better time  of it. If you can get  medical pot, do so.  It works great for  nausea. Look at  the  differences this way, If only 2600 men a yr were diagnosed with breast cancer and women  didnt get it by  the thousands.. We'd be goners. Nobody would bother to do  the research for that small a group.

Fiddleman

Pops, Congratulations on 16 years as a survivor!!!  I was diagnosed with stage 2, right breast back in May.  As with all male survivors I've contacted, my first reaction was incredulous shock. Thankfully I'm near a large nationally recognized world class cancer research center. They found 2 tumors and did not hesitate to schedule a mastectomy .  May 31, surgery. They removed the sentinel nodes and a few others and the sentinels were clear. A glitch in processing the samples required almost a 2 week wait for the path report, and 3 nodes had cancer. The buggers skipped the sentinels.  Go figure.  June 21, second surgery to remove the remaining nodes to ensure the cancer had not spread farther.  All the removed nodes were clear, so we now go to adjuvant therapy. I did find a clinical trial open to males called a Mammoprint. They sent a tumor sample to an outfit in CA for assay and we're waiting (yet again in limbo) for results.  This test is likely to tell me whether I get tamoxiifen alone or in conjunction with chemo (P and E receptors positive, HER2 - stage 2, non metastasis, tumor grade 2). All along they have been talking about the most effective treatment with the least side effects.  Unfortunately because aromatase inhibitors are shown to be effective mostly in post menopausal women and have not been sufficiently tested in men, that les intrusive therapy was not available, but it is one of the newer therapies base on hormonal treatment.

What you've gone through seems typical of the scattershot therapies of a decade or more ago me.  Obviously it has worked well for you.  Thankfully there now appear to be more options for men to participate in clinical trials, but perhaps they are available mostly through major cancer research.  Traveltext, have you heard of the Mammaaprint study?  I'd be interested to know.

PS   My theme song now is Jimmy Cliff's "Waiting Here in Limbo" from "The Harder They Come" sound track

Traveltext

Great to have pops and Fiddleman chime in on this post. My calculation makes pops 7 years post treatment and that's certainly a great milestone. It's certainly true that we benefit from the research done on women who make up 99% of the cases. But the pink hoopla signifies the disease as women only and I know several guys who have ended up with a late diagnosis because they and their doctors weren't looking for the disease.

Fiddleman, great you are happy with your treatment to date. The surgery is an important start, but I wouldn't hesitate to take the chemo if it is recommended. Plus radiation to mop up. pops is doing well after his cut, poison and burn treatmet and I'm nearly two years NED after same. Haven't heard of the Mammaprint study. Do your both know of the Male Breast Cancer Coalition? If not, check them out.

Let's keep up the dialogue.

Fiddleman

Traveltext, I guess my calculator (wet wired) was impaired when I posted earlier. Pops, I certainly hope my addition of another decade to your survivorship becomes a  reality.  Regardless, 9 years post surgery is still a great coup.  Keep on keepin' on!  Just out of curiosity,, is your oncologist 's real name Lucretia Borgia? How ironc.

Traveltext, yes, I have heard of the MBCC.  I found the site doing my "pre chemo homework". 

I have another source that may help.  It's a book written by a male breast cancer survivor,. Dr. Wayne Dornan titled "How I Survived Breast Cancer".  Along with descriptions of his own personal struggle. it contains a wealth of current information on treatments, and statistical outcomes. He specifically addresses the differences between male and female BC, and the lack of a significantly large enough sample of males to warrant research dedicated exclusively us.  I found out about him and his book while searching the Koman website, http://blog.komen.org/male-breast-cancer-badge-honor/.

My research so far has connected me in one way or another with, including this blog, about 15 male survivors. Yep, not a huge number, but enough to know that  WE ARE NOT ALONE!!  Can you imagine not having the web for both research and connections? Oh. and BTW, I emailed Dr. Dornan, and we've had a few pleasant exchanges. I'm certain he would welcome hearing from other members of our "Club".

This October will be my first as a survivor, and already I'm getting the heebie jeebies over the "Pink Invasion!"

Traveltext

Yep, nine years is fine and a great goal for us all. I'm just looking forward to the five-year mark!

Will certainly check out the Dorman book and get in touch. Absolutely the best book on the topic I have found is the recently published Male Breast Cancer: Taking Control by Dr John Boyages. You must read it. The Amazon link is HERE. I also have posted some useful links at the bottom of this web page HERE.

I have a network of five guys in my country. One of them, Rob, is Stage IV but doing well over two years. He has a zest for life that is really infectious and he's a great role model for me.

I have a real beef with the pink hoopla too. It may might raise heaps of revenue (mostly spent on "awareness"), but it just reinforces bc as a women only disease and stops men, and even their physicians, from considering they might get it too. Later diagnosis leads to poorer prognosis. BCO has a good thread on the topic HERE.

Fiddleman

Traveltext, sorry I haven't responded until now.  You know how the beast can command your time and attention.  At any rate, thanks for the book suggestion and links. I'll check them out.  Re rarity, my GP said he's never seen a male case in his 20 years of practice, and you should have seen the expression on the face of the person fitting me for lymphedema sleeves!  My next door neighbor, who's a PT assistant, had also never seen a case, nor has my lymphedema  therapist.  I don't know if I'll have more to post in this thread, but I look forward to seeing you on others. BTW, I know a guy who is now a 20 year survivor, Stage II with the full load of the relatively primitive  adjuvant therapies that were available back in the late 90's.  He's still very active and is going strong.  Also, some of the stats I've seen suggest that  91% of (again) women who even refuse post surgical treatment at stage 2 are likely to survive for 5 years (Dornan, 2015 "How I Survived Breast Cancer" p.8).  Even at Stage 3  your 5 year goal, and then some, seems quite reasonable.  The following link will bring you to a survival prediction tool that will address your specific situation.  I think you might find it encouraging (http://www.predict.nhs.uk/predict.htm ) I'm sorry about the grammatical errors in previous posts.  For some reason my typing skills are starting to lag behind my thought processes

Traveltext

Fiddleman, that predictor link doesn't work. Are you having chemo? It helps those following your treatment if you fill in your profile. People tend to come and go here, but when further treatment issues arise you'll find a willing bunch of helpers here. My advice is to be conservative with your treatment, and read widely both about anything offered and anything you're considering opting out of.

Fiddleman

My apologies Traveltext. Here's the correct address, complete with the "l" that was chopped off : http://www.predict.nhs.uk/predict.html . What browser are you using? The direct link seems to work fine with Firefox and Explorer (I just tested it on both browsers). It does not seem to play well with Edge (you could make it work by copying the link to Word, removing the hyperlink, and then pasting it directly into the address bar. Clunky but effective for all browsers). I've found Edge, my default browser, to be a little wonky running scripts sometimes. I did order the book and I look forward to comparing the American and Australian approaches. I'm not in chemo yet and am still awaiting the Mammaprint results. I see my oncologist next week. I'll update my profile as you suggested and will continue to keep you informed.

Traveltext

Yep, that works thanks. A very optimistic result for me compared to other calculators, so I'll run with it!

Great to see your profile updated, don't forget to add your surgery details. When do you hear about chemo? Aromatase inhibitors are not effective in men with ER+, HR+, HER2-. My pal Rob was put on them and he went stage IV after four years. Tamoxifen is the drug used mostly for men. I've been on it for nearly two years without any side effects at all.

In the book you'll find the standard treatment practices worldwide for male bc cases. It came out after my treatment, but its an excellent book that will help you make decisions and follow what is recommended for you in terms of treatment.

Fiddleman

Glad it worked for you.  Here's another tool that Dornan references.  I haven't tried it yet, but you might be interested

http://tools.bcsc-scc.org/BC5yearRisk/ .  I'd try it out on another browser than wonky Edge. 

Sorry about Rob. Have his results been documented with some sort of research facility?  Perhaps his experience would add to the data on treatments for MALE BC, so at least something good can come out of it.  Just a suggestion. Glad to hear that you've tolerated tamoxifen well.  I'm a little worried about the next phase and your experience is giving me hope.  I'm back to playing my fiddle and am regaining my old chops. I hope hormonal/chemo therapy (ies) won't stop my returning to orchestra and quartet.  We'll see. One day at a time

On that score, I had my 2nd lymphodema session today and we're making slow but sure progress.  Range of motion is also improving too.   Will update as I get more info.

Traveltext

Rob has a great medical team, is two years post Stage IV diagnosis, and is getting on with life full steam ahead including travel and motorbike touring.

My best advice is to not have preconceptions about any stage of your treatment. I know several guys who have been through full treatment and they came through with few, if any, side effects. Nothing should stop you getting back to your fiddle unless, perhaps, the lymphedema doesn't settle down. How did that happen, and how bad is it?

Fiddleman

Glad he's dong so well.  I hear Stage 4 and I think the worst. Like Rob, we've decided that we're travelling, to the Galapagos, once I'm free and clear of all this.  I'm a former biology teacher, need to pay my respects and I also hear the trip is fantastic.  My wife has always wanted to go through the Panama Canal, so we may include that If there's enough $ and the gods allow. 

The lymphedema was there from the very the get go.  I kept asking the nurses if the swelling was lymphedema, and they said it was not.  One said it's unusual for it to come on so soon after surgery.  Looks like my winning lottery ticket is still valid. HA!  My full right arm is swollen a little and I've caught it at the early stages.  Already the therapist has noticed a slight reduction and I don't even have the corrective sleeve yet.  My friend had it so badly her whole hand looked like a mitten, and this therapist got her to the point that she can go without a sleeve, at least for limited times.  BTW, how's the weather Down Under?  We're hot, humid and hazy, but we'll get our share of cold come Feb. 

Traveltext

Sounds like you have a good therapist for the LE. The sleeve will help a lot, I know. Areyou ok to play the fiddle? That may be good therapy. It's certainly frustrating when you suspect something is up and you can't persuade a health professional to take you seriously. I've learned to follow closely every aspect of my treatment and be my own advocate. These people are busy and we need to take charge of our treatment ourselves. Rob got this condition four years post treatment after an insect bite and it has flared to Cellulitis a couple of times. I'm paranoid about caring for my lymph-free arm since that's a lottery win I'll pass on.

Had a friend do the Galapagos recently and she loved it. Go for it. It's winter in Australia, but I'm in a subtropical zone so it's pretty mild.

Fiddleman

It's been a few days and I've had a lot to digest. Right now I've had to decide between 2 therapies. More about that later. Yes, my LE is getting better and I'm now wearing a reduction device on the arm 24/7. Between that, the LE therapy and LE exercises, I"m making progress ( swelling's down from initial circumference readings from 1cm on one site and 2 cm on another.) I'm given the OK to just wear the sleeve without the glove for practice, and had my first quartet practice yesterday The first fiddle thought I'd not lost too much of my chops. Of course we were all a little rusty since they've not seriously worked on a quartet with my sub.

Now to the decision. My oncologist, following the results of the Mammaprint and oncogene tests, suggested Cytoxen&Taxotere for 4 cycles of 21 days. However there's more than a reasonable chance of my getting permanent peripheral neuropathy. Not good for a fiddle player, canoer, and model hobbyist.

Another possible protocol is cytoxen/flurouracil/methotextrate (CMF) for 6 cycles of 21 days. This is about 2-3% less effective, and my immune system will be down for at least 42 days longer, but there's no PN risk. I've been going 'round and 'round on this but I have finally decided on the CMF x6. My wife agrees, as does the oncological PA. Now the fun begins. Chemo starts next Thurs with an IV. They'll put a mediport in the following week. It's going on the affected right side so I can hold the fiddle.Now I focus on controlling SE's as well as the LE (will be extremely vigilant of the LE arm, do NOT want cellulitis) , and keeping myself positive. Will keep you posted.

BTW, should this be posted in another forum? It's a little off-topic. Go Galapagos!!!!!!!!!!!!!

Traveltext

Fiddleman. looks like you are getting the LE under control, great news. The fiddle practice is likely PT in itself.

As to the chemo regimen, all I know is that FEC x 3 and Taxotere x 3 (21-day intervals and always with ice mittens) got me through without PN.

Sounds like you are set on a reasonable course, but it wouldn't hurt to start a new post with your questions here: https://community.breastcancer.org/forum/69

Plus, this thread would be very appropriate since these people have PN: https://community.breastcancer.org/forum/69/topics/763459?page=53

Good luck and keep us posted.

Valstim52

Fiddleman and Traveltext your posts are inspiring. Fiddleman in your pocket for chemo. It's very doable and it may not seem like it now but treatment does end. It was in January Traveltext was giving me words of wisdom as we are in the dreaded iBC club. Now I'm done with treatment

Val

Fiddleman

Wow, Valstim! I wasn't sure there was anyone else monitoring this thread except for Traveltext and me. Thank you for your kind words and encouragement Congrats on the end of your chemo and I hope you have a long and happy remission. I guess we both owe Traveltext a huge amount of gratitude. Thanksa gain, and keep both of us posted on how you're doing.

Traveltext

We all learn from each other at BCO. Actually, Valsrim has already had a long and happy remission from a bout of bc 25 years ago. That may be a story for her to tell.

Valstim52

Yes traveltext I did. no lump. Was sent for a battery of tests by my ob/gyn and he had checked off mammogram. I was only 31. But went anyway. They found a spot, biopsied, and it was cancer. A total shock. I had a lumpectomy (was considered somewhat experimental back then) rads, and on tamoxifen only a year as that was then a clinical trial. Back then there was not really staging, chemo before surgery etc. I was fortunate to get in a major university hospital that had trials and were on the leading edge of breast cancer. I know now, my tumor was estrogen positive, but in those days there was not a lot of dissecting, analyzing etc. They cut it out, radiated you and sent you on your way.

How things have changed. It took a while for cancer to leave my daily thoughts but it did. I'm hoping to get there again.

Traveltext

Thanks for sharing that story Val, you were certainly lucky to get such timely and excellent treatment. And fortunate, now, to be a TN when the treatments are so much better. Are your rads done with? Are AIs in the plan?

It's pretty hard not to dwell on this disease when you have scars and burns to recover from. I always think, though, how lucky we are to have such good health services at our disposal.

Valstim52

You are so right traveltext. I'm so glad to have so many options, though they are somewhat limited after standard treatment for TN, but so much is in the pipeline.

Being TN no AI's, or additional chemo for me. Some go to xeloda, but from what I understand that it only works if you are BRCA positive.

I'm still quite burned. Still trying to recover.

Traveltext

As I understand it xeloda works well in TN's who haven't achieved pathologic complete response, not just BRCA + people, although the side effects are a worry.

http://www.ascopost.com/issues/december-25-2015/patients-with-incomplete-response-to-neoadjuvant-chemotherapy-benefit-from-capecitabine/

It must feel good to have the treatment behind you. Certainly the burns will heal given good care and some time.

Smurfette26

Traveltext I was interested to read that you have trained as a cancer counsellor. This is something I'd be really interested in. I worked for LifeLine for many years though not as a counsellor. May I ask what course of study you undertook? You posts are always informative and interesting. Thanks for your contributions. Donna.

Traveltext

Donna, I did my training with CCQ and you can read the job descriptions HERE. I did the Hospital Volunteer and Cancer Connect (telephone counselling) courses. This is QLD Cancer Council but each state group has similar courses. I've specialised is telephone counselling men, and have made contact with eight men with bc. I enjoy talking with them as much as imparting what I know about this disease. But since these candidates are few and far between, I do the hospital visits to the oncology ward of my local public hospital. That's where you see really sick people and I have to say I feel quite lucky after returning from a couple of hours in the ward. The thing I've really learned is to be a good listener. That way you are of most help. Good luck finding a suitable course, you'll find it very rewarding.