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  • • Painless lump beneath the areola in a man who is usually over the age of 50

    • Nipple discharge, retraction, or ulceration may be present

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Epidemiology

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  • • Rare disease, with an incidence only about 1% of that for carcinoma of the female breast

    • Average age of occurrence is about 60 years

    • 75% of males with nipple discharge have a breast carcinoma

    • Increase risk with BrCA-2 mutation

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Symptoms and Signs

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  • • Hard, painless breast lump, often beneath the areola

    • Nipple discharge, retraction, erosion, or ulceration

    • May have accompanying gynecomastia

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Imaging Findings

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  • • Mass on mammography

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  • • Blood-borne metastases often present at initial presentation, although may be latent

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Rule Out

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  • • Gynecomastia

    • Metastatic cancer from another site

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  • • History and physical exam

    • Mammography

    • Needle biopsy

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  • • Modified radical mastectomy is first-line therapy for surgical candidates

    • Surgical candidates chosen by the same criteria as women

    • Irradiation is the first step in treating localized metastases to skin, lymph nodes, or bone that are causing symptoms

    • Tumor hormone receptor status may be of benefit in determining role of adjuvant biochemotherapy

    • Castration is possible palliative measure for advanced metastatic disease

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Medications

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  • • Tamoxifen for metastatic disease

    • Potential role of aminoglutethimide to suppress adrenal androgen production (has replaced adrenalectomy)

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Prognosis

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  • • Worse prognosis, stage for stage, than female breast carcinoma

    • 5- and 10-year survival for stage I cancer is 58% and 38%, respectively

    • 5- and 10-year survival for stage II cancer is 38% and 10%, respectively

    • 5- and 10-year survival rates for all stages combined are 36% and 17%, respectively

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References

Agrawal A et al: Male breast cancer: a review of clinical management. Breast Cancer Res Treat 2007;103:11.  [PubMed: 17033919]
Fentiman IS et al: Male breast cancer. Lancet 2006;367:595.  [PubMed: 16488803]
Karhu R et al: Large genomic BRCA2 rearrangements and male breast cancer. Cancer Detect Prev 2006;30:530.  [PubMed: 17113724]
Nahleh ZA: Hormonal therapy for male breast cancer: A different approach for a different disease. Cancer Treat Rev 2006;32:101.  [PubMed: 16472925]

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Practice Guidelines

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