A study that looked at nearly 1.9 million people diagnosed with breast cancer found that men have lower overall survival compared to women. The characteristics of the breast cancers and undertreatment of male breast cancer seem to account for much of the difference in survival rates.
Overall survival is how long a person lives, whether or not the cancer grows.
The research was published online on Sept. 19, 2019, in JAMA Oncology. Read the abstract of “Overall Mortality After Diagnosis of Breast Cancer in Men vs Women.”
Male breast cancer
While breast cancer in men is rare, it does happen. Fewer than 1% of all breast cancers are diagnosed in men. In 2019, about 2,670 new cases of invasive breast cancer will be diagnosed in men. For men, the lifetime risk of getting breast cancer is about 1 in 833.
Like breast cancer in women, breast cancer in men can be hormone-receptor-positive or hormone-receptor-negative, as well as HER2-positive or HER2-negative.
Because the number of cases of breast cancer in men is relatively small compared to the number of cases in women, there is a lack of information on male breast cancer in general. Treatment decisions for male breast cancer are usually based on studies in women.
About the study
The study looked at information from:
- 16,025 men diagnosed with breast cancer
- 1,800,708 women diagnosed with breast cancer
The information came from the National Cancer Database, a collection of information from more than 1,500 Commission on Cancer-accredited facilities in the United States. The database is sponsored by the American College of Surgeons and the American Cancer Society. The data represent more than 70% of newly diagnosed cancer cases in the country.
The people were diagnosed between 2004 and 2014.
The characteristics of the people in the study:
- the men’s average age at diagnosis was 63.3 years; the women’s was 59.9 years
- 82.5% of the men and 83.1% of the women were white; 13% of the men and 11.4% of the women were black; and 3% of the men and 4.3% of the women were Hispanic
- both men and women lived between 21 and 22 miles from a cancer care facility
- 46.5% of the men and 55.4% of the women had private insurance; 48.4% of the men and 40.4% of the women had government insurance; and 2.8% of the men and 2.2% of the women had no insurance
More men were diagnosed with later-stage cancer than women:
- 14.0% of men and 8.9% of women were diagnosed with stage III breast cancer
- 5.8% of men and 3.8% of women were diagnosed with stage IV breast cancer
When looking at treatments, the researchers found that men diagnosed with hormone-receptor-positive breast cancer were less likely to be treated with hormonal therapy than women (hormonal therapy is the standard of care for early-stage hormone-receptor-positive breast cancer):
- 57.9% of men diagnosed with hormone-receptor-positive disease were treated with hormonal therapy
- 70.2% of women diagnosed with hormone-receptor-positive disease were treated with hormonal therapy
Men also were less likely to be treated with radiation therapy, including men who had lumpectomy to remove the breast cancer (lumpectomy and radiation therapy is considered to be just as effective as mastectomy to treat early-stage breast cancer):
- 64.9% of men who had lumpectomy had radiation
- 78.6% of women who had lumpectomy had radiation
The men were followed for about 4.5 years, and the women were followed for about 5 years.
- 3,988 men died (24.9%)
- 288,989 women died (16.0%)
Compared to women, men had:
- lower overall survival rates: 45.8% vs 60.4%
- lower 3-year survival rates: 86.4% vs 91.7%
- lower 5-year survival rates: 77.6% vs 86.4%
These differences were seen regardless of cancer stage, hormone-receptor status, HER2 status, age, year of diagnosis, and other health conditions.
By breast cancer stage, 5-year survival rates were:
- 87.8% for men and 92.5% for women diagnosed with stage I disease
- 78.9% for men and 85.9% for women diagnosed with stage II disease
- 63.3% for men and 70.1% for women diagnosed with stage III disease
- 21.4% for men and 25.1% for women diagnosed with stage IV disease
A number of factors were linked to lower overall survival for men diagnosed with breast cancer, including:
- cancer grade
- cancer stage
- type of surgery
- whether a man received chemotherapy, radiation therapy, hormonal therapy, or targeted therapy
- access to care
“The [cause] of male breast cancer is largely unknown,” Xiao-Ou Shu, M.D., Ingram professor of cancer research and professor of medicine at Vanderbilt University and one of the study’s authors, said in an interview. “Except for [a] BRCA gene mutation, there [are] almost no known risk factor[s]. Thus, it is difficult to identify high-risk men. More research that specifically focuses on male breast cancer is needed.”
What this means for you
If you’re a man who has been diagnosed with breast cancer, this study may seem disheartening. But it does show that you need to be your own best advocate to make sure that you get the treatments that are best for your unique situation. Based on the study results, undertreatment is likely the reason for much of the survival rate difference between men and women diagnosed with breast cancer.
It’s also very important to talk to your doctor right away about any changes in your breasts, including:
- nipple pain
- inverted nipple
- nipple discharge
- sores on the nipple and/or areola area
- enlarged lymph nodes under the arm
Because many men don’t consider the possibility that they may develop breast cancer, they may wait a year or longer to talk to their doctor after noticing a breast symptom. This means the cancer is diagnosed at a later stage, which also contributes to higher mortality rates for men with breast cancer.
“Future research should focus on why and how clinical characteristics, as well as biological features, may have different implications for the survival of male and female patients with breast cancer,” the researchers concluded. “Additional factors, particularly compliance to treatment, biological attributes, and lifestyle factors (e.g., smoking, drinking, and obesity), should be assessed to help in developing treatments tailored for men, which would mitigate this sex-based disparity.”
For more information, visit the Breastcancer.org pages on Male Breast Cancer.
If you're a man who has been diagnosed with breast cancer and would like to talk with others, join the Breastcancer.org Discussion Board forum Male Breast Cancer.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser