American Society of Breast Surgeons (ASBS): Annual Meeting

Radiofrequency ablation could become an option for some patients facing adjuvant radiation after breast-conserving surgery for invasive breast cancer, the results of a phase II trial suggest.

Excision followed by radiofrequency ablation (eRFA) was at least as effective as radiation therapy following lumpectomy in preventing local tumor recurrence in the single-arm study of 73 patients who underwent breast conserving surgery, according to investigators. Only one patient had an in-site recurrence while three had recurrences, they reported at the annual meeting of the American Society of Breast Surgeons.

"For selected breast cancer patients undergoing breast-conservation therapy, eRFA is an attractive alternative to breast irradiation," said Dr. Misti Wilson at a press briefing.

The intraoperative procedure of excision followed by radiofrequency ablation employs heat to create an additional tumor-free zone, approximating the zone treated by brachytherapy, around the lumpectomy cavity. Its benefits include reduced likelihood of the need for re-excision and for additional radiation; lower cost, compared with radiation; and good to excellent cosmetic results, said Dr. Wilson, a breast surgical oncology fellow at the University of Arkansas in Little Rock.

The study enrolled 73 patients with tumors of less than 3 cm. Median follow-up was 55 months. All underwent standard lumpectomy followed by radiofrequency ablation, in which the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 degrees C for 15 minutes.

None of the patients received subsequent radiation or chemotherapy. Only those with grossly positive margins or residual calcifications on postoperative mammography were re-resected.

Among 19 patients who had inadequate margins, RFA spared 16 (84%) from additional surgery. Only three patients (4%) had to return to the operating room for resection because of grossly positive margins. There was just one in-site recurrence out of 73 patients, and 3 had recurrences elsewhere, Dr. Wilson reported.

Of 40 patients who scored their cosmesis, 18 (45%) reported excellent cosmetic results, 18 (45%) reported good results, and 4 (10%) reported fair cosmetic results.

"These findings show that this is a safe procedure, patients can have less repeat surgery, they have good cosmetic outcomes, and RFA may replace radiation therapy in patients with small tumors and are node negative," Dr. Wilson said in an interview.

The cost of eRFA is around $2,000 dollars. In contrast, standard whole breast radiation costs approximately $11,000, and partial breast around $18,000 depending upon site and location, she said.

The ABLATE trial is investigating eRFA in a larger patient population. To date, the trial includes five centers (Columbia University, N.Y; University of Kansas, Lawrence; Comprehensive Breast Care of San Diego, University of Arizona, Tucson; and Rockefeller Cancer Institute in Little Rock) and is actively recruiting and training additional sites.

Early results were presented in a poster by the primary investigator of both studies, Dr. V. Suzanne Klimberg, professor of surgery and pathology and director of the breast program at the University of Arkansas.

Of 55 patients (mean age 65 years) with ductal carcinoma in situ or invasive breast cancer with average tumor size 0.9 cm who underwent eRFA, 20 had positive margins: 14 had close margins (less than 2 mm), 2 had focally positive margins, and 4 had grossly positive margins. Of those, 15 were spared re-excision. Morbidity at 30 days was 7.2% and there were no deaths.

The University of Arkansas sponsored the study in collaboration with AngioDynamics, maker of the RFA delivery system.Dr. Wilson stated that she has no disclosures. Dr. Klimberg received research grants from AngioDynamics and retailers Fashion Footwear Association of New York and QVC.

Radiofrequency ablation could become an option for some patients facing adjuvant radiation after breast-conserving surgery for invasive breast cancer, the results of a phase II trial suggest.

Excision followed by radiofrequency ablation (eRFA) was at least as effective as radiation therapy following lumpectomy in preventing local tumor recurrence in the single-arm study of 73 patients who underwent breast conserving surgery, according to investigators. Only one patient had an in-site recurrence while three had recurrences, they reported at the annual meeting of the American Society of Breast Surgeons.

"For selected breast cancer patients undergoing breast-conservation therapy, eRFA is an attractive alternative to breast irradiation," said Dr. Misti Wilson at a press briefing.

The intraoperative procedure of excision followed by radiofrequency ablation employs heat to create an additional tumor-free zone, approximating the zone treated by brachytherapy, around the lumpectomy cavity. Its benefits include reduced likelihood of the need for re-excision and for additional radiation; lower cost, compared with radiation; and good to excellent cosmetic results, said Dr. Wilson, a breast surgical oncology fellow at the University of Arkansas in Little Rock.

The study enrolled 73 patients with tumors of less than 3 cm. Median follow-up was 55 months. All underwent standard lumpectomy followed by radiofrequency ablation, in which the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 degrees C for 15 minutes.

None of the patients received subsequent radiation or chemotherapy. Only those with grossly positive margins or residual calcifications on postoperative mammography were re-resected.

Among 19 patients who had inadequate margins, RFA spared 16 (84%) from additional surgery. Only three patients (4%) had to return to the operating room for resection because of grossly positive margins. There was just one in-site recurrence out of 73 patients, and 3 had recurrences elsewhere, Dr. Wilson reported.

Of 40 patients who scored their cosmesis, 18 (45%) reported excellent cosmetic results, 18 (45%) reported good results, and 4 (10%) reported fair cosmetic results.

"These findings show that this is a safe procedure, patients can have less repeat surgery, they have good cosmetic outcomes, and RFA may replace radiation therapy in patients with small tumors and are node negative," Dr. Wilson said in an interview.

The cost of eRFA is around $2,000 dollars. In contrast, standard whole breast radiation costs approximately $11,000, and partial breast around $18,000 depending upon site and location, she said.

The ABLATE trial is investigating eRFA in a larger patient population. To date, the trial includes five centers (Columbia University, N.Y; University of Kansas, Lawrence; Comprehensive Breast Care of San Diego, University of Arizona, Tucson; and Rockefeller Cancer Institute in Little Rock) and is actively recruiting and training additional sites.

Early results were presented in a poster by the primary investigator of both studies, Dr. V. Suzanne Klimberg, professor of surgery and pathology and director of the breast program at the University of Arkansas.

Of 55 patients (mean age 65 years) with ductal carcinoma in situ or invasive breast cancer with average tumor size 0.9 cm who underwent eRFA, 20 had positive margins: 14 had close margins (less than 2 mm), 2 had focally positive margins, and 4 had grossly positive margins. Of those, 15 were spared re-excision. Morbidity at 30 days was 7.2% and there were no deaths.

The University of Arkansas sponsored the study in collaboration with AngioDynamics, maker of the RFA delivery system.Dr. Wilson stated that she has no disclosures. Dr. Klimberg received research grants from AngioDynamics and retailers Fashion Footwear Association of New York and QVC.

Radiofrequency ablation could become an option for some patients facing adjuvant radiation after breast-conserving surgery for invasive breast cancer, the results of a phase II trial suggest.

Excision followed by radiofrequency ablation (eRFA) was at least as effective as radiation therapy following lumpectomy in preventing local tumor recurrence in the single-arm study of 73 patients who underwent breast conserving surgery, according to investigators. Only one patient had an in-site recurrence while three had recurrences, they reported at the annual meeting of the American Society of Breast Surgeons.

"For selected breast cancer patients undergoing breast-conservation therapy, eRFA is an attractive alternative to breast irradiation," said Dr. Misti Wilson at a press briefing.

The intraoperative procedure of excision followed by radiofrequency ablation employs heat to create an additional tumor-free zone, approximating the zone treated by brachytherapy, around the lumpectomy cavity. Its benefits include reduced likelihood of the need for re-excision and for additional radiation; lower cost, compared with radiation; and good to excellent cosmetic results, said Dr. Wilson, a breast surgical oncology fellow at the University of Arkansas in Little Rock.

The study enrolled 73 patients with tumors of less than 3 cm. Median follow-up was 55 months. All underwent standard lumpectomy followed by radiofrequency ablation, in which the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 degrees C for 15 minutes.

None of the patients received subsequent radiation or chemotherapy. Only those with grossly positive margins or residual calcifications on postoperative mammography were re-resected.

Among 19 patients who had inadequate margins, RFA spared 16 (84%) from additional surgery. Only three patients (4%) had to return to the operating room for resection because of grossly positive margins. There was just one in-site recurrence out of 73 patients, and 3 had recurrences elsewhere, Dr. Wilson reported.

Of 40 patients who scored their cosmesis, 18 (45%) reported excellent cosmetic results, 18 (45%) reported good results, and 4 (10%) reported fair cosmetic results.

"These findings show that this is a safe procedure, patients can have less repeat surgery, they have good cosmetic outcomes, and RFA may replace radiation therapy in patients with small tumors and are node negative," Dr. Wilson said in an interview.

The cost of eRFA is around $2,000 dollars. In contrast, standard whole breast radiation costs approximately $11,000, and partial breast around $18,000 depending upon site and location, she said.

The ABLATE trial is investigating eRFA in a larger patient population. To date, the trial includes five centers (Columbia University, N.Y; University of Kansas, Lawrence; Comprehensive Breast Care of San Diego, University of Arizona, Tucson; and Rockefeller Cancer Institute in Little Rock) and is actively recruiting and training additional sites.

Early results were presented in a poster by the primary investigator of both studies, Dr. V. Suzanne Klimberg, professor of surgery and pathology and director of the breast program at the University of Arkansas.

Of 55 patients (mean age 65 years) with ductal carcinoma in situ or invasive breast cancer with average tumor size 0.9 cm who underwent eRFA, 20 had positive margins: 14 had close margins (less than 2 mm), 2 had focally positive margins, and 4 had grossly positive margins. Of those, 15 were spared re-excision. Morbidity at 30 days was 7.2% and there were no deaths.

The University of Arkansas sponsored the study in collaboration with AngioDynamics, maker of the RFA delivery system.Dr. Wilson stated that she has no disclosures. Dr. Klimberg received research grants from AngioDynamics and retailers Fashion Footwear Association of New York and QVC.

Infrared thermography did not accurately predict malignancy and produced an unacceptably high false-positive rate in women with radiologic abnormalities requiring breast biopsy in a 2-year prospective study.

The No-Touch Breast Scan (NTBS) is a noninvasive, non–radiation-based imaging tool that measures and compares thermal abnormalities in breasts using dual infrared cameras and computer analysis. It generates a score that reflects blood flow patterns based on the theory of tumor angiogenesis.

The technology is being explored as an alternative to radiation-based imaging in women at risk for breast cancer and as a way to reduce the number of benign biopsies, Dr. Andrea V. Barrio said during a press briefing at the annual meeting of the American Society of Breast Surgeons.

This study evaluated NTBS screening as a predictor of breast cancer in patients undergoing minimally invasive breast biopsy for suspicious mammogram, ultrasound, or MRI findings.

But the results demonstrated that NTBS "cannot be used as a successful adjunct to mammography, nor can it replace any of the screening modalities that are standard practice. Mammography remains the gold standard for breast cancer screening," said Dr. Barrio, an attending breast surgeon at Bryn Mawr (Pa.) Hospital.

"I think the utility of NTBS remains unclear. For the purposes of our study, NTBS could not discriminate between benign and malignant lesions in the low-specificity mode, and the high-sensitivity mode resulted in an unacceptable number of false-positive results," she added in an interview.

A total of 181 women (median age at diagnosis 52.5 years) with 187 abnormal radiologic findings were evaluated from October 2009 to May 2011. Each patient had an NTBS prior to tissue biopsy, and final tissue pathologies were compared with the corresponding NTBS scan results. Each breast was interpreted as positive or negative based on computer analysis of thermal abnormalities. The contralateral breast was scanned in all patients.

Prior to Oct. 15, 2010, patients were initially scanned using a "high-specificity" NTBS mode termed NTBS1. Subsequently a "high-sensitivity mode (NTBS2)" was used to minimize false-negative results. Following initial data analysis, all patients were retrospectively re-evaluated in the NTBS2 mode.

Of the 181 patients initially evaluated, 3 were excluded due to a nonductal or lobular breast malignancy, leaving a total of 178 patients. Of those, 50 had 52 positive breast biopsies and 128 had 132 negative biopsies.

Of the 52 positive biopsies, only 26 had a positive NTBS, giving a sensitivity of just 50%. The sensitivity of NTBS was even lower in the 20 in situ cancers, compared with the 32 invasive cancers (35% vs. 59%, respectively), Dr. Barrio reported.

Of the 132 negative biopsies, 88 had negative NTBS scans, giving a 67% specificity. "The positive predictive value of NTBS was 37% and the negative predictive value was 77%," the study results showed.

Of 173 normal contralateral breasts that were scanned, 42 (24%) had a positive NTBS scan.

Among the 178 patients retrospectively evaluated using NTBS2, 22 were excluded because of an uninterpretable scan. Of the remaining 156 patients, 44 had 46 positive breast biopsies and 112 had 116 negative biopsies. Forty of the 46 positive biopsies matched a positive NTBS (sensitivity 87%).

Sensitivity was not appreciably different between in situ and invasive cancers in the NTBS2 mode (88% vs. 86%, respectively), she said.

Of the 116 negative biopsies, 55 had a negative NTBS, giving a specificity of just 48%. "The positive predictive value of NTBS2 was 40% and the negative predictive value was 90%," the study reported. Of the 151 normal contralateral breasts that were scanned, 72 (47%) had a positive reading.

In the interview, Dr. Barrio said that her group is not seeking a replacement for mammography, as it is a cost-efficient screening tool that has been proven to decrease mortality from breast cancer.

However, "we are looking for studies to supplement mammography, in order to address its limitations, i.e., dense breasts. I think molecular breast imaging in particular shows a lot of promise for the future in women with dense breasts."

This study was funded by the Humler Oncology fund. Dr. Barrio had no other disclosures.

Infrared thermography did not accurately predict malignancy and produced an unacceptably high false-positive rate in women with radiologic abnormalities requiring breast biopsy in a 2-year prospective study.

The No-Touch Breast Scan (NTBS) is a noninvasive, non–radiation-based imaging tool that measures and compares thermal abnormalities in breasts using dual infrared cameras and computer analysis. It generates a score that reflects blood flow patterns based on the theory of tumor angiogenesis.

The technology is being explored as an alternative to radiation-based imaging in women at risk for breast cancer and as a way to reduce the number of benign biopsies, Dr. Andrea V. Barrio said during a press briefing at the annual meeting of the American Society of Breast Surgeons.

This study evaluated NTBS screening as a predictor of breast cancer in patients undergoing minimally invasive breast biopsy for suspicious mammogram, ultrasound, or MRI findings.

But the results demonstrated that NTBS "cannot be used as a successful adjunct to mammography, nor can it replace any of the screening modalities that are standard practice. Mammography remains the gold standard for breast cancer screening," said Dr. Barrio, an attending breast surgeon at Bryn Mawr (Pa.) Hospital.

"I think the utility of NTBS remains unclear. For the purposes of our study, NTBS could not discriminate between benign and malignant lesions in the low-specificity mode, and the high-sensitivity mode resulted in an unacceptable number of false-positive results," she added in an interview.

A total of 181 women (median age at diagnosis 52.5 years) with 187 abnormal radiologic findings were evaluated from October 2009 to May 2011. Each patient had an NTBS prior to tissue biopsy, and final tissue pathologies were compared with the corresponding NTBS scan results. Each breast was interpreted as positive or negative based on computer analysis of thermal abnormalities. The contralateral breast was scanned in all patients.

Prior to Oct. 15, 2010, patients were initially scanned using a "high-specificity" NTBS mode termed NTBS1. Subsequently a "high-sensitivity mode (NTBS2)" was used to minimize false-negative results. Following initial data analysis, all patients were retrospectively re-evaluated in the NTBS2 mode.

Of the 181 patients initially evaluated, 3 were excluded due to a nonductal or lobular breast malignancy, leaving a total of 178 patients. Of those, 50 had 52 positive breast biopsies and 128 had 132 negative biopsies.

Of the 52 positive biopsies, only 26 had a positive NTBS, giving a sensitivity of just 50%. The sensitivity of NTBS was even lower in the 20 in situ cancers, compared with the 32 invasive cancers (35% vs. 59%, respectively), Dr. Barrio reported.

Of the 132 negative biopsies, 88 had negative NTBS scans, giving a 67% specificity. "The positive predictive value of NTBS was 37% and the negative predictive value was 77%," the study results showed.

Of 173 normal contralateral breasts that were scanned, 42 (24%) had a positive NTBS scan.

Among the 178 patients retrospectively evaluated using NTBS2, 22 were excluded because of an uninterpretable scan. Of the remaining 156 patients, 44 had 46 positive breast biopsies and 112 had 116 negative biopsies. Forty of the 46 positive biopsies matched a positive NTBS (sensitivity 87%).

Sensitivity was not appreciably different between in situ and invasive cancers in the NTBS2 mode (88% vs. 86%, respectively), she said.

Of the 116 negative biopsies, 55 had a negative NTBS, giving a specificity of just 48%. "The positive predictive value of NTBS2 was 40% and the negative predictive value was 90%," the study reported. Of the 151 normal contralateral breasts that were scanned, 72 (47%) had a positive reading.

In the interview, Dr. Barrio said that her group is not seeking a replacement for mammography, as it is a cost-efficient screening tool that has been proven to decrease mortality from breast cancer.

However, "we are looking for studies to supplement mammography, in order to address its limitations, i.e., dense breasts. I think molecular breast imaging in particular shows a lot of promise for the future in women with dense breasts."

This study was funded by the Humler Oncology fund. Dr. Barrio had no other disclosures.

Infrared thermography did not accurately predict malignancy and produced an unacceptably high false-positive rate in women with radiologic abnormalities requiring breast biopsy in a 2-year prospective study.

The No-Touch Breast Scan (NTBS) is a noninvasive, non–radiation-based imaging tool that measures and compares thermal abnormalities in breasts using dual infrared cameras and computer analysis. It generates a score that reflects blood flow patterns based on the theory of tumor angiogenesis.

The technology is being explored as an alternative to radiation-based imaging in women at risk for breast cancer and as a way to reduce the number of benign biopsies, Dr. Andrea V. Barrio said during a press briefing at the annual meeting of the American Society of Breast Surgeons.

This study evaluated NTBS screening as a predictor of breast cancer in patients undergoing minimally invasive breast biopsy for suspicious mammogram, ultrasound, or MRI findings.

But the results demonstrated that NTBS "cannot be used as a successful adjunct to mammography, nor can it replace any of the screening modalities that are standard practice. Mammography remains the gold standard for breast cancer screening," said Dr. Barrio, an attending breast surgeon at Bryn Mawr (Pa.) Hospital.

"I think the utility of NTBS remains unclear. For the purposes of our study, NTBS could not discriminate between benign and malignant lesions in the low-specificity mode, and the high-sensitivity mode resulted in an unacceptable number of false-positive results," she added in an interview.

A total of 181 women (median age at diagnosis 52.5 years) with 187 abnormal radiologic findings were evaluated from October 2009 to May 2011. Each patient had an NTBS prior to tissue biopsy, and final tissue pathologies were compared with the corresponding NTBS scan results. Each breast was interpreted as positive or negative based on computer analysis of thermal abnormalities. The contralateral breast was scanned in all patients.

Prior to Oct. 15, 2010, patients were initially scanned using a "high-specificity" NTBS mode termed NTBS1. Subsequently a "high-sensitivity mode (NTBS2)" was used to minimize false-negative results. Following initial data analysis, all patients were retrospectively re-evaluated in the NTBS2 mode.

Of the 181 patients initially evaluated, 3 were excluded due to a nonductal or lobular breast malignancy, leaving a total of 178 patients. Of those, 50 had 52 positive breast biopsies and 128 had 132 negative biopsies.

Of the 52 positive biopsies, only 26 had a positive NTBS, giving a sensitivity of just 50%. The sensitivity of NTBS was even lower in the 20 in situ cancers, compared with the 32 invasive cancers (35% vs. 59%, respectively), Dr. Barrio reported.

Of the 132 negative biopsies, 88 had negative NTBS scans, giving a 67% specificity. "The positive predictive value of NTBS was 37% and the negative predictive value was 77%," the study results showed.

Of 173 normal contralateral breasts that were scanned, 42 (24%) had a positive NTBS scan.

Among the 178 patients retrospectively evaluated using NTBS2, 22 were excluded because of an uninterpretable scan. Of the remaining 156 patients, 44 had 46 positive breast biopsies and 112 had 116 negative biopsies. Forty of the 46 positive biopsies matched a positive NTBS (sensitivity 87%).

Sensitivity was not appreciably different between in situ and invasive cancers in the NTBS2 mode (88% vs. 86%, respectively), she said.

Of the 116 negative biopsies, 55 had a negative NTBS, giving a specificity of just 48%. "The positive predictive value of NTBS2 was 40% and the negative predictive value was 90%," the study reported. Of the 151 normal contralateral breasts that were scanned, 72 (47%) had a positive reading.

In the interview, Dr. Barrio said that her group is not seeking a replacement for mammography, as it is a cost-efficient screening tool that has been proven to decrease mortality from breast cancer.

However, "we are looking for studies to supplement mammography, in order to address its limitations, i.e., dense breasts. I think molecular breast imaging in particular shows a lot of promise for the future in women with dense breasts."

This study was funded by the Humler Oncology fund. Dr. Barrio had no other disclosures.

Men with breast cancer died more than 2 years sooner than did women with the condition, in the largest-ever study of male breast cancer, investigators reported.

Male breast cancer patients presented with more advanced disease and had lower 5-year survival rates as well as shorter median overall survival than did women, Dr. Jon M. Greif said at the annual meeting of the American Society of Breast Surgeons.

They were less likely to have radiation therapy or partial mastectomy, but chemotherapy rates were not significantly different, said Dr. Greif, a breast surgeon who practices in Oakland, Calif.

The data come from an analysis of 13,457 men – representing 0.9% of all breast cancers – and 1,439,866 women with breast cancer in the National Cancer Data Base spanning the years 1998 through 2007. The explanation for the differences in overall survival is most likely multifactorial, according to Dr. Greif.

"Certainly, one reason is that with well accepted screening for female breast cancer, and heightened awareness amongst women, female breast cancer is detected earlier. Evidence from our study is that male breast cancer is larger and more likely to have spread to lymph nodes and beyond when first discovered," he said in an interview.

"However, male breast cancer was less likely to be low grade, and this would be a biological difference. And, finally, men were older, and more likely to die of other causes."

Men at particularly high risk should have careful clinical examinations annually, and consider annual screening mammography, advised Dr. Greif. Among those at high risk, he included men with known gene mutations that increase their risk (BRCA and Klinefelter’s syndrome, for example), men who have been treated or otherwise exposed to high levels of radiation to the chest, men with previous breast cancer, and men with strong family histories of male or female breast cancer.

"Currently, breast cancer in men is found as a palpable retro- or periareolar mass, a nipple discharge or crusting, skin erosion, or palpable lymph nodes. Examination of the retroareolar and periareolar tissues for lumps and/or skin changes should be a part of every man’s annual physical exam, and men should check occasionally themselves," Dr. Greif said.

Five-year overall survival was 83% for women with breast cancer (median survival 129 months) and 74% for men (median 101 months), a highly statistically significant difference (P less than. 0001), he reported.

A comparison of overall survival by stages showed significantly better outcomes for women with early disease, but similar outcomes in more advanced disease. Females had significantly better 5-year survival rates (P less than .0001) for stage 0 (94% vs. 90%), stage I (90% vs. 87%) and stage II (82% vs. 74%) breast cancer. No significant differences were seen in 5-year survival for stage III (56.9% vs. 56.5%, P = .99) or stage IV (19% vs. 16%, P = .20).

The following findings also were reported:

– Men with breast cancer were more often African American (11.7% vs. 9.9%, odds ratio 1.19), less often Hispanic (3.6% vs. 4.5%, OR 0.74), and older (63 vs. 59 years old).

– Men had larger tumors (median 20.0 vs. 15.0 mm), were less likely to have grade 1 tumors (16.0% vs. 20.7%), were more likely to have lymph node metastasis (41.9% vs. 33.2%, OR 1.45), and were more likely to have distant metastasis (4% vs. 3%, OR 1.39).

– Men were less likely to have lobular carcinoma (10% vs. 18%, OR 0.51) and more likely to be estrogen receptor positive (88.3% vs. 78.2%, OR 2.10) and progesterone receptor positive (76.8% vs. 67.0%, OR 1.63).

– Men were less likely to have been treated with a partial mastectomy (33% vs. 62%, OR 0.31) and less likely to have received radiation (35.9% vs. 50.4%, OR 0.55).

All of these differences were highly statistically significant, with P values less than .0001. However, the differences may not have been of clinical significance, the investigators said, citing the large numbers of cases.

The proportions of men and women receiving chemotherapy were similar (40.1% vs. 39.8%, OR 1.01, P = .40) and only small differences were seen in hormonal therapy rates (41.2% vs. 42.4%, OR 0.95, P = .006).

Treatment of male breast cancer is similar to that of female breast cancer, according to Dr. Greif. Nearly all male breast cancers are hormone receptor positive, so treatment with antiestrogenic endocrine therapy should be a part of the adjuvant treatment of nearly all male breast cancer.

Chemotherapy should be considered for tumors with higher risk of systemic return, he said. For tumors with risk of locoregional return, including those that are large and/or have lymph node involvement, adjuvant radiation should be part of the treatment.

The surgery for male breast cancer is almost always total mastectomy, he noted, and there is evidence that sentinel lymph node biopsy works for male breast cancer as well as in female breast cancer.

This study was funded in part by Alta Bates Summit Medical Center. None of the authors have any conflicts of interest or financial disclosures.

Men with breast cancer died more than 2 years sooner than did women with the condition, in the largest-ever study of male breast cancer, investigators reported.

Male breast cancer patients presented with more advanced disease and had lower 5-year survival rates as well as shorter median overall survival than did women, Dr. Jon M. Greif said at the annual meeting of the American Society of Breast Surgeons.

They were less likely to have radiation therapy or partial mastectomy, but chemotherapy rates were not significantly different, said Dr. Greif, a breast surgeon who practices in Oakland, Calif.

The data come from an analysis of 13,457 men – representing 0.9% of all breast cancers – and 1,439,866 women with breast cancer in the National Cancer Data Base spanning the years 1998 through 2007. The explanation for the differences in overall survival is most likely multifactorial, according to Dr. Greif.

"Certainly, one reason is that with well accepted screening for female breast cancer, and heightened awareness amongst women, female breast cancer is detected earlier. Evidence from our study is that male breast cancer is larger and more likely to have spread to lymph nodes and beyond when first discovered," he said in an interview.

"However, male breast cancer was less likely to be low grade, and this would be a biological difference. And, finally, men were older, and more likely to die of other causes."

Men at particularly high risk should have careful clinical examinations annually, and consider annual screening mammography, advised Dr. Greif. Among those at high risk, he included men with known gene mutations that increase their risk (BRCA and Klinefelter’s syndrome, for example), men who have been treated or otherwise exposed to high levels of radiation to the chest, men with previous breast cancer, and men with strong family histories of male or female breast cancer.

"Currently, breast cancer in men is found as a palpable retro- or periareolar mass, a nipple discharge or crusting, skin erosion, or palpable lymph nodes. Examination of the retroareolar and periareolar tissues for lumps and/or skin changes should be a part of every man’s annual physical exam, and men should check occasionally themselves," Dr. Greif said.

Five-year overall survival was 83% for women with breast cancer (median survival 129 months) and 74% for men (median 101 months), a highly statistically significant difference (P less than. 0001), he reported.

A comparison of overall survival by stages showed significantly better outcomes for women with early disease, but similar outcomes in more advanced disease. Females had significantly better 5-year survival rates (P less than .0001) for stage 0 (94% vs. 90%), stage I (90% vs. 87%) and stage II (82% vs. 74%) breast cancer. No significant differences were seen in 5-year survival for stage III (56.9% vs. 56.5%, P = .99) or stage IV (19% vs. 16%, P = .20).

The following findings also were reported:

– Men with breast cancer were more often African American (11.7% vs. 9.9%, odds ratio 1.19), less often Hispanic (3.6% vs. 4.5%, OR 0.74), and older (63 vs. 59 years old).

– Men had larger tumors (median 20.0 vs. 15.0 mm), were less likely to have grade 1 tumors (16.0% vs. 20.7%), were more likely to have lymph node metastasis (41.9% vs. 33.2%, OR 1.45), and were more likely to have distant metastasis (4% vs. 3%, OR 1.39).

– Men were less likely to have lobular carcinoma (10% vs. 18%, OR 0.51) and more likely to be estrogen receptor positive (88.3% vs. 78.2%, OR 2.10) and progesterone receptor positive (76.8% vs. 67.0%, OR 1.63).

– Men were less likely to have been treated with a partial mastectomy (33% vs. 62%, OR 0.31) and less likely to have received radiation (35.9% vs. 50.4%, OR 0.55).

All of these differences were highly statistically significant, with P values less than .0001. However, the differences may not have been of clinical significance, the investigators said, citing the large numbers of cases.

The proportions of men and women receiving chemotherapy were similar (40.1% vs. 39.8%, OR 1.01, P = .40) and only small differences were seen in hormonal therapy rates (41.2% vs. 42.4%, OR 0.95, P = .006).

Treatment of male breast cancer is similar to that of female breast cancer, according to Dr. Greif. Nearly all male breast cancers are hormone receptor positive, so treatment with antiestrogenic endocrine therapy should be a part of the adjuvant treatment of nearly all male breast cancer.

Chemotherapy should be considered for tumors with higher risk of systemic return, he said. For tumors with risk of locoregional return, including those that are large and/or have lymph node involvement, adjuvant radiation should be part of the treatment.

The surgery for male breast cancer is almost always total mastectomy, he noted, and there is evidence that sentinel lymph node biopsy works for male breast cancer as well as in female breast cancer.

This study was funded in part by Alta Bates Summit Medical Center. None of the authors have any conflicts of interest or financial disclosures.

Men with breast cancer died more than 2 years sooner than did women with the condition, in the largest-ever study of male breast cancer, investigators reported.

Male breast cancer patients presented with more advanced disease and had lower 5-year survival rates as well as shorter median overall survival than did women, Dr. Jon M. Greif said at the annual meeting of the American Society of Breast Surgeons.

They were less likely to have radiation therapy or partial mastectomy, but chemotherapy rates were not significantly different, said Dr. Greif, a breast surgeon who practices in Oakland, Calif.

The data come from an analysis of 13,457 men – representing 0.9% of all breast cancers – and 1,439,866 women with breast cancer in the National Cancer Data Base spanning the years 1998 through 2007. The explanation for the differences in overall survival is most likely multifactorial, according to Dr. Greif.

"Certainly, one reason is that with well accepted screening for female breast cancer, and heightened awareness amongst women, female breast cancer is detected earlier. Evidence from our study is that male breast cancer is larger and more likely to have spread to lymph nodes and beyond when first discovered," he said in an interview.

"However, male breast cancer was less likely to be low grade, and this would be a biological difference. And, finally, men were older, and more likely to die of other causes."

Men at particularly high risk should have careful clinical examinations annually, and consider annual screening mammography, advised Dr. Greif. Among those at high risk, he included men with known gene mutations that increase their risk (BRCA and Klinefelter’s syndrome, for example), men who have been treated or otherwise exposed to high levels of radiation to the chest, men with previous breast cancer, and men with strong family histories of male or female breast cancer.

"Currently, breast cancer in men is found as a palpable retro- or periareolar mass, a nipple discharge or crusting, skin erosion, or palpable lymph nodes. Examination of the retroareolar and periareolar tissues for lumps and/or skin changes should be a part of every man’s annual physical exam, and men should check occasionally themselves," Dr. Greif said.

Five-year overall survival was 83% for women with breast cancer (median survival 129 months) and 74% for men (median 101 months), a highly statistically significant difference (P less than. 0001), he reported.

A comparison of overall survival by stages showed significantly better outcomes for women with early disease, but similar outcomes in more advanced disease. Females had significantly better 5-year survival rates (P less than .0001) for stage 0 (94% vs. 90%), stage I (90% vs. 87%) and stage II (82% vs. 74%) breast cancer. No significant differences were seen in 5-year survival for stage III (56.9% vs. 56.5%, P = .99) or stage IV (19% vs. 16%, P = .20).

The following findings also were reported:

– Men with breast cancer were more often African American (11.7% vs. 9.9%, odds ratio 1.19), less often Hispanic (3.6% vs. 4.5%, OR 0.74), and older (63 vs. 59 years old).

– Men had larger tumors (median 20.0 vs. 15.0 mm), were less likely to have grade 1 tumors (16.0% vs. 20.7%), were more likely to have lymph node metastasis (41.9% vs. 33.2%, OR 1.45), and were more likely to have distant metastasis (4% vs. 3%, OR 1.39).

– Men were less likely to have lobular carcinoma (10% vs. 18%, OR 0.51) and more likely to be estrogen receptor positive (88.3% vs. 78.2%, OR 2.10) and progesterone receptor positive (76.8% vs. 67.0%, OR 1.63).

– Men were less likely to have been treated with a partial mastectomy (33% vs. 62%, OR 0.31) and less likely to have received radiation (35.9% vs. 50.4%, OR 0.55).

All of these differences were highly statistically significant, with P values less than .0001. However, the differences may not have been of clinical significance, the investigators said, citing the large numbers of cases.

The proportions of men and women receiving chemotherapy were similar (40.1% vs. 39.8%, OR 1.01, P = .40) and only small differences were seen in hormonal therapy rates (41.2% vs. 42.4%, OR 0.95, P = .006).

Treatment of male breast cancer is similar to that of female breast cancer, according to Dr. Greif. Nearly all male breast cancers are hormone receptor positive, so treatment with antiestrogenic endocrine therapy should be a part of the adjuvant treatment of nearly all male breast cancer.

Chemotherapy should be considered for tumors with higher risk of systemic return, he said. For tumors with risk of locoregional return, including those that are large and/or have lymph node involvement, adjuvant radiation should be part of the treatment.

The surgery for male breast cancer is almost always total mastectomy, he noted, and there is evidence that sentinel lymph node biopsy works for male breast cancer as well as in female breast cancer.

This study was funded in part by Alta Bates Summit Medical Center. None of the authors have any conflicts of interest or financial disclosures.