Gender Disparity in Breast Cancer Among US Veterans

While breast cancer is the number one diagnosed cancer in women, it is one of the rarest forms of cancer in men (accounting for 1% of all breast cancers diagnosed); however, the incidence of breast cancer in men is increasing.^1,2 Risk of breast cancer in males persists for at least 20 years after the diagnosis and depends on clinical features of the cancer. Currently, screening recommendations for men are lacking and there is a need for more awareness of the disease in men. Breast cancer develops in male veterans more often from toxic exposures during their deployment, such as Agent Orange and burn pits.³

Male and female breast cancer characteristics share some similarities but differ notably. Symptoms of male breast cancer dif fer from those seen in females. Males with breast cancer typically present with gynecomastia, mass under the nipple, or pain in the breast, whereas breast cancer in females is usually diagnosed by either a screening mammogram or self-palpated breast mass. Although infiltrating ductal carcinoma is the most common tumor type in both male and female patients, male breast cancer has clinicopathologic differences. Male breast cancer is positive for hormone receptors (estrogen receptor-positive [ER+]/progesterone receptor-positive [PR+], human epidermal growth factor receptor 2 [HER2]-negative) in 84% of cases compared to 50% to 60% of female breast cancer cases. Males are usually older at the time of diagnosis and present with a higher stage of breast cancer; therefore, their survival rate is lower than that of females.^3-5 Men are diagnosed with later-stage disease most likely because of the lack of screening mammograms.³

Treatment remains the same in males and females, stage by stage. Because of the small amount of breast tissue, males need mastectomy as their surgical treatment, whereas females can have a lumpectomy or mastectomy. Most males with breast cancer refuse to take tamoxifen because of the side effect of hot flashes, and because male breast cancer patients can feel stigmatized.⁶ Aromatase inhibitors have not been studied in males.

There is most certainly a gender disparity in breast cancer awareness and a need for screening recommendations for males. A better understanding of the biology of male breast cancer is also needed to develop markers for earlier diagnosis and therapeutic intervention—which may help reduce mortality and increase overall survival rates of males presenting with breast cancer.³

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