Carcinoma of the male breast (MBC) is an uncommon phenomenon, accounting for <1% of all
malignancies in man. It represents a biologically heterogeneous disorder, and its
clinical course may vary from indolent and slowly progressive to rapidly metastatic disease. Most of our current knowledge regarding its biology, natural history, and treatment strategies has been extrapolated from its female counterpart. Information regarding prognostic relevance of new molecular markers is limited. At the European Institute of Oncology we performed a study showing data in which p21Waf1 and p27Kip1
proteins were evaluated in a series of
male breast cancer patients. Our data suggest that the immunohistochemical evaluation of p21Waf1 and p27Kip1 expression in male
breast carcinomas may be a further useful marker for selecting patients who express functional
proteins that can be predictive for the most efficient endocrine response. Moreover, searching for more
conservative treatment, we introduced in our clinical practice sentinel node biopsy, and if present, sentinel node biopsy of the internal mammary chain. The potential clinical implications of complete nodal staging are far-reaching, and give us a major new opportunity to stratify male patients with
breast cancer for appropriate surgery as well as giving valuable prognostic information.
Male breast cancer has
biological differences compared with female
breast cancer. It responds to hormonal manipulation and
chemotherapy, but optimal treatment regimens in males are unknown. By analogy to the female
breast cancer, post-
mastectomy radiotherapy should be proposed in case of advanced T stage and/or lymph node positivity (considering the small volume of the male mammary gland, we suggest post-
mastectomy irradiation in case of T >1 cm and/or presence of >1 metastatic axillary lymph node).
Breast conserving surgery, performed in selected cases of
male breast cancer, should be always followed by
radiotherapy. Despite a wealth of small retrospective studies on MBC, its rarity means there is a lack of prospective randomized controlled treatment trials, which needs to be addressed if significant advances are to be made in the treatment of this unusual challenging disease.