Study: Male breast cancer: Patient and surgeon experiences
Summary
By surveying male breast cancer patients and the surgeons who treat them, researchers gained insight into the experiences of both groups, shedding light on an important issue for men with breast cancer. (Posted 12/22/22)
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RELEVANCE
Most relevant for: Men with breast cancer.
It may also be relevant for:
- people with a genetic mutation linked to cancer risk
- people with a family history of cancer
Relevance: Medium-High
Strength of Science: Medium-High
Research Timeline: Human Research
What is this study about?
In this study, researchers used surveys to understand the surgical experiences of men with breast cancer and the breast surgeons who treat them.
Why is this study important?
Little is known about the experiences of men who are diagnosed with breast cancer. Men are often left out of clinical trials, and as a result, the management of men with breast cancer is frequently assumed to be similar to the management of women with breast cancer.
Immediate reconstruction can involve recreation of a breast mound. While common for female patients it is not typically offered to male patients. Mastectomy in men typically involves removal of the nipple. Reconstruction of the nipple would occur a few months after mastectomy if desired.
The goal of this study was to better understand the opinions and perspectives of men who were diagnosed with breast cancer, their surgical decisions for treatment, and to compare their experiences with surgeons' approaches to treatment. The findings of this study can serve as the framework to better the experience of male breast cancer patients.
Study findings
The researchers developed two surveys for this study: One for men diagnosed with breast cancer and the other for the breast surgeons who treat them. They distributed these between August and October 2020.
Using social media and patient advocate websites to look for male breast cancer survivors, the team recruited 63 men to complete the survey. Questions were based on the WhySurg study for female breast cancer survivors that asked about surgical choice and satisfaction with their decisions.
The breast surgeon survey was emailed to all members of the American Society of Breast Surgeons; 438 surgeons responded. The physician survey was designed to assess surgeons’ opinions and perspectives on surgical approaches to treating men with breast cancer.
Patient survey results
Most men had been diagnosed with 1, 2 or 3 breast cancer in the last 10 years. The average age of participants was 62 years. Among these:
- only a few participants (5) said their surgeon recommended breast-conserving surgery.
- most (60) had no reconstruction.
The majority of patients felt they had a choice in the decision for surgery, and felt they had enough information to make a decision. However, many patients felt uncomfortable with their appearance after surgery. The most common reasons included feeling asymmetric, self-conscious and feeling that their chest was “indented.”
Breast surgeon survey results
The survey included a case scenario that described a 66-year-old man with breast cancer. Most surgeons said they were very comfortable or somewhat comfortable recommending breast-conserving surgery to the hypothetical patient. This is in direct contrast to what patients reported, as only a few reported that their surgeons recommended breast-conserving surgery.
In contrast to breast-conserving surgery, among surgeons:
- 20% did not routinely offer reconstruction to male mastectomy patients.
- 22% offer reconstruction only to patients who request it.
- 37% never offer reconstruction to men.
Importantly, just over a third of surgeons reported that they had never considered reconstruction as an option until taking the survey.
This study highlights the differences in experience and satisfaction between male breast cancer patients and the surgeons who treated them.
What does this mean for me?
If you have been diagnosed with male breast cancer, you should carefully consider your options for treatment. According to several studies, breast cancers in men can be safely treated with breast-conserving surgery. However, breast-conserving surgery, such as a or partial mastectomy, is not often performed in men. If your cancer is , you might want to advocate for this type of surgery.
If your surgeon recommends a mastectomy, you might want to talk to them about breast reconstruction, even if they don’t immediately offer it as an option. Limited research has shown that men who feel uncomfortable with their post-op appearance are more likely to experience cancer-related distress and depression, so it’s important to consider how your body image might change after a mastectomy. Be sure to talk to your surgeon about all possible treatment options and outcomes so you can make an informed decision about your care.
Reference
Chichura A, Attai DJ, Kuchta K, et al. Male breast cancer patient and surgeon experience: the male WhySurg study. Annals of Surgical Oncology; 2022; 29. Published online July 25, 2022.
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posted 12/22/2022
Related resources
The following organizations have resources related to breast cancer.
- FORCE related resources:
- Information: Breast cancer screening and prevention
- Information: Breast cancer treatment
- Personalized portal: Breast cancer
- XRAY category: Breast cancer
- XRAY category: breast cancer
- Video playlist: Breast cancer
- Blogs: Breast cancer
- General breast cancer resources:
- breast cancer resources:
- Male breast cancer resources:
- Resources for Black, Indigenous and People of Color:
Updated: 06/28/2023
Guidelines
The National Comprehensive Cancer Network (NCCN) has a panel of experts who address male breast cancer in their breast cancer treatment guidelines.
- The NCCN panel points out that few clinical trials have focused on men with breast cancer, and treatment recommendations for men are taken from findings from research involving only women. Therefore, many of the recommendations for the treatment of male breast cancer are similar to treatment in women, including:
- sentinel lymph node biopsy
- radiation therapy
- Oncotype Dx
- The panel highlights the following considerations for male breast cancer:
- All men with breast cancer should be referred for genetic counseling and testing.
- Although men with breast cancer were previously recommended to undergo mastectomy, emerging data suggest that breast-conservation therapy for men may be as safe and effective as mastectomy.
For ER receptor-positive cancers, hormone therapy options include tamoxifen or a GnRH analog plus an aromatase inhibitor. Aromatase inhibitors used alone (without a GnRH analog medication) have resulted in worse outcomes than tamoxifen alone in men. Men who receive GnRH analogs and aromatase inhibitors should have their bone density checked.
Updated: 03/08/2023
IN-DEPTH REVIEW OF RESEARCH
Study background
Male breast cancer is rare in the general population, accounting for less than 1 percent of newly diagnosed breast cancers in the US. However, men who carry a mutation have about a 7 percent lifetime risk for breast cancer. Other inherited mutations may also increase risk.
In the past, male breast cancer has been treated with surgery (mastectomy) without breast reconstruction. However, research has shown that breast-conserving surgery ( or partial mastectomy) for male breast cancer provides survival outcomes that are similar to women with breast cancer. In addition, although breast reconstruction is an option for men who are concerned about the appearance of their chest post-surgery, few male breast cancer patients undergo reconstruction.
Researchers of this study wanted to know
Researchers wanted to know more about the experiences of men with breast cancer. They were particularly interested in male patients’ opinions and perspectives on the surgical approach to treatment and compared their experiences to that of their surgeons.
Populations looked at in this study
Two populations were surveyed in this study:
- Male patients with breast cancer
- Surgeons who treat male breast cancer patients
Study design
Two online surveys were deployed between August to October 2020. Social media was used to distribute the survey to male breast cancer patients, while an email was sent to members of the American Society of Breast Surgeons.
The survey for patients was based on another survey of experiences of women with breast cancer as well as their surgical choice and satisfaction. The survey for surgeons was designed to determine a surgeon’s current opinion and their surgical approach to men with breast cancer.
Study findings
Patient survey results
Demographics
- 75% (47) of patients were diagnosed between the ages of 51 and 75.
- 86% (54) had a family history of cancer, with the most frequently reported cancers being breast, ovarian and .
- 95% (60) underwent genetic testing, with 91% (57) reporting that they had testing.
- Of these, about half reported having genetic testing before surgery and about half reported that they had genetic testing after surgery.
- 17% (11) reported testing positive for an .
Other demographics included:
- 57% (36) of patients had a bachelor’s degree or higher.
- 95% (55) of patients were non-Hispanic white.
Recommended surgeries included:
- single mastectomy (54)
- double mastectomy (10)
Reported treatments:
- 85.7% (54) reported treatment with a single mastectomy.
- 12.7% (8) reported treatment with a double mastectomy.
- 98.6% (61) had their nipples removed during surgery.
- 96.8% (60) did not undergo reconstruction.
- 58.7% (37) received radiation.
- 77.8% (49) received chemotherapy.
Surgeon survey results
Researchers sent the physician survey to 2,650 members of the American Society of Breast Surgeons and received 438 responses.
Of the surgeon respondents:
- 73% were female;
- 59% had been in practice for more than 16 years.
- 84% said they treated 1-5 male breast cancer patients per year.
- 60% said they routinely offer breast-conserving surgery to eligible men.
- 41% said they had performed breast-conserving surgery on a man with breast cancer.
- About 20% said they routinely offer reconstruction, while another 20% said they do not.
- About 23% said they offered reconstruction only if a patient requested it.
- Almost 37% said they never considered it to be an option.
Strengths and limitations
Strengths
- This is the largest study to investigate the experiences of men diagnosed with breast cancer.
- This is the first study to investigate the perspectives and opinions of breast surgeons who treat male breast cancer.
Limitations
- Despite this being the largest study to investigate the experiences of men with breast cancer, male breast cancer is relatively rare. Therefore, the sample size was relatively small (63 men). In addition, only a small percentage (about 17%) of surgeons who received the survey sent responses to the researchers.
- Because the surgeon survey was sent to all members of the American Society of Breast Surgeons, it is possible that the responses from the surgeons who chose to respond do not reflect the views of all surgeons. This is known as sample bias. For example, about 40% of surgeons who responded to the survey reported performing breast-conserving surgery for men with breast cancer, but research shows that anywhere from 4 to 20% of male breast cancer patients have breast-conserving surgery. Thus, the surgeons and the men with breast cancer in this study might not be representative of the average physician or male breast cancer patient.
- This research used new surveys that have not been studied as well as a survey known as BREAST-Q, which was not designed for men.
Context
Research from the past decade shows that breast-conserving surgery yields similar survival outcomes as a single or double mastectomy for men with breast cancer. Although the current National Comprehensive Cancer Network guidelines for men with breast cancer support breast-conserving surgery for eligible patients, this study found that nearly half of the surgeon respondents felt evidence supporting breast-conserving surgery for male breast cancer patients was weak.
Male breast cancer patients are eligible for reconstruction (see this FORCE blog post here to learn more), but an analysis by the National Surgical Quality Improvement Program found that only about 4 percent of men with breast cancer underwent immediate reconstruction, most commonly with an implant. Some insurance companies might not cover breast reconstruction for men, which may explain in part why the procedure is so uncommon.
Conclusions
The experience of male breast cancer patients is an under-explored topic in breast cancer research. Little is known about men’s perspectives on their surgical decisions and outcomes. This study found that about one-third of men who undergo a mastectomy to treat their cancer felt uncomfortable with the appearance of their chest post-surgery. But the study also showed that less than half of surgeons offer reconstruction to their male breast cancer patients or even consider it as an option
NCCN guidelines also recommend genetic testing for all male breast cancer patients. While genetic testing could guide treatment and surgical decisions, more than half of the patient respondents in this study reported receiving their test results after their breast surgery.
This study reveals discrepancies between NCCN guidelines, surgeon recommendations and patient experiences. Based on their findings, the authors advocate for the use of breast-conserving surgery for qualifying patients, increased discussion with men regarding reconstruction options and genetic testing for all men who are diagnosed with breast cancer.
Share your thoughts on this XRAY review by taking our brief survey.
posted 12/22/2022
Who covered this study?
General Surgery News
Male breast cancer patients often dissatisfied with post-op results 
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