Are more men with breast cancer opting for prophylactic mastectomy?

Expert 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 
  • systemic therapy
• 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. 

Questions To Ask Your Health Care Provider

• What are the pros and cons of mastectomy vs. lumpectomy?
• What are the costs and complications that can be associated with double mastectomy?
• Is lumpectomy an option?
• As a man with breast cancer, should I consider genetic counseling and/or genetic testing?
• A male blood relative has had breast cancer, should I be concerned that it is hereditary?