Breast Cancer Coverage from Every Angle

Updated ASCO Guidelines on Male Breast Cancer: Different Approaches for Men and Women?

By: Joseph Cupolo
Posted: Monday, July 6, 2020

Within the medical community, there are substantial knowledge gaps concerning the optimal management of breast cancer in men. Although male breast cancer is rare, approximately 500 men will die of breast cancer each year. To date, approaches to treating men with breast cancer have been extrapolated largely from research conducted in women with breast cancer. 

With this mind, a recent article published in JCO Oncology Practice provides management guidelines from the American Society of Clinical Oncology (ASCO) that are specifically geared towards male breast cancer. Michael J. Hassett, MD, MPH, of Dana-Farber Cancer Institute, Boston, noted that the expert panel particularly identified aspects of management for which practice among men and women differed. They include the approaches to endocrine therapy in the adjuvant and metastatic settings, genetic testing for inherited risk factors, and survivorship care. In addition, tamoxifen is recommended as first-line endocrine therapy for men in the adjuvant and advanced/metastatic settings, and testing for inherited predisposing risk factors is recommended routinely for men.

For men with hormone receptor–positive breast cancer who are candidates for adjuvant endocrine therapy but have a contraindication to tamoxifen, they may be offered a gonadotropin-releasing hormone agonist/antagonist and an aromatase inhibitor. The guidelines also note that men who receive adjuvant endocrine therapy should be treated for an initial duration of 5 years.

The advisory panel did report a high-level consensus that the following components of management were largely the same for men and women with breast cancer: use of gene-expression profile testing to guide adjuvant treatment decision-making (eg, genetic evaluation and prognostic tests), primary surgery, adjuvant chemotherapy, adjuvant radiation therapy, and chemotherapy for advanced/metastatic disease.

Disclosure: The authors reported no conflicts of interest.

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