The surgical management of male breast cancer: Time for an easy access national reporting database?

• Male breast cancer is extremely rare with an incidence of less than 1% of all breast cancers.
• We report a series of seven cases of male breast cancer encountered over three years, evaluating patient demographics, treatment and outcomes.
• Review of these patients highlighted a lack of consensus on the optimal surgical strategy for their management.
• The paper discusses the plausible options for surgical reconstruction of male breast cancer defects.
• The authors advocate an easy access national reporting database to improve large scale data collection and surgical intervention.

IntroductionMale breast cancer is extremely rare with an incidence of less than 1% of all breast cancers. Literature reports a peak of incidence at roughly 71 years of age. Management currently follows the same clinical pathways as female breast cancer as a general rule.MethodsA retrospective search for all patients who were referred and diagnosed with male breast cancer at our centre was undertaken. Patients notes were then explored for demographics, histological staging, multidisciplinary team meeting outcome and treatment.A literature search including the search terms ‘Male Breast Cancer AND Surgery’ or ‘Male Breast Cancer AND Experience’ were used. Non English language articles, or those without abstracts were excluded.ResultsSeven patients were reviewed over 3 years (2006–2009). Mean agea was 69 years and mean lesion size was 15 mm. Histology was invasive ductal carcinoma for all patients. All patients were ER receptor positive. Two patients were HER2 positive. Five patients were offered mastectomy. One patient refused treatment. In follow up at 36 months there were 3 recurrences. 1 patient was lost to follow up. There were 3 mortalities.The literature search identified 72 articles. Articles were subdivided into those that discussed the surgical management of male breast cancer (n = 8), articles that discussed male breast cancer as podium presentations or posters with no full text article publication (n = 13) and finally full text publications of case experience of male breast cancer (n = 21).DiscussionWe report a series of seven cases of male breast cancer encountered over three years, evaluating patient demographics as well as treatment and outcomes. In our series patients were managed with mastectomy. New evidence is questioning the role of mastectomy against breast conserving surgery in male patients. Furthermore there is a lack of reporting infrastructure for national data capture of the benefits of surgical modalities. Literature review highlights the varied clinical experience between units that remains reported as podium presentation but not published. The establishment of an online international reporting registry would allow for efficient analysis of surgical outcomes to improve patient care from smaller single centres. This would facilitate large scale meta analysis by larger academic surgical centres.