B reast carcinoma in males continues to challenge investigators as an unusual disease entity, but is able to provide insight into the much more common occurrence of breast carcinoma in women. Although breast carcinoma is uncommon in men, disease factors in this gender provide a more consistent presentation for analysis. Compared with women, there is a unimodal distribution of age at presentation. The obscuring effects of menopause on the pathogenesis of breast carcinoma are avoided in men and disease presentation, although commonly delayed, is consistent with a typically palpable, subareolar mass.
To assimilate any logic conclusions regarding this disease in men, investigators, including Donegan et al. 1 in this issue of Cancer, have relied on a multiinstitutional analysis. The study by Donegan et al. pooled the resources of 18 hospitals to create a series of 217 patients. 1 The benefits of such an approach are obvious. However, their study, like other retrospective multiinstitutional reviews, lacks complete data for all patients.
As previously noted by other authors, male breast carcinoma has a unimodal age distribution, a later age at onset, a propensity for estrogen receptor expression, and a poorer prognosis compared with breast carcinoma in women. [2][3][4] Others have noted no difference in prognosis based on gender. 5,6 In the study by Donegan et al., a careful analysis of the cause of death helps to clarify this discrepancy by noting that ΟΎ 25% of the patients died of causes unrelated to their history of breast carcinoma. Given the mean age of 65.4 years at the time of diagnosis, competing causes of mortality are a likely explanation of the poor 5-and 10-year survival figures that have been reported. Although noted infrequently, the median age at diagnosis is considerably older in men due to a unimodal age distribution. A premenopausal woman cured of breast carcinoma is much more likely to survive longer than a 65-year-old man who is cured of the same disease. Comparing stage for stage and taking into account the age difference, survival according to gender most likely is equivalent. 5,6 The American Joint Committee on Cancer staging system for breast carcinoma remains the same for both males and females. As expected, there is a significant separation of survival according to stage as observed in this study. Men commonly are diagnosed at a later stage. Within this study, the average duration of symptoms was 10.2 months, suggesting a lack of recognition of this uncommon entity by both patient and physician. Over time, this appeared to