A new study authored by researchers from the Dana Farber Cancer Institute (MA, USA) and the American Cancer Society has identified a trend in males with breast cancer in which surgery is elected to remove the unaffected breast. The report, featured recently in JAMA Surgery, is the first to identify this trend, which reflects a trend observed in American women over the past two decades.
Breast cancer is rare in men, accounting for approximately 1% of all male cancers in the USA. In women, the use of contralateral prophylactic mastectomy (CPM) surgery to remove the unaffected breast has increased. In 1998 the percentage of women with invasive breast cancer in one breast undergoing CPM was 2.2%; in 2011 this percentage had increased to 11%. This increase was observed despite the lack of evidence for a survival benefit from CPM, allied with the associated costs and potential complications of surgery.
The research, led by Ahmedin Jemal of the American Cancer Society, aimed to ascertain whether the same increase was occurring among men. The treatment records of 6332 men who underwent surgery for breast cancer limited to one breast between 2004 and 2011 were obtained from the nationwide data collected by the North American Association of Central Cancer Registries study.
The data suggest that the rates of CPM among men increased from 3.0% in 2004 to 5.6% in 2011 and the procedure was more prevalent in younger, white, and privately insured patients. The same sociodemographic factors were also found in women with breast cancer who selected CPM.
However, there were no data available to examine the link between genetic testing, family history, magnetic resonance imaging, or fear of contralateral breast cancer and the decision to opt for surgery in men. All of these factors have been linked to surgery in women.
“The increase in the rate of this costly, serious procedure with no evidence of survival benefit comes, paradoxically, at a time of greater emphasis on quality and value in cancer care,” explained Jemal. “Health care providers should be aware that the increase we’ve seen in removal of the unaffected breast is not limited to women, and doctors should carefully discuss with their male patients the benefits, harms, and costs of this surgery to help patients make informed decisions about their treatments.”