Gender Disparity in Breast Cancer Among US Veterans

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Gender Disparity in Breast Cancer Among US Veterans

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Anita Aggarwal, DO, PhD

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References

1. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51-57. doi:10.1002/cncr.20312
2. Key statistics for breast cancer in men. American Cancer Society. Updated January 12, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html
3. Aggarwal A, Adepoju B, Yacur M, Maron D, Sharma MH. Gender disparity in breast cancer: a veteran population-based comparison. Clin Breast Cancer. 2021;21(4):e471-e478. doi:10.1016/j.clbc.2021.01.013
4. Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998;34(9):1341-1347. doi:10.1016/s0959-8049(98)00028-8
5. Giordano SH. A review of diagnosis and management of male breast cancer. Oncologist. 2005;10(7):471-479. doi:10.1634/theoncologist.10-7-471
6. Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman's disease”: stigmatization of male breast cancer patients—a mixed methods analysis. Am J Mens Health. 2018;12(6):2194-2207. doi:10.1177/1557988318799025
7. Key statistics for breast cancer. American Cancer Society. Updated October 6, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
8. Male breast cancer incidence and mortality, United States—2013-2017. Centers for Disease Control and Prevention. Updated October 1, 2020. Accessed December 14, 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm
9. Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004;83(1):77-86. doi:10.1023/B:BREA.0000010701.08825.2d 10. Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575-586. doi:10.1007/s10549-016-4085-4
11. Ottini L, Capalbo C, Rizzolo P, et al. HER2-positive male breast cancer: an update. Breast Cancer (Dove Med Press). 2010;2:45-58. doi:10.2147/BCTT.S6519
12. Risk factors for breast cancer in men. American Cancer Society. Updated April 27, 2018. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
13. Palli D, Masala G, Mariani-Constantini R, et al. A gene–environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer? Eur J Cancer. 2004;40(16):2472-2479. doi:10.1016/j.ejca.2004.07.012
14. Hansen J. Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000;37(4):349-352. doi:10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l
15. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091. doi:10.1093/jncics/pkz091
16. Breast cancer, male: statistics. Cancer.net. January 2022. Accessed December 14, 2022. https://www.cancer.net/cancer-types/breast-cancer-male/statistics

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Anita Aggarwal, DO, PhD
Chief, Hematology-Oncology Section, DC VA Medical Center
Professor of Medicine, George Washington University
Adjunct Professor, USUHS
Adjunct Clinical Professor of Medicine, Georgetown University
Washington, DC

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Breast Cancer

Author(s)

Anita Aggarwal, DO, PhD

Author(s)

Anita Aggarwal, DO, PhD

Author and Disclosure Information

Anita Aggarwal, DO, PhD
Chief, Hematology-Oncology Section, DC VA Medical Center
Professor of Medicine, George Washington University
Adjunct Professor, USUHS
Adjunct Clinical Professor of Medicine, Georgetown University
Washington, DC

Author and Disclosure Information

Anita Aggarwal, DO, PhD
Chief, Hematology-Oncology Section, DC VA Medical Center
Professor of Medicine, George Washington University
Adjunct Professor, USUHS
Adjunct Clinical Professor of Medicine, Georgetown University
Washington, DC

Click here to view more from Cancer Data Trends 2023.

References

1. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51-57. doi:10.1002/cncr.20312
2. Key statistics for breast cancer in men. American Cancer Society. Updated January 12, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html
3. Aggarwal A, Adepoju B, Yacur M, Maron D, Sharma MH. Gender disparity in breast cancer: a veteran population-based comparison. Clin Breast Cancer. 2021;21(4):e471-e478. doi:10.1016/j.clbc.2021.01.013
4. Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998;34(9):1341-1347. doi:10.1016/s0959-8049(98)00028-8
5. Giordano SH. A review of diagnosis and management of male breast cancer. Oncologist. 2005;10(7):471-479. doi:10.1634/theoncologist.10-7-471
6. Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman's disease”: stigmatization of male breast cancer patients—a mixed methods analysis. Am J Mens Health. 2018;12(6):2194-2207. doi:10.1177/1557988318799025
7. Key statistics for breast cancer. American Cancer Society. Updated October 6, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
8. Male breast cancer incidence and mortality, United States—2013-2017. Centers for Disease Control and Prevention. Updated October 1, 2020. Accessed December 14, 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm
9. Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004;83(1):77-86. doi:10.1023/B:BREA.0000010701.08825.2d 10. Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575-586. doi:10.1007/s10549-016-4085-4
11. Ottini L, Capalbo C, Rizzolo P, et al. HER2-positive male breast cancer: an update. Breast Cancer (Dove Med Press). 2010;2:45-58. doi:10.2147/BCTT.S6519
12. Risk factors for breast cancer in men. American Cancer Society. Updated April 27, 2018. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
13. Palli D, Masala G, Mariani-Constantini R, et al. A gene–environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer? Eur J Cancer. 2004;40(16):2472-2479. doi:10.1016/j.ejca.2004.07.012
14. Hansen J. Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000;37(4):349-352. doi:10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l
15. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091. doi:10.1093/jncics/pkz091
16. Breast cancer, male: statistics. Cancer.net. January 2022. Accessed December 14, 2022. https://www.cancer.net/cancer-types/breast-cancer-male/statistics

References

1. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51-57. doi:10.1002/cncr.20312
2. Key statistics for breast cancer in men. American Cancer Society. Updated January 12, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html
3. Aggarwal A, Adepoju B, Yacur M, Maron D, Sharma MH. Gender disparity in breast cancer: a veteran population-based comparison. Clin Breast Cancer. 2021;21(4):e471-e478. doi:10.1016/j.clbc.2021.01.013
4. Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998;34(9):1341-1347. doi:10.1016/s0959-8049(98)00028-8
5. Giordano SH. A review of diagnosis and management of male breast cancer. Oncologist. 2005;10(7):471-479. doi:10.1634/theoncologist.10-7-471
6. Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman's disease”: stigmatization of male breast cancer patients—a mixed methods analysis. Am J Mens Health. 2018;12(6):2194-2207. doi:10.1177/1557988318799025
7. Key statistics for breast cancer. American Cancer Society. Updated October 6, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
8. Male breast cancer incidence and mortality, United States—2013-2017. Centers for Disease Control and Prevention. Updated October 1, 2020. Accessed December 14, 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm
9. Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004;83(1):77-86. doi:10.1023/B:BREA.0000010701.08825.2d 10. Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575-586. doi:10.1007/s10549-016-4085-4
11. Ottini L, Capalbo C, Rizzolo P, et al. HER2-positive male breast cancer: an update. Breast Cancer (Dove Med Press). 2010;2:45-58. doi:10.2147/BCTT.S6519
12. Risk factors for breast cancer in men. American Cancer Society. Updated April 27, 2018. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
13. Palli D, Masala G, Mariani-Constantini R, et al. A gene–environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer? Eur J Cancer. 2004;40(16):2472-2479. doi:10.1016/j.ejca.2004.07.012
14. Hansen J. Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000;37(4):349-352. doi:10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l
15. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091. doi:10.1093/jncics/pkz091
16. Breast cancer, male: statistics. Cancer.net. January 2022. Accessed December 14, 2022. https://www.cancer.net/cancer-types/breast-cancer-male/statistics

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While breast cancer is the number one diagnosed cancer in women, it is one of the rarest forms of cancer in men (accounting for 1% of all breast cancers diagnosed); however, the incidence of breast cancer in men is increasing.^1,2Risk of breast cancer in males persists for at least 20 years after the diagnosis and depends on clinical features of the cancer. Currently, screening recommendations for men are lacking and there is a need for more awareness of the disease in men. Breast cancer develops in male veterans more often from toxic exposures during their deployment, such as Agent Orange and burn pits.³

Male and female breast cancer characteristics share some similarities but differ notably. Symptoms of male breast cancer dif fer from those seen in females. Males with breast cancer typically present with gynecomastia, mass under the nipple, or pain in the breast, whereas breast cancer in females is usually diagnosed by either a screening mammogram or self-palpated breast mass. Although infiltrating ductal carcinoma is the most common tumor type in both male and female patients, male breast cancer has clinicopathologic differences. Male breast cancer is positive for hormone receptors (estrogen receptor-positive [ER+]/progesterone receptor-positive [PR+], human epidermal growth factor receptor 2 [HER2]-negative) in 84% of cases compared to 50% to 60% of female breast cancer cases. Males are usually older at the time of diagnosis and present with a higher stage of breast cancer; therefore, their survival rate is lower than that of females.^3-5 Men are diagnosed with later-stage disease most likely because of the lack of screening mammograms.³

Treatment remains the same in males and females, stage by stage. Because of the small amount of breast tissue, males need mastectomy as their surgical treatment, whereas females can have a lumpectomy or mastectomy. Most males with breast cancer refuse to take tamoxifen because of the side effect of hot flashes, and because male breast cancer patients can feel stigmatized.⁶ Aromatase inhibitors have not been studied in males.

There is most certainly a gender disparity in breast cancer awareness and a need for screening recommendations for males. A better understanding of the biology of male breast cancer is also needed to develop markers for earlier diagnosis and therapeutic intervention—which may help reduce mortality and increase overall survival rates of males presenting with breast cancer.³

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