Kuroi Katsumasa, Toi Masakazu
Dept. of Surgery, Toyosu Hospital, Showa University.
Gan To Kagaku Ryoho. 2003 May;30(5):599-605.
As male breast cancer remains rare entity (less than 1% of cases of breast cancer), most of our current knowledge of it has been extrapolated from its female counterpart. The prevalence of male breast cancer increases with age, and the presentation occurs at an average age of approximately 60 years, 10 years older than in females with the disease. The majority of patients present with a painless, firm, subareolar mass, and the tumors are usually larger than 2 cm in diameter. There may be fixation to skin. Mammography and ultrasonography are useful to distinguish between breast cancer and gynecomastia. Pathologically, invasive ductal carcinoma is the predominant subtype, and lobular carcinoma is rare. Modified radical mastectomy is a principal surgical approach, and adjuvant therapy has been advocated in men based on the beneficial results of it in women. Hormonal manipulations constitute an essential part of adjuvant therapy, as male breast cancers have a high rate of hormone-receptor positivity. Although orchiectomy was practiced in the past, today, tamoxifen is the standard hormone therapy. With respect to systemic chemotherapy, the most common regimens are CMF (cyclophosphamide, methotrexate, 5-fluorouracil), or other anthracyclin-based regimens. In cases of disease recurrence, hormonal manipulations, chemotherapy, or radiotherapy can be administered for palliative purposes. Several selective aromatase inhibitors are now available; however, there are limited data regarding their efficacy in men. The prognosis does not seem to be poor compared to that of females when age and stage are matched. Further studies are needed to characterize the biologic and molecular properties of male breast cancer and their prognostic significance, and to devise optimal treatment strategies. However, it is interesting to note that p53 and c-erbB-2, are expressed and angiogenesis occurs in male breast cancer. Moreover, male breast cancer patients can carry BRCA2 mutations.
由于男性乳腺癌仍然是一种罕见疾病（占乳腺癌病例不到1%），我们目前对它的大部分了解都是从女性乳腺癌推断而来的。男性乳腺癌的患病率随年龄增长而增加，发病的平均年龄约为60岁，比患该疾病的女性大10岁。大多数患者表现为无痛、质地硬的乳晕下肿块，肿瘤直径通常大于2厘米。可能与皮肤粘连。乳房X线摄影和超声检查有助于区分乳腺癌和男性乳腺增生。病理上，浸润性导管癌是主要亚型，小叶癌罕见。改良根治性乳房切除术是主要的手术方法，基于其在女性中的有益结果，男性也主张进行辅助治疗。激素治疗是辅助治疗的重要组成部分，因为男性乳腺癌激素受体阳性率很高。虽然过去曾施行睾丸切除术，但如今他莫昔芬是标准的激素治疗药物。关于全身化疗，最常用的方案是CMF（环磷酰胺、甲氨蝶呤、5-氟尿嘧啶）或其他基于蒽环类药物的方案。在疾病复发的情况下，可以进行激素治疗、化疗或放疗以达到姑息治疗目的。现在有几种选择性芳香化酶抑制剂；然而，关于它们在男性中的疗效数据有限。当年龄和分期相匹配时，与女性相比，男性乳腺癌的预后似乎并不差。需要进一步研究以明确男性乳腺癌的生物学和分子特性及其预后意义，并制定最佳治疗策略。然而，值得注意的是，p53和c-erbB-2在男性乳腺癌中表达，并且存在血管生成。此外，男性乳腺癌患者可能携带BRCA2基因突变。
