Di Rito Alessia, Grillo Antonietta, Carbonara Roberta
Radiotherapy Unit, Hospital Mons. A.R. Dimiccoli, Barletta, Italy.
Radiotherapy Unit, Azienda Ospedaliero Universitaria Policlinico Di Bari, Bari, Italy.
Curr Oncol Rep. 2025 Feb;27(2):120-134. doi: 10.1007/s11912-024-01629-z. Epub 2025 Jan 5.
Male breast cancer (MBC) is a rare entity which often arises in elderly people. Aim of this review is to evaluate the principal issues related to MBC in elderly, because the therapeutic management of disease is not only related to the biological behavior of the tumor, but also to the comorbidities and frailty of older population. A scoping literature review was performed on Pubmed and Cochrane Database using the following keywords: therapeutic management/ male/ breast cancer/ elderly patients. Papers published before 2000, not edited in English or French language, or not related to the main topic, were excluded. Only articles related to therapeutic issues in MBC and including more than 10 elderly (≥ 65 years) patients were selected for the qualitative outcome analysis.
36 papers regarding surgery, radiotherapy, systemic therapy, racial disparities and therapeutic management in retrospective series of MBC in elderly were examined in details. MBC has a different biological behavior and a poorer prognosis than female, especially in cases with positive nodes at diagnosis. Elderly MBC patients have often larger tumors in more advanced stages at the time of diagnosis compared with younger patients. In spite of the advanced tumors at presentation, older patients present often cancers with more favorable biological characteristics, but they receive less guideline-concordant curative treatments (as adequate lymph node staging or adjuvant radiation therapy) compared to women. Moreover, racial differences in treatment of older MBC were observed. Therapeutic management of MBC in elderly patients is a subject rarely addressed in literature. Our review highlighted differences in the treatment and in guidelines-concordance for elderly MBC patients. Adequate geriatric assessment and use of therapeutic schemes adapted to age and comorbidities can avoid under/overtreatment, contributing to a better standard of care in this frail population.
男性乳腺癌（MBC）是一种罕见疾病，多见于老年人。本综述旨在评估与老年男性乳腺癌相关的主要问题，因为该疾病的治疗管理不仅与肿瘤的生物学行为有关，还与老年人群的合并症和身体虚弱有关。我们在PubMed和Cochrane数据库上进行了一项范围界定文献综述，使用了以下关键词：治疗管理/男性/乳腺癌/老年患者。排除了2000年以前发表的、非英文或法文编辑的、或与主题无关的论文。仅选择与男性乳腺癌治疗问题相关且纳入超过10名老年（≥65岁）患者的文章进行定性结果分析。
详细审查了36篇关于老年男性乳腺癌回顾性系列研究中手术、放疗、全身治疗、种族差异和治疗管理的论文。与女性相比，男性乳腺癌具有不同的生物学行为和更差的预后，尤其是在诊断时淋巴结阳性的病例中。与年轻患者相比，老年男性乳腺癌患者在诊断时往往处于更晚期，肿瘤更大。尽管就诊时肿瘤已处于晚期，但老年患者的癌症生物学特征往往更有利，但与女性相比，他们接受符合指南的根治性治疗（如充分的淋巴结分期或辅助放疗）较少。此外，还观察到老年男性乳腺癌治疗中的种族差异。老年男性乳腺癌患者的治疗管理是文献中很少涉及的主题。我们的综述强调了老年男性乳腺癌患者在治疗和指南依从性方面的差异。充分的老年评估以及使用适合年龄和合并症的治疗方案可以避免治疗不足/过度治疗，有助于提高这一脆弱人群的护理标准。
