Breast cancer in men

Editor—Perkins and Middleton point out that treatment of breast cancer in men may be suboptimal.¹ The diagnostic work up is also a problem and not mentioned by the authors. Jobse and I recently evaluated our experience with fine needle aspiration cytology and core needle biopsy procedures in male breast lesions.²,³

Fine needle aspiration cytology had a sensitivity of 87%, a specificity of 78%, and a positive predictive value of malignancy of 100%.² In this study a preoperative diagnosis by either aspiration cytology or core needle biopsy was not available in nine out of 28 breast carcinomas, a situation that would generally be regarded as unacceptable in women.

I reported preliminary results for core needle biopsy, but there were no false positive or false negative diagnoses, suggesting that it is a reliable preoperative procedure.³ In this study six out of 19 men did not receive a preoperative diagnosis. In both studies we found evidence that a benign result with either procedure helps to avoid unnecessary operations.

These data are evidence of suboptimal preoperative work up of breast cancer in men, presumably because of a low level of suspicion of this diagnosis. As a consequence, too many men with breast cancer have to undergo a second operation. In addition, they are denied the benefits of a sentinel node biopsy procedure because of a previous breast operation.⁴ Therefore, core needle biopsy or fine needle aspiration cytology should be used more often as a preoperative diagnostic procedure in men with a breast lesion.