Breast-Conserving Surgery (BCS) is the standard operation for small, early-stage breast cancer for women. Given the advances in systemic therapies, there is now a large body of evidence that indicates wide margins are not necessary when removing invasive breast cancer.
Indeed, it has been well proven that survival outcomes are no different between BCS and total mastectomy. In other words, BCS does not have significant survival benefit over total mastectomy. Preservation of the breast tissue and shape are the major advantage of BCS.
Because breast cancer is far less common in men than women, there is no solid evidence on the benefit of BCS in males. On the other hand, the number of BCS procedures for male breast cancer appears to be on the rise, based on a comparison of the percentages of BCS cases in a large case series that spanned different time frames.
A review of 489 male breast cancers operated between 1990 and 2005 in France revealed that only 42 (8.6%) patients underwent BCS.
On the other hand, 17% of 1,777 men with early-stage breast cancer registered in the SEER database underwent breast-conserving therapy from 1998 to 2011. In the North American Association of Central Cancer Registries, 1,254 of 6,332 (19.8%) men with early-stage breast cancer underwent BCS from 2004 to 2011.
Equivocally, these studies report that BCS offers comparable survival compared with total mastectomy. In other words, BCS is feasible for male breast cancer. With that said, what benefit does BCS provide to male patients? Male breast cancers are commonly located centrally, so total mastectomy is indicated. With breast tissue remaining after BCS, the patient needs to undergo adjuvant radiation, which takes time and resources. Adjuvant therapies are not free from complications. With the minimal volume of the breast, follow-up mammograms will be more painful for men than women with larger breasts.
Again, the benefit of BCS for women is to preserve breast tissue and shape, and there is no survival benefit compared with total mastectomy.
How many of our male patients with breast cancer prefer to preserve their breasts? I agree that breast-conserving therapy is feasible; however, is not recommended for male breast cancer unless the patient has the specific desire for it. We have reviewed the male breast cancer cases in our own institution from 1990 to 2015, and we found that only two (2.5%) of the 78 patients for whom records were available underwent BCS.
Footnotes
Disclosure: Takabe reports no relevant financial disclosures.
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