- How is breast cancer in men treated?
- Surgery for breast cancer in men
- Radiation therapy for breast cancer in men
- Chemotherapy for breast cancer in men
- Hormone therapy for breast cancer in men
- Targeted therapy for breast cancer in men
- Bone-directed therapy for breast cancer in men
- Treatment of breast cancer in men, by stage
- What should you ask your doctor about breast cancer in men?
Treatment of breast cancer in men, by stage
Because there have been few clinical trials on treatment of male breast cancer, most doctors base their treatment recommendations on their experience with the disease and on the results of studies of breast cancer in women. With some minor variations, breast cancer in men is treated the same way as breast cancer in women.
Stage 0 (ductal carcinoma in situ)
Ductal carcinoma in situ (DCIS) is considered a pre-cancer because it has not spread to lymph nodes or distant sites. It is treated with surgery to remove the cancer. Most often in males, a mastectomy is done. If breast-conserving surgery is done, it is followed by radiation therapy to the remaining breast tissue. If the DCIS is estrogen receptor-positive, tamoxifen might be given as well.
Because sometimes DCIS can contain an area of invasive cancer, the lymph nodes under the arm may be checked for spread, most often with a sentinel lymph node biopsy. If cancer cells are found in the sentinel lymph node, the tumor must contain some invasive cancer, and the man will be treated based on his invasive cancer stage.
These cancers are still relatively small and either have not spread to the lymph nodes (N0) or there is a tiny area of cancer spread in the sentinel lymph node (N1mi).
The main treatment for stage I breast cancer is to remove it with surgery. Although this is usually done by mastectomy, breast-conserving surgery such as a lumpectomy may also be an option. But because there is very little breast tissue in men, usually the whole breast (including the nipple) needs to be removed. If breast-conserving surgery is done, it is usually followed by radiation therapy.
The lymph nodes under the arm will be checked for cancer spread, either with an axillary lymph node dissection (ALND) or sentinel node biopsy (SLNB). If the sentinel lymph node contains cancer, a full ALND may be needed, depending on the size of the cancer in the lymph node as well as what other treatment is planned.
Hormone therapy and/or chemotherapy (chemo) may be recommended after surgery as adjuvant therapy, based on the tumor size and results of lab tests. Hormone therapy with tamoxifen is usually recommended for hormone receptor-positive tumors. Adjuvant chemo is commonly used for tumors larger than 1 cm (about 1/2 inch) across and some smaller tumors that may be more likely to spread (based on features such as grade or a high growth rate). Men with HER2-positive tumors may also receive trastuzumab (Herceptin).
These cancers are larger and/or have spread to a few nearby lymph nodes. One option is to treat first with chemo and/or hormone therapy before surgery (neoadjuvant therapy). For HER2-positive cancers, neoadjuvant therapy will likely include trastuzumab and may also include pertuzumab (Perjeta). Then, as with stage I cancers, mastectomy is usually done. The lymph nodes under the arm will be checked for cancer spread, either with an axillary lymph node dissection (ALND) or sentinel lymph node biopsy. If the sentinel lymph node contains cancer, a full ALND may be needed, depending on the size of the cancer in the lymph node as well as what other treatment is planned.
Radiation therapy may be given after surgery if the tumor is large or if it is found to have spread to several lymph nodes. Radiation therapy lowers the risk of the cancer coming back later (recurrence).
Adjuvant hormone therapy with tamoxifen is usually recommended for hormone receptor-positive tumors. If neoadjuvant chemo wasn’t given, adjuvant chemo will likely be also recommended. Choices about chemo may be influenced by a man's age and general state of health. Men with HER2-positive cancer will probably also receive trastuzumab.
This stage includes more advanced tumors (large or with growth into nearby skin or muscle) and cancers with more lymph node involvement (either more underarm lymph nodes containing cancer or lymph nodes inside the chest containing cancer).
Most often, these cancers are treated with chemo before surgery (neoadjuvant chemo). For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab. This is followed by surgery, usually mastectomy. If the lymph nodes aren’t known to contain cancer before surgery, a sentinel lymph node biopsy (SLNB) may be done to check the lymph nodes for cancer. Most patients with this stage, though, need a full axillary lymph node dissection (ALND). Radiation therapy is usually recommended after surgery. Adjuvant hormone therapy with tamoxifen is given for at least 5 years after surgery if the tumor is hormone receptor-positive. Men with HER2-positive cancers will probably also receive trastuzumab to complete a year of treatment.
Another option for stage III cancers is to treat with surgery first. This usually means a mastectomy with an ALND. Surgery is usually followed by adjuvant systemic chemo. Trastuzumab is given with chemo if the tumor is HER2 positive, and then it is continued to complete a year of treatment. Radiation is recommended after surgery and chemo. Adjuvant hormone therapy is given for at least 5 years to men with hormone receptor-positive breast cancers.
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. Breast cancer most commonly spreads to the bones, liver, and lungs. As the cancer progresses, it may spread to the brain, but it can affect any organ and tissue, even the eyes.
While surgery and/or radiation may be useful in some situations (see below), systemic therapy is the main treatment. Depending on many factors, this may be hormone therapy, chemo, targeted therapy, or some combination of these treatments. Targeted therapy options include trastuzumab, trastuzumab plus pertuzumab (Perjeta), ado-trastuzumab emtansine (Kadcyla), and lapatinib.
All of the systemic therapies given for breast cancer — hormone therapy, chemo, and targeted therapies — have potential side effects, which were described in previous sections. Your doctor will explain to you the benefits and risks of these treatments before prescribing them.
Radiation therapy and/or surgery may also be used in certain situations, such as:
- When the breast tumor is causing an open wound in the breast (or chest)
- To treat a small number of metastases in a certain area
- To prevent bone fractures
- When an area of cancer spread is pressing on the spinal cord
- To treat a blockage in the liver
- To relieve pain or other symptoms
- When the cancer has spread to the brain
If your doctor recommends such local treatments, it is important that you understand their goal, whether it is to try to cure the cancer or to prevent or treat symptoms.
In some cases, regional chemo (where drugs are delivered directly into a certain area, such as the fluid around the brain or into the liver) may be useful as well.
Treatment to relieve symptoms depends on where the cancer has spread. For example, pain from bone metastases may be treated with external beam radiation therapy and/or bisphosphonates or denosumab (Xgeva). Most doctors recommend bisphosphonates or denosumab along with calcium and vitamin D for all patients whose breast cancer has spread to their bones. For more information, see our document Bone Metastasis.
Advanced cancer that progresses during treatment: Treatment for advanced breast cancer can often shrink or slow the growth of the cancer (sometimes for many years), but after a time it may stop working. Further treatment at this point depends on several factors, including previous treatments, where the cancer is located, and a man's age, general health, and desire to continue getting treatment.
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy is sometimes helpful. Some doctors could also try giving another hormone drug with everolimus (Afinitor), but this has not been studied in men (so it isn’t clear that it would be helpful). If not, chemo is usually the next step.
For cancers that are no longer responding to one chemo regimen, trying another may be helpful. Many different drugs and combinations can be used to treat breast cancer. However, each time a cancer progresses during treatment it becomes less likely that further treatment will have an effect.
HER2-positive cancers that no longer respond to trastuzumab may respond if lapatinib (Tykerb) is added. Lapatinib or the drug ado-trastuzumab emtansine (Kadcyla) can also be given instead of trastuzumab. These drugs also attack the HER2 protein. Lapatinib is usually given along with the chemo drug capecitabine (Xeloda), but it may be used with other chemo drugs, hormone drugs, or even by itself (without chemo or hormone therapy). Ado-trastuzumab emtansine is given by itself.
Because current treatments are very unlikely to cure advanced breast cancer, patients in otherwise good health are encouraged to think about taking part in clinical trials of other promising treatments. You can also read about living with later-stage cancer in our document Advanced Cancer.
Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bones). Rarely, breast cancer comes back in nearby lymph nodes. This is called regional recurrence.
Local recurrence: This includes cancer coming back in the breast or in the chest wall (near the mastectomy scar). If a patient has a local recurrence and no evidence of distant metastases, cure may still be possible. Treatment depends on what other treatments have already been given. If the initial treatment was mastectomy, recurrence is treated by removing the tumor whenever possible. This may be followed by radiation therapy. If the area has already been treated with radiation, it may not be possible to give more radiation to the area without severely damaging nearby normal tissues.
Regional recurrence: When breast cancer comes back in nearby lymph nodes (such as those under the arm or around the collar bone), it is treated by removing those lymph nodes. This may be followed by radiation treatments aimed at the area.
Hormone therapy, chemo, trastuzumab, or some combination of these may be used after surgery and/or radiation therapy.
Distant recurrence: Men who have a recurrence in organs such as the bones, lungs, brain, etc., are often treated the same way as those found to have stage IV breast cancer with spread to these organs when they were first diagnosed (see above). The only difference is that treatment may be affected by the previous treatments a man has had.
Should your cancer come back, our document When Your Cancer Comes Back: Cancer Recurrence can provide you with more general information on how to manage and cope with this phase of your treatment.
You can also read about treatments for metastatic cancer in our document Advanced Cancer.
Last Medical Review: 10/10/2014
Last Revised: 01/26/2016