Advertisement

Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk?

  • Suzanne B. CoopeyEmail author
  • Kinyas Kartal
  • Clara Li
  • Adam Yala
  • Regina Barzilay
  • Heather R. Faulkner
  • Tari A. King
  • Francisco Acevedo
  • Judy E. Garber
  • Anthony J. Guidi
  • Kevin S. Hughes
Review
  • 60 Downloads

Abstract

Purpose

Atypical ductal hyperplasia (ADH) significantly increases the risk of breast cancer in women. However, little is known about the implications of ADH in men.

Methods

Review of 932 males with breast pathology was performed to identify cases of ADH. Patients were excluded if ADH was upgraded to cancer on excision, or if they had contralateral breast cancer. Cases were reviewed to determine whether any male with ADH developed breast cancer.

Results

Nineteen males were diagnosed with ADH from June 2003 to September 2018. All had gynecomastia. Surgical procedure was mastectomy in 8 patients and excision/reduction in 11. One patient had their nipple areola complex removed, and 1 required a free nipple graft. Median patient age at ADH diagnosis was 25 years (range 18–72 years). Of the 14 patients with bilateral gynecomastia, 10 had bilateral ADH and 4 had unilateral. Five cases of ADH were described as severe, bordering on ductal carcinoma in situ. No patient reported a family history of breast cancer. No patient took tamoxifen. At a mean follow-up of 75 months (range 4–185 months), no patient developed breast cancer.

Conclusion

Our study is the first to provide follow-up information for males with ADH. With 6 years of mean follow-up, no male in our series has developed breast cancer. This suggests that either ADH in men does not pose the same risk as ADH in women or that surgical excision of symptomatic gynecomastia in men effectively reduces the risk of breast cancer.

Keywords

Atypical ductal hyperplasia Gynecomastia Male Breast cancer Risk 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Because of the retrospective nature of this study with minimal risk to participants, the need for informed consent was waived by our institutional review board.

References

  1. 1.
    Johnson RE, Murad MH (2009) Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc 84:1010–1015CrossRefGoogle Scholar
  2. 2.
    Handschin AE, Bietry D, Husler R, Banic A, Constantinescu M (2008) Surgical management of gynecomastia—a 10-year analysis. World J Surg 32:38–44CrossRefGoogle Scholar
  3. 3.
    Gunaydin G, Altundag K (2011) Ductal carcinoma in situ and bilateral atypical ductal hyperplasia in a 23-year-old man with gynecomastia. Am Surg 77:1272–1273Google Scholar
  4. 4.
    Lapid O, Jolink F, Meijer SL (2015) Pathological findings in gynecomastia: analysis of 5113 breasts. Ann Plast Surg 74:163–166CrossRefGoogle Scholar
  5. 5.
    Koshy JC, Goldberg JS, Wolfswinkel EM, Ge Y, Heller L (2011) Breast cancer incidence in adolescent males undergoing subcutaneous mastectomy for gynecomastia: is pathologic examination justified? A retrospective and literature review. Plast Reconstr Surg 127:1–7CrossRefGoogle Scholar
  6. 6.
    Wells JM, Liu Y, Ginter PS, Nguyen MT, Shin SJ (2015) Elucidating encounters of atypical ductal hyperplasia arising in gynaecomastia. Histopathology 66:398–408CrossRefGoogle Scholar
  7. 7.
    Dupont WD, Page DL (1985) Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 312:146–151CrossRefGoogle Scholar
  8. 8.
    Hartmann LC, Sellers TA, Frost MH et al (2005) Benign breast disease and the risk of breast cancer. N Engl J Med 353:229–237CrossRefGoogle Scholar
  9. 9.
    Coopey SB, Mazzola E, Buckley JM et al (2012) The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Res Treat 136:627–633CrossRefGoogle Scholar
  10. 10.
    Hartmann LC, Radisky DC, Frost MH et al (2014) Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res 7:211–217CrossRefGoogle Scholar
  11. 11.
    Hartmann LC, Degnim AC, Santen RJ, Dupont WD, Ghosh K (2015) Atypical hyperplasia of the breast—risk assessment and management options. N Engl J Med 372:78–89CrossRefGoogle Scholar
  12. 12.
    Yala A, Barzilay R, Salama L et al (2017) Using machine learning to parse breast pathology reports. Breast Cancer Res Treat 161:203–211CrossRefGoogle Scholar
  13. 13.
    Wagoner MJ, Laronga C, Acs G (2009) Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol 131:112–121CrossRefGoogle Scholar
  14. 14.
    Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD (2009) Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR 192:229–234CrossRefGoogle Scholar
  15. 15.
    Mainiero MB, Lourenco AP, Barke LD et al (2015) ACR appropriateness criteria evaluation of the symptomatic male breast. J Am Coll Radiol 12:678–682CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Suzanne B. Coopey
    • 1
    • 9
    Email author
  • Kinyas Kartal
    • 2
  • Clara Li
    • 3
  • Adam Yala
    • 3
  • Regina Barzilay
    • 3
  • Heather R. Faulkner
    • 4
  • Tari A. King
    • 5
  • Francisco Acevedo
    • 6
  • Judy E. Garber
    • 7
  • Anthony J. Guidi
    • 8
  • Kevin S. Hughes
    • 1
  1. 1.Division of Surgical OncologyMassachusetts General HospitalBostonUSA
  2. 2.Department of General SurgeryKoc University HospitalIstanbulTurkey
  3. 3.Department of Electrical Engineering and Computer ScienceCSAIL, MITCambridgeUSA
  4. 4.Division of Plastic and Reconstructive SurgeryMassachusetts General HospitalBostonUSA
  5. 5.Department of SurgeryDana-Farber/Brigham and Women’s Cancer CenterBostonUSA
  6. 6.Department of Hematology-OncologyPontificia Universidad Catolica de ChileSantiagoChile
  7. 7.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  8. 8.Department of PathologyNewton-Wellesley HospitalNewtonUSA
  9. 9.BostonUSA

Personalised recommendations