Poor compliance with breast cancer treatment guidelines in men undergoing breast-conserving surgery
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Lumpectomy is performed in a small but growing proportion of men with breast cancer. It is unknown whether men undergoing breast-conserving surgery (BCS) receive care compliant with breast cancer treatment guidelines. Patients with breast cancer in the surveillance, epidemiology, and end results (SEER) database who underwent lumpectomy between 1983 and 2009 were identified. Gender differences in the receipt of lymph node staging and adjuvant radiation therapy were assessed. Multivariate logistic regression was utilized to evaluate the independent association of gender on these outcomes. The influence of gender on breast cancer-specific survival (BCSS) was analyzed. 382,030 of 824,408 (46.3 %) women compared to 712 of 6,039 (11.8 %) men with breast cancer underwent lumpectomy. Men were older, more likely to be black, less likely to have stage I disease and more likely to have stage IV disease. Only 59.2 % of men had lymph nodes sampled at the time of surgery compared to 81.6 % of women (p < 0.0001). In addition, only 35.4 % of men received adjuvant breast radiation therapy compared to 69.8 % of women (p < 0.0001). After controlling for age, race, stage, grade, and year of diagnosis, female gender was significantly associated with receiving adjuvant radiation therapy (OR 2.9, 95 % CI 2.4–3.4) and lymph node staging (OR 1.6, 95 % CI 1.3–1.90). Five- and ten-year BCSS were 88.0 and 83.5 % for men compared to 93.2 and 88.2 % for women (p < 0.001). Men with breast cancer are less likely to receive lymph node staging or adjuvant radiation therapy following BCS compared to women.
KeywordsMale breast cancer Breast-conservation therapy Lumpectomy Sentinel lymph node biopsy Axillary lymph node dissection Radiation therapy Compliance Health disparities
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, Cochran AJ, Cody HS 3rd, Edge SB, Galper S, Hayman JA, Kim TY, Perkins CL, Podoloff DA, Sivasubramaniam VH, Turner RR, Wahl R, Weaver DL, Wolff AC, Winer EP (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23(30):7703–7720PubMedCrossRefGoogle Scholar
- 9.Cloyd JM, Hernandez-Boussard T, Wapnir IL (2013) Outcomes of partial mastectomy in male breast cancer patients: analysis of SEER, 1983–2009. Ann Surg Oncol Mar 2013Google Scholar
- 10.National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology. Breast Cancer. Available http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 1 April 2013
- 13.Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wolmark N, Deutsch M, Montague E (1985) Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312(11):665–673PubMedCrossRefGoogle Scholar
- 14.Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong J-H, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241PubMedCrossRefGoogle Scholar
- 15.Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106PubMedGoogle Scholar
- 16.Korde LA, Zujewski JA, Kamin L, Giordano S, Domchek S, Anderson WF, Bartlett JMS, Gelmon K, Nahleh Z, Bergh J, Cutuli B, Pruneri G, McCaskill-Stevens W, Gralow J, Hortobagyi G, Cardoso F (2010) Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol 28(12):2114–2122PubMedCrossRefGoogle Scholar
- 31.Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, Wheeler J, Champion LA, Smith TJ, Smith BL, Shapiro C, Muss HB, Winer E, Hudis C, Wood W, Sugarbaker D, Henderson IC, Norton L (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351(10):971–977PubMedCrossRefGoogle Scholar
- 33.Cutuli B, Dilhuydy JM, De Lafontan B, Berlie J, Lacroze M, Lesaunier F, Graic Y, Tortochaux J, Resbeut M, Lesimple T, Gamelin E, Campana F, Reme-Saumon M, Moncho-Bernier V, Cuilliere JC, Marchal C, De Gislain G, N’Guyen TD, Teissier E, Velten M (1997) Ductal carcinoma in situ of the male breast. Analysis of 31 cases. Eur J Cancer 33(1):35–38PubMedCrossRefGoogle Scholar
- 35.Nguyen T, Cowher M (2012) Demand for breast-conserving surgery among male breast cancer patients, in 13th annual meeting of American Society of Breast Surgeons, Phoenix, AZGoogle Scholar