Annals of Surgical Oncology

, Volume 18, Issue 7, pp 1837–1844 | Cite as

Poorer Survival Outcomes for Male Breast Cancer Compared with Female Breast Cancer May Be Attributable to In-Stage Migration

  • Jennifer L. Gnerlich
  • Anjali D. Deshpande
  • Donna B. Jeffe
  • Susmitha Seelam
  • Eric Kimbuende
  • Julie A. Margenthaler
Breast Oncology



Male breast cancer accounts for less than 1% of all breast cancers, yet males have a worse prognosis than females with breast cancer.


Using the 1988–2003 Surveillance, Epidemiology, and End Results Program data, we conducted a retrospective, population-based cohort study to investigate stage-specific differences in breast cancer-specific and all-cause mortality between males and females. We calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CI) using Cox regression models to compare breast cancer-specific and all-cause mortality by stage between males and females, controlling for potential confounding variables.


There were 246,059 patients with a first, single, primary breast cancer [1,541 (0.6%) male; 244,518 (99.4%) female]. Compared with females, males were more likely to be older, Black, married, diagnosed at more advanced stages, and treated with mastectomy (each P < 0.001). Males also were more likely to have lower grade and estrogen/progesterone receptor-positive tumors (each P < 0.001). After controlling for confounders, males were more likely to die from their breast cancer when compared with females, only if diagnosed with stage I disease (aHR 1.72, CI 1.15–2.61). For all-cause mortality, males were more likely than females to die at each stage of disease except stage IV.


Although all-cause mortality was higher for men than women at all stages of nonmetastatic breast cancer, higher male breast cancer-specific mortality was attributed to poorer survival in stage I disease. However, this statistical difference is unlikely to be clinically relevant and attributable to in-stage migration.


Breast Cancer Male Breast Male Breast Cancer Female Breast Cancer Female Breast Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri, for the use of the Health Behavior, Communication and Outreach Core. The Core is supported in part by the National Cancer Institute Cancer Center Support Grant #P30 CA91842 to the Siteman Cancer Center.


  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.PubMedCrossRefGoogle Scholar
  2. 2.
    Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101:51–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Stang A, Thomssen C. Decline in breast cancer incidence in the United States: what about male breast cancer? Breast Cancer Res Treatment. 2008;112:595–6.CrossRefGoogle Scholar
  4. 4.
    Speirs V, Shaaban AM. The rising incidence of male breast cancer. Breast Cancer Res Treatment. 2009;115:429–30.CrossRefGoogle Scholar
  5. 5.
    Giordano SH. Male breast cancer: it’s time for evidence instead of extrapolation. Onkologie. 2008;31:505–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Ciatto S, Iossa A, Bonardi R, Pacini P. Male breast carcinoma: review of amulticenter series of 150 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy. Tumori. 1990;76:555–8.PubMedGoogle Scholar
  7. 7.
    Salvadori B, Saccozzi R, Manzari A, Andreola S, Conti RA, Cusumano F, et al. Prognosis of breast cancer in males: an analysis of 170 cases. Eur J Cancer. 1994;30A:930–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Donegan WL, Redlich PN, Lang PJ, Gall MT. Carcinoma of the breast in males: a multiinstitutional survey. Cancer. 1998;83:498–509.PubMedCrossRefGoogle Scholar
  9. 9.
    Yildirim E, Berberoglu U. Male breast cancer: a 22-year experience. Eur J Surg Oncol. 1998;24:548–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Tajima N, Tsukuma H, Oshima A. Descriptive epidemiology of male breast cancer in Osaka, Japan. J Epidemiol. 2001;11:1–7.PubMedGoogle Scholar
  11. 11.
    Sandler B, Carmen C, Perry RR. Cancer of the male breast. Am Surg. 1994;60:816–20.PubMedGoogle Scholar
  12. 12.
    Thalib L, Hall P. Survival of male breast cancer patients: population-based cohort study. Cancer Sci. 2009;100:292–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Borgen PI, Senie RT, McKinnon WMP, Rosen PP. Carcinoma of the male breast: analysis of prognosis compared with matched female patients. Ann Surg Oncol. 1997:4:385–88.PubMedCrossRefGoogle Scholar
  14. 14.
    Borgen PI, Wong GY, Vlamis V, et al. Current management of breast cancer: a review of 104 cases. Ann Surg. 1992;215:451–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Levi F, Randimbison L, La VC. Breast cancer survival in relation to sex and age. Oncology. 1992;49:413–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Cutuli B, Lacroze M, Dilhuydy JM, et al. Male breast cancer: results of the treatments and prognostic factors in 397 cases. Eur J Cancer. 1995;31A:1960–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Anan K, Mitsuyama S, Nishihara K, et al. Breast cancer in Japanese men: does sex affect prognosis? Breast Cancer. 2004;11:180–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Hill TD, Khamis HJ, Tyczynski JE, Berkel HJ. Comparison of male and female breast cancer incidence trends, tumor characteristics, and survival. Ann Epidemiol. 2005;15:773–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Adami, HO, Holmberg L. Malker B, Ries L. Long-term survival in 406 males with breast cancer. Br J Cancer. 1985;52:99–103.PubMedCrossRefGoogle Scholar
  20. 20.
    Atalay C, Kanlioz M, Altinok M. Prognostic factors affecting survival in male breast cancer. J Exp Clin Cancer Res. 2003;22:29–33.PubMedGoogle Scholar
  21. 21.
    El-Tamer MB, Komenaka IK, Troxel A, et al. Men with breast cancer have better disease-specific survival than women. Arch Surg. 2004;139:1079–82.PubMedCrossRefGoogle Scholar
  22. 22.
    National Cancer Institute: Surveillance, Epidemiology, and End Results. Overview of the SEER Program. Accessed April 21, 2009.
  23. 23.
    Schaub NP, Maloney N, Schneider H, Feliberti E, Perry R. Changes in male breast cancer over a 30-year period. Am Surg. 2008;74:707–12.PubMedGoogle Scholar
  24. 24.
    Nahleh ZA, Srikantiah R, Safa M, Jazieh AR, Muhleman A, Komrokji R. Male breast cancer in the Veterans Affairs population: a comparative analysis. Cancer. 2007;109:1471–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Weiss JR, Moysich KB, Swede H. Epidemiology of male breast cancer. Cancer Epidemiol Biomarkers Prev. 2005;14:20–26.PubMedCrossRefGoogle Scholar
  26. 26.
    Giordano SH, Buzdar AU, Hortobagyi GN. Breast cancer in men. Ann Intern Med. 2002;137:678–687.PubMedGoogle Scholar
  27. 27.
    Temmim L, Luqmani YA, Jarallah M, Juma I, Mathew M. Evaluation of prognostic factors in male breast cancer. Breast. 2001;10:166–75.PubMedCrossRefGoogle Scholar
  28. 28.
    Rudlowski C, Friedrichs N, Faridi A, et al. Her-2/neu gene amplification and protein expression in primary male breast cancer. Breast Cancer Res Treat. 2004;84:215–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Avisar E, McParland E, Dicostanzo D, Axelrod D. Prognostic factors in node-negative male breast cancer. Clin Breast Cancer. 2006;7:331–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Onami S, Ozaki M, Mortimer JE, Pal SK. Male breast cancer: an update in diagnosis, treatment, and molecular profiling. Maturitas. 2010;65(4):308–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Blin N, Kardas I, Welter C, Rys J, Niezabitowski A, Limon J, et al. Expression of the c-erbB2 proto-oncogene in male breast carcinoma: lack of prognostic significance. Oncology. 1993;50:408–11.PubMedCrossRefGoogle Scholar
  32. 32.
    Giordano SH, Perkins GH, Broglio K, Garcia SG, Middleton LP, Buzdar AU, et al. Adjuvant systemic therapy for male breast carcinoma. Cancer. 2005;104:2359–64.PubMedCrossRefGoogle Scholar
  33. 33.
    Ribeiro G, Swindell R. Adjuvant tamoxifen for male breast cancer (MBC). Br J Cancer. 1992;65:252–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Goss PE, Reid C, Pintilie M, Lim R, Miller N. Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955–1996. Cancer. 1999;85:629–39.PubMedCrossRefGoogle Scholar
  35. 35.
    Wang-Rodriguez J, Cross K, Gallagher S, Djahanban M, Armstrong JM, Wiedner N, et al. Male breast carcinoma: correlation of ER, PR, Ki-67, Her2-Neu, and p53 with treatment and survival, a study of 65 cases. Mod Pathol. 2002;15:853–61.PubMedCrossRefGoogle Scholar
  36. 36.
    Anderson WF, Jatoi I, Tse J, Rosenberg PS. Male breast cancer: a population-based comparison with female breast cancer. J Clin Oncol. 2010;28:232–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Sorlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001;98:10869–73.PubMedCrossRefGoogle Scholar
  38. 38.
    Esteva FJ, Valero V, Pusztai L, Boehnke-Michaud L, Buzdar AU, Hortobagyi GN. Chemotherapy of metastatic breast cancer: what to expect in 2001 and beyond. Oncologist. 2001;6:133–146.PubMedCrossRefGoogle Scholar
  39. 39.
    Wang J, Kollias J, Marsh C, Maddern G. Are males with early breast cancer treated differently from females with early breast cancer in Australia and New Zealand? Breast (Edinburgh). 2009;18:378–81.Google Scholar
  40. 40.
    Gough DB, Donohue JH, Evans MM, Pernicone PJ, Wold LE, Naessens JM, et al. A 50-year experience of male breast cancer: is outcome changing? Surg Oncol. 1993;2:325–33.PubMedCrossRefGoogle Scholar
  41. 41.
    Golshan M, Rusby J, Dominguez F, Smith BL. Breast conservation for male breast carcinoma. Breast (Edinburgh). 2007;16:653–6.Google Scholar
  42. 42.
    Merrill RM, Dearden KA. How representative are the surveillance, epidemiology, and end results (SEER) program cancer data of the United States. Cancer Cause Control. 2004;15:1027–34.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Jennifer L. Gnerlich
    • 1
  • Anjali D. Deshpande
    • 2
    • 3
  • Donna B. Jeffe
    • 2
    • 3
  • Susmitha Seelam
    • 4
  • Eric Kimbuende
    • 4
  • Julie A. Margenthaler
    • 1
    • 3
  1. 1.Department of SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of MedicineWashington University School of MedicineSt. LouisUSA
  3. 3.Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of MedicineSaint LouisUSA
  4. 4.Department of Community HealthSaint Louis University School of Public HealthSt. LouisUSA

Personalised recommendations