男性乳癌較少見 診斷時多已惡化


  【24drs.com】根據發表於美國乳房外科協會第13屆年會的研究,男性乳癌只佔所有乳癌的1%,不過,腫瘤比女性大且惡化,整體存活率明顯低於女性。
  
  為了進行研究,研究者使用國家癌症資料庫1998-2007年所有乳癌病患的數據, 他們比較各性別、年紀、種族、組織學、等級、腫瘤大小、有影響淋巴結、荷爾蒙受體狀態、初次療程、整體存活。
  
  加州奧克蘭的Jon Greif醫師表示,這篇研究和其他研究的不同之處在於它的樣本數,這是迄今最大型的男性乳癌研究,包括了13,457名乳癌男性,佔所有乳癌的0.9%,以及1,439,866名女性乳癌案例。
  
  與女性乳癌相比,男性乳癌發生率在黑人較高(11.7% vs 9.9%;勝算比[OR],1.19)、西班牙裔較低(3.6% vs 4.5%;OR,0.74),年長者較高(63歲 vs 59歲)。
  
  整體而言,男性癌症比女性癌症惡化,男性腫瘤較大(中位數20.0 vs 15.0 mm);男性比較不會是等級1腫瘤(16.0% vs 20.7%),比較可能有淋巴結轉移(41.9% vs 33.2%;OR,1.45),比較可能有遠端轉移(4 vs 3;OR,1.39)。
  
  此外,男性的葉狀癌比率較低(10% vs 18%;OR,0.51),雌激素受體(ER)陽性的比率較高(88.3% vs 78.2%;OR,2.10),黃體素受體陽性比率也是較高(76.8% vs 67.0%;OR,1.63)。
  
  男性比女性不會進行部份乳房切除(33% vs 62%;OR,0.31)與接受放射線治療(35.9% vs 50.4%;OR,0.55)。
  
  男性和女性之間的化療比率差異並不顯著,荷爾蒙治療比率只有一點差異。
  
  不過,整體存活率有顯著差異,女性乳癌的5年存活率顯著較佳,不論是第0期(94% vs 90%)、第I期(90% vs 87%)與第II期(82% vs 74%)乳癌(全部P<.0001);但第III期(56.9% vs 56.5%;P= .99)或第IV期(19% vs 16%;P= .20)的整體存活率在男性和女性則無顯著差異。
  
  對於各種昂貴的乳癌警覺努力,這些結果提供證據顯示,男性對這些訊息依舊充耳不聞。
  
  Greif醫師表示,男性和他們的健康照護者確實警覺性較低。
  
  許多人甚至不知道男性會發生乳癌,若有可以提高警覺的計畫、發展高風險男性篩檢機制(根據基因、家族史、放射線曝露或其他已知致癌因子、曾患病之病史)將會有所幫助。預防的基礎為健康的生活型態:健康飲食、運動、維持健康體重、不抽菸、限量飲酒等等。
  
  他指出,這篇研究有一些限制,包括缺乏死因和某些篩檢細節的資料。主要的研究限制是,資料庫無法讓我們實際地瞭解這些男性研究對象的死因;有些可能是死於乳癌之外的其他疾病。
  
  另一個限制是,我們分析時未排除篩檢發現乳癌的女性,產生所謂的前導期偏差。這是她們發現初期腫瘤且有較佳結果的主要原因,這一點是研究限制,但也是要強調的重點:我們必須提高男性乳癌的警覺。
  
  根據加州乳癌中心主任、乳房外科Deanna Attai醫師指出,有許多因素可以解釋這個趨勢。男性研究對象出現比較末期的疾病,或許是因為他們比較不會有等級1腫瘤,也或許是因為還沒有一般可接受的男性篩檢指引。
  
  Attai醫師解釋,如果依各個腫瘤階段比較存活差異,男性和女性之間有存活差異,這或許是因為幾項因素或者同時有多種因素,較高等級的腫瘤和比較無法用tamoxifen治療的腫瘤,雖然大多是ER陽性腫瘤,我們並無法從資料庫中得知為何tamoxifen比較無效,或許有使用此藥,但是因為副作用導致耐受不佳,或者是沒有使用該藥。
  
  或許是因為男性平均壽命比女性短。
  
  Attai醫師表示,儘管有許多尚待解答的問題,這仍是篇重要的研究。
  
  這是回顧男性乳癌的最大型研究,提高男性與其醫師的警覺,最起碼定期自我檢查和醫師臨床檢查是重要的。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6816&x_classno=0&x_chkdelpoint=Y
  

Male Breast Cancers Less Common, More Advanced at Diagnosis

By Nancy A. Melville
Medscape Medical News

May 9, 2012 (Phoenix, Arizona) — Breast cancer in men represents only about 1% of all breast cancers; however, the tumors tend to be larger, the cancer more advanced, and overall survival is substantially lower than for women, according to research presented here at the American Society of Breast Surgeons 13th Annual Meeting.

For their study, investigators used data from the National Cancer Data Base on all patients with breast cancer from 1998 to 2007. They first compared the cases for differences in sex, then for age, race/ethnicity, histology, grade, tumor size, lymph node involvement, hormone-receptor status, course of first treatment, and overall survival.

"This study differs from others mainly in its magnitude," lead author Jon Greif, DO, a breast surgeon from Oakland, California, told Medscape Medical News. "It is, by far, the largest series of male breast cancer ever studied."

The study involved 13,457 cases of male breast cancer, representing 0.9% of all breast cancers, and 1,439,866 cases of female breast cancer.

The incidence of male breast cancer, compared with female breast cancer, was higher among blacks (11.7% vs 9.9%; odds ratio [OR], 1.19), lower among Hispanics (3.6% vs 4.5%; OR, 0.74), and higher among older patients (63 vs 59 years).

Overall, male cancers were more advanced than female cancers, and male tumors were larger (median, 20.0 vs 15.0 mm). Males were less likely to have grade 1 tumors (16.0% vs 20.7%), more likely to have lymph node metastasis (41.9% vs 33.2%; OR, 1.45), and more likely to have distant metastasis (4 vs 3; OR, 1.39).

In addition, males had lower rates of lobular carcinoma (10% vs 18%; OR, 0.51) and a greater likelihood of being estrogen-receptor (ER) positive (88.3% vs 78.2%; OR, 2.10) and progesterone-receptor positive (76.8% vs 67.0%; OR, 1.63).

Males were less likely than females to have a partial mastectomy (33% vs 62%; OR, 0.31) and to receive radiation (35.9% vs 50.4%; OR, 0.55).

Chemotherapy rates were not significantly different between males and females, and there were only small differences in hormonal therapy rates.

Overall survival rates, however, were significantly different. Females with breast cancer had significantly better 5-year overall survival for stage 0 (94% vs 90%), stage I (90% vs 87%), and stage II (82% vs 74%) breast cancer (P < .0001 for all).

However, there were no significant differences between females and males in overall survival for stage III (56.9% vs 56.5%; P = .99) or stage IV (19% vs 16%; P = .20) disease.

The findings provide evidence that, for all of the expansive breast cancer awareness efforts, the message still falls largely on deaf ears when it comes to men.

"Absolutely there is less awareness among men and their healthcare providers," Dr. Greif said.

"Many are unaware that men even get breast cancer," he said. "A program of increasing awareness, and developing screening for men at high risk — genetically, by family history, by exposure to radiation or other known carcinogens, and by having had the disease before — would all be helpful."

"The basics of prevention are a healthy lifestyle — eat healthy, exercise, maintain a healthy weight, don't smoke, limit alcohol, etc."

He noted that the study has several limitations, including a lack of data on cause of death and certain screening specifics.

"The major limitation of our study is that the database does not let us see exactly what the men in the study are dying of; certainly some are dying of diseases other than breast cancer," he said.

"Another limitation is that we don't exclude from analysis the women whose cancers were detected by screening — so-called lead-time bias. This is a major reason that they have earlier tumors and do better. It's a limitation, but it also underscores our point — we need to raise awareness about male breast cancer."

According to breast surgeon Deanna Attai, MD, head of the Center for Breast Care in Burbank, California, several factors could explain the trends.

"Men in the study presented with more advanced-stage disease, possibly because they were less likely to have grade 1 tumors, and possibly because there are no generally accepted screening guidelines for men," she said.

Survival differences were seen "even when men were compared stage-for-stage with women. That might be due to several factors, or a combination of factors — higher-grade tumors and tumors that are less likely to be treated with tamoxifen even though most of the tumors are ER-positive. We don't know from the database why tamoxifen was less likely to be used. Maybe it was offered and the side effects made it intolerable, or maybe it was not offered," Dr. Attai explained.

"Perhaps there is even the issue that men generally don't live as long as women."

Despite several unanswered questions, the research is significant, Dr. Attai said.

"It's the largest review of male breast cancer, and it raises awareness — in men and their physicians — that, at the very least, periodic self-exams and clinical exam by the physician are important."

Dr. Greif and Dr. Attai have disclosed no relevant financial relationships.

American Society of Breast Surgeons (ASBS) 13th Annual Meeting. Abstract 0104. Presented May 4, 2012.

    
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