Br. J. Surg. Vol. 62 (1975) 963-965
The survival rate of men with carcinoma of t h e breast R O B E R T W. T. S L A C K * SUMMARY
The Cancer Register for the South-West Region of England has been used to examine the survival rate of men with carcinoma of the breast, and a comparison has been made with carcinoma of’the breast in women. For all men with carcinoma of the breast the prognosis is worse than for all women, but comparing the prognosis by clinical stage, the difference between men and women is small. Howeuer, the survival rate in men under 65 years of age is appreciably better than for men over 65, and for older men the survival rate is considerably less than .for women over 65.
CARCINOMA of the breast is rare in men, with an incidence of approximately 1 per cent of the incidence in women. The Registrar General’s Statistics for England and Wales for 1972 show that the mortality rate from carcinoma of the breast was 3 per million for men compared with 443 per million for women. Notification of incidence for cancer of the breast occurs at a later age in men than in women; among 507 cases of carcinoma of the breast in men reported from the United States by Moss in 1964 the median age for notification was 64 years compared with 58 years among females. Fig. 1 shows a similar shift in age at death from carcinoma of the breast in men compared with women in this country, as recorded by the Registrar General for England and Wales in 1972. The prognosis for carcinoma of the breast is generally believed to be poorer in men than in women (Vanderbilt and Warren, 1971), and Moss (1964) reported that in his series the 10-year survival rate for women was 49 per cent compared with 32 per cent for men. The discrepancy might be due to the relatively older age of the male patients, but even after correction is made for other causes of death, the female survival rate is 56 per cent compared with 43 per cent in males. The stage of spread of the disease at the time of notification has an important effect upon survival in both men and women. Jn Moss’s (1964) series in which the stage of the disease was classified as ‘localized’, ‘regional’ or ‘distant’, the prognosis was more favourable for women with localized disease or regional metastases but more favourable for men with distant metastases. The relationship between the age of notification and the stage of the spread of disease in carcinoma of the male breast is not clear from the studies reported. The present investigation was undertaken to examine the survival rate in carcinoma of the male breast in the South-West Region of England and to find the effects of both age and clinical stage of the spread of the disease upon prognosis.
Patients and methods The Cancer Register of the South-Western Regional Health Authority was examined and all the records of carcinoma of the male breast notified between 1960 and 1968 were extracted. Patients with carcinoma of the male breast who died from unrelated causes, including one who died from renal complications of carcinomatosis with a primary carcinoma in the kidney, were excluded. Preliminary examination of the whole series showed that no deaths from carcinoma of the male breast occurred more than 7 years after diagnosis; therefore in order to allow a full 7-year follow-up, all the patients presenting in 1968 were excluded. Patients were divided into 10-year age groups and into the four international clinical stage (TNM) groups (CopeIand, 1969). Percentage survival rates were calculated by age and stage. Female
Male
e-.3000-
2500
--
2000-
am u
1500-0
z 1000-500 --
015-24
25-34
35-44 45-54 55-64 65-74 75-84 10-year age groups
85*
Fig. 1. Number of deaths from carcinoma of the breast in men and women recorded by the Registrar General for England and Wales in 1972.
Results Between 1960 and 1968, 56 cases of carcinoma of the male breast were reported to the Cancer Registry of the South-Western Regional Health Authority. During that time 6000 cases of carcinoma of the female breast were notified, giving a male to female ratio of 0.93 per cent. After exclusion of 5 patients notified in 1968 and 13 patients who died from causes unrelated to carcinoma of the breast, 38 cases of carcinoma of the male breast were available for study.
* Medical student, University of Bristol Medical School, Bristol Royal Infirmary. 963
Robert W. T. Slack Table I: COMPARISON OF AGE OF PATIENTS AND CLINICAL STAGE OF THE DISEASE Clinical stage Age I I1 111 IV Not known Total 3 5-44 3 0 0 0 1 4 45-54 1 2 3 0 0 6 55-64 5 2 3 1 0 11 ~. 65-74 3 3 2 2 0 10 75 1 1 3 1 1 7 Total 13 8 11 4 2 38
+
Table I1 : PERCENTAGE SURVIVAL RATE ACCORDING TO CLINICAL STAGE OF THE DISEASE Survival time in years
The survival rate of men with carcinoma of t h e breast R O B E R T W. T. S L A C K * SUMMARY
The Cancer Register for the South-West Region of England has been used to examine the survival rate of men with carcinoma of the breast, and a comparison has been made with carcinoma of’the breast in women. For all men with carcinoma of the breast the prognosis is worse than for all women, but comparing the prognosis by clinical stage, the difference between men and women is small. Howeuer, the survival rate in men under 65 years of age is appreciably better than for men over 65, and for older men the survival rate is considerably less than .for women over 65.
CARCINOMA of the breast is rare in men, with an incidence of approximately 1 per cent of the incidence in women. The Registrar General’s Statistics for England and Wales for 1972 show that the mortality rate from carcinoma of the breast was 3 per million for men compared with 443 per million for women. Notification of incidence for cancer of the breast occurs at a later age in men than in women; among 507 cases of carcinoma of the breast in men reported from the United States by Moss in 1964 the median age for notification was 64 years compared with 58 years among females. Fig. 1 shows a similar shift in age at death from carcinoma of the breast in men compared with women in this country, as recorded by the Registrar General for England and Wales in 1972. The prognosis for carcinoma of the breast is generally believed to be poorer in men than in women (Vanderbilt and Warren, 1971), and Moss (1964) reported that in his series the 10-year survival rate for women was 49 per cent compared with 32 per cent for men. The discrepancy might be due to the relatively older age of the male patients, but even after correction is made for other causes of death, the female survival rate is 56 per cent compared with 43 per cent in males. The stage of spread of the disease at the time of notification has an important effect upon survival in both men and women. Jn Moss’s (1964) series in which the stage of the disease was classified as ‘localized’, ‘regional’ or ‘distant’, the prognosis was more favourable for women with localized disease or regional metastases but more favourable for men with distant metastases. The relationship between the age of notification and the stage of the spread of disease in carcinoma of the male breast is not clear from the studies reported. The present investigation was undertaken to examine the survival rate in carcinoma of the male breast in the South-West Region of England and to find the effects of both age and clinical stage of the spread of the disease upon prognosis.
Patients and methods The Cancer Register of the South-Western Regional Health Authority was examined and all the records of carcinoma of the male breast notified between 1960 and 1968 were extracted. Patients with carcinoma of the male breast who died from unrelated causes, including one who died from renal complications of carcinomatosis with a primary carcinoma in the kidney, were excluded. Preliminary examination of the whole series showed that no deaths from carcinoma of the male breast occurred more than 7 years after diagnosis; therefore in order to allow a full 7-year follow-up, all the patients presenting in 1968 were excluded. Patients were divided into 10-year age groups and into the four international clinical stage (TNM) groups (CopeIand, 1969). Percentage survival rates were calculated by age and stage. Female
Male
e-.3000-
2500
--
2000-
am u
1500-0
z 1000-500 --
015-24
25-34
35-44 45-54 55-64 65-74 75-84 10-year age groups
85*
Fig. 1. Number of deaths from carcinoma of the breast in men and women recorded by the Registrar General for England and Wales in 1972.
Results Between 1960 and 1968, 56 cases of carcinoma of the male breast were reported to the Cancer Registry of the South-Western Regional Health Authority. During that time 6000 cases of carcinoma of the female breast were notified, giving a male to female ratio of 0.93 per cent. After exclusion of 5 patients notified in 1968 and 13 patients who died from causes unrelated to carcinoma of the breast, 38 cases of carcinoma of the male breast were available for study.
* Medical student, University of Bristol Medical School, Bristol Royal Infirmary. 963
Robert W. T. Slack Table I: COMPARISON OF AGE OF PATIENTS AND CLINICAL STAGE OF THE DISEASE Clinical stage Age I I1 111 IV Not known Total 3 5-44 3 0 0 0 1 4 45-54 1 2 3 0 0 6 55-64 5 2 3 1 0 11 ~. 65-74 3 3 2 2 0 10 75 1 1 3 1 1 7 Total 13 8 11 4 2 38
+
Table I1 : PERCENTAGE SURVIVAL RATE ACCORDING TO CLINICAL STAGE OF THE DISEASE Survival time in years
