The first 60 days: Male breast cancer
Men get breast cancer too, usually a hormone-sensitive kind found as a lump near the nipple. It is treated much as in women, with surgery, radiotherapy and tamoxifen, and inherited BRCA2 mutations are found often enough that every man diagnosed is offered genetic testing. The main fix under way is including men in trials so their care stops being borrowed from women. Below, week by week, is what OnCo's record of Male breast cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Early stage, Germline BRCA carriers.
- SurgeonNamed in the standard of care for: Early stage.
- Medical oncologistNamed in the standard of care for: Early stage, Adjuvant endocrine, ER-positive, Advanced, ER-positive, Germline BRCA carriers.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Early stage.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.Early stageNCCN category Category 2A, NCCN Guidelines: Breast Cancer (special considerations for men); ASCO guideline on management of male breast cancer 2020
Mastectomy (or breast conservation where feasible) with sentinel node biopsy; adjuvant radiotherapy by the same criteria as women; chemotherapy and HER2-directed therapy as indicated.
Tamoxifen for five to ten years; aromatase inhibitor only with GnRH agonist suppression if tamoxifen is contraindicated.
Endocrine therapy (tamoxifen, or aromatase inhibitor or fulvestrant with GnRH agonist) with a CDK4/6 inhibitor by extrapolation; chemotherapy for visceral crisis.
PARP inhibitor (olaparib adjuvant per OlympiA; olaparib or talazoparib for metastatic disease) and cascade testing of relatives.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example ER, PR, HER2, Germline BRCA1/2 and multigene panel, Ki-67 and genomic assays, Nodal status, Testosterone and oestradiol if aromatase inhibitors are considered), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Invasive ductal carcinoma, ER-positive / HER2-negative, HER2-positive, Triple-negative.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Early stage
- For my situation (early stage), which of the standard options do you recommend and why?Guideline options include: Mastectomy (or breast conservation where feasible) with sentinel node biopsy; adjuvant radiotherapy by the same criteria as women; chemotherapy and HER2-directed therapy as indicated.
- Am I a candidate for Trastuzumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Adjuvant endocrine, ER-positive
- For my situation (adjuvant endocrine, er-positive), which of the standard options do you recommend and why?Guideline options include: Tamoxifen for five to ten years; aromatase inhibitor only with GnRH agonist suppression if tamoxifen is contraindicated.
- Am I a candidate for Tamoxifen, Goserelin / leuprolide (ovarian function suppression), Letrozole (and other aromatase inhibitors), and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Advanced, ER-positive
- For my situation (advanced, er-positive), which of the standard options do you recommend and why?Guideline options include: Endocrine therapy (tamoxifen, or aromatase inhibitor or fulvestrant with GnRH agonist) with a CDK4/6 inhibitor by extrapolation; chemotherapy for visceral crisis.
- Am I a candidate for Tamoxifen, Fulvestrant, Palbociclib or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Germline BRCA carriers
- For my situation (germline brca carriers), which of the standard options do you recommend and why?Guideline options include: PARP inhibitor (olaparib adjuvant per OlympiA; olaparib or talazoparib for metastatic disease) and cascade testing of relatives.
- Am I a candidate for Olaparib, Talazoparib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of OlympiA apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Olaparib, Palbociclib, Ribociclib, Trastuzumab deruxtecan?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Men are still under-enrolled in breast cancer trials; regulatory guidance and label harmonisation are the response”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Aromatase inhibitor efficacy and the need for GnRH co-treatment rest on small studies; registries are collecting outcomes”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Male breast cancer: the full pageMen get breast cancer too, usually a hormone-sensitive kind found as a lump near the nipple. It is treated much as in women, with surgery, radiotherapy and tamoxifen, and inherited BRCA2 mutations are found often enough that every man diagnosed is offered genetic testing. The main fix under way is including men in trials so their care stops being borrowed from women.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Hormone receptor status (ER / PR): Whether a breast cancer's cells carry receptors for oestrogen (ER) and progesterone (PR).
- Germline BRCA mutation (gBRCA): An inherited fault in the BRCA1 or BRCA2 gene, present in every cell from birth, that greatly raises the risk of breast, ovarian, prostate and pancreatic cancer and makes those cancers sensitive to PARP inhibitors and platinum.
- Mastectomy: Removing the whole breast, either for cancer or preventively in BRCA1/2 carriers, where bilateral risk-reducing mastectomy cuts breast cancer risk by 90% or more.
- Hereditary cancer syndromes: About 5-10% of cancers arise from an inherited gene fault.
Every term links to the glossary.