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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
Male breast cancer is almost always invasive ductal carcinoma, oestrogen-receptor positive (in the large majority) and HER2-negative; lobular carcinoma is rare because men lack terminal lobules, and triple-negative disease is uncommon. Germline BRCA2 mutations are the strongest hereditary factor (BRCA1 less so), and testing is recommended for every man with breast cancer regardless of age or family history; other risks are Klinefelter syndrome, oestrogen exposure, radiation, obesity and liver disease. Men present later and with higher stage than women because there is no screening and awareness is low, and the tumour sits close to the skin and nipple.
Treatment follows the female algorithm with adjustments. Mastectomy is usual because of tumour position, though breast-conserving surgery is feasible in some; sentinel node biopsy, radiotherapy and chemotherapy indications mirror women's. Endocrine therapy differs: tamoxifen is the preferred adjuvant agent, because aromatase inhibitors used alone in men raise testosterone and oestradiol through feedback and appear less effective, so if used they should be combined with a GnRH agonist. CDK4/6 inhibitors, HER2-directed therapy and PARP inhibitors for germline BRCA carriers are used in men on the basis of extrapolation and small cohorts. The EORTC 10085 / International Male Breast Cancer Program (Ann Oncol 2018) was the largest characterisation effort, and the FDA's 2020 guidance 'Male Breast Cancer: Developing Drugs for Treatment' instructs sponsors to include men in breast cancer trials rather than excluding them by default.
| Setting | Approach | Guideline |
|---|---|---|
| Early stage | 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. | NCCN Category 2A |
| Adjuvant endocrine, ER-positive | Tamoxifen for five to ten years; aromatase inhibitor only with GnRH agonist suppression if tamoxifen is contraindicated. | not mapped |
| Advanced, ER-positive | Endocrine therapy (tamoxifen, or aromatase inhibitor or fulvestrant with GnRH agonist) with a CDK4/6 inhibitor by extrapolation; chemotherapy for visceral crisis. | not mapped |
| Germline BRCA carriers | PARP inhibitor (olaparib adjuvant per OlympiA; olaparib or talazoparib for metastatic disease) and cascade testing of relatives. | not mapped |