CHICAGO, Oct. 24, 2021 /PRNewswire/ --
Key takeaways
- Men with Stage IV breast cancer who are receptive to systemic
therapy benefit from surgical intervention.
- Patients also benefitted who received trimodal therapy
consisting of systemic therapy, surgery, and radiation compared to
just receiving systemic therapy.
- The authors hope their findings prompt reconsideration of
National Comprehensive Cancer Network guidelines for this group of
male breast cancer patients, which now recommends systemic therapy
with surgical intervention only to be used as a palliative
measure.
Men with Stage IV breast cancer and known estrogen (ER) and
progesterone receptor (PR) status benefit from surgical
intervention and from trimodal therapy (systemic therapy, surgery,
and radiation), according to a study presented at the virtual
American College of Surgeons (ACS) Clinical Congress 2021.
The National Comprehensive Cancer Network guidelines to treat
men with Stage IV breast cancer recommend systemic therapy, with
surgery to be used to minimize symptoms such as ulcerations, pain,
or bleeding, said first author Kelly A.
Stahl, MD, a surgical resident at Penn
State College of Medicine, Hershey. However, new study findings, show
that surgery does have survival benefits for men with Stage IV
breast cancer, she said.
"We need to re-examine the notion that Stage IV breast cancer in
men is so dire that there is no survival benefit to surgical
intervention," said Daleela G. Dodge, MD, FACS, a general surgeon
at Penn State Health Milton S. Hershey Medical Center in
Hershey, PA, and a co-author of
the study.
"For this subgroup of patients who are responsive to systemic
therapy and do not have a lot of metastatic burden, we'd like there
to be a reconsideration of best practices."
Breast cancer in men accounts for less than 1 percent of all
breast cancer cases, whereas one in eight women get breast cancer
compared to one in 1,000 men, Dr. Dodge said. As a result, public
awareness of breast cancer in men is low.
"We have a whole month devoted to breast cancer awareness for
women, but it's not well known that men can get it, too, and that
some men even have a genetic predisposition to getting it," Dr.
Stahl said.
Unfortunately, low public awareness has contributed to the fact
that 6 percent of women compared with 10 percent of men are not
diagnosed until they have Stage IV cancer. In addition, 40 percent
of male breast cancer patients do not get diagnosed until Stages
III or IV even though breast cancer is easier for male patients to
detect on their own, said Dr. Dodge. She added, "Men have a worse
prognosis based on late diagnosis, so awareness is important."
About the study
The authors were surprised at how many patients they were able
to find that fit the parameters of their study, crediting the
extensive dataset in the National Cancer Database (NCDB). The
researchers identified 539 Stage IV breast cancer patients with
known ER/PR status from 2004-2017 in the NCDB. Chi-square tests
examined subgroup differences between the treatment modalities
received. Overall survival was assessed using the Kaplan-Meier
method. Multivariate Cox proportional hazard models examined
factors associated with survival.
A noted survival advantage
The researchers found a survival advantage noted in patients who
received trimodal therapy compared with patients who received
systemic therapy alone. ER positive patients who received trimodal
therapy or systemic therapy and surgery had an improved 5-year
overall survival rate when compared with systemic therapy. PR
positive patients who received trimodal therapy or systemic therapy
and surgery had an improved 5-year overall survival rate when
compared with systemic therapy. The sequence of treatment was
significant, with the greatest survival advantage noted in ER
positive patients who received neoadjuvant chemotherapy compared
with those who received adjuvant chemotherapy.
"We're trying to catch up to better tailor our treatment of men
with breast cancer and this study shows how treatment can be
tailored in Stage IV disease," Dr. Dodge said.
Other study authors are Rolfy Perez Holguin, MD; William Wong, DO; Christopher McLaughlin, MD; Elizabeth J. Olecki, MD; Chan Shen, PhD.
There are no author disclosures to report.
"FACS" designates that a surgeon is a Fellow of the American
College of Surgeons.
Citation: Stahl KA, et al. Benefits of Surgical
Treatment in Stage IV Male Breast Cancer Patients with Known
Hormone Receptor Status. Scientific Forum Presentation.
American College of Surgeons Clinical Congress 2021.
About the American College of Surgeons
The American College of Surgeons is a scientific and educational
association of surgeons that was founded in 1913 to raise the
standards of surgical education and practice and to improve the
quality of care for surgical patients. Its achievements have placed
it at the forefront of American surgery and have made the College
an important advocate for all surgical patients. The College has
more than 84,000 members and is the largest organization of
surgeons in the world. For more information, visit
www.facs.org.
View original content to download
multimedia:https://www.prnewswire.com/news-releases/surgery-has-survival-benefits-for-male-stage-iv-breast-cancer-patients-who-are-receptive-to-systemic-therapy-301407153.html
SOURCE American College of Surgeons