男性乳腺癌的基本信息
发病率和死亡率
2020年美国乳腺癌（仅男性）的预计新发病例和死亡病例：
男性乳腺癌较为罕见。
在全部乳腺癌病例中，男性患者不足1%。
男性乳腺癌的平均发病年龄为60-70岁。然而，任何年龄的男性都可能发病。
解剖
男性乳房解剖。乳头和乳晕在乳腺外面。淋巴结、脂肪组织、导管及其他内部结构如图所示。
风险因素
男性乳腺癌的诱发危险因素，包括：
临床特征
男性乳腺癌的体征可能包括：
诊断评估
当疑似乳腺癌时，患者管理通常包括：
采用以下检查和程序诊断乳腺癌：
有关对侧乳房评估和肿瘤标本的分子表达情况【雌激素受体及孕激素受体、人类表皮生长因子受体2（(HER2/neu)】的更多信息，请参考关于“乳腺癌治疗【成人】”的PDQ摘要中的“诊断”部分。
病理组织学分类
男性乳腺癌的病理学特征与女性相似，浸润型导管癌是最为常见的肿瘤类型（参考表1）。
已有男性乳腺导管内癌、炎性乳腺癌和乳头Paget病的报道，但尚未有男性小叶原位癌病例。
有研究发现，男性乳腺癌的淋巴结受累和血性转移方式与女性类似。
| 肿瘤部位 | 组织学亚型 |
|---|---|
| 癌症，NOS | |
| 导管 | 导管内（原位） |
| 浸润的主要部分 | |
| 浸润性，NOS | |
| 粉刺型 | |
| 炎性 | |
| 髓样淋巴细胞性浸润 | |
| 粘液性（胶状） | |
| 乳头状 | |
| 硬癌 | |
| 管状 | |
| 其他 | |
| 小叶状 | 浸润性 |
| 乳头 | 乳头Paget病，NOS |
| 乳腺导管内癌伴Paget病 | |
| 浸润性导管癌伴Paget病 | |
| 其他 | 未分化型癌 |
| 化生型 | |
| NOS=未特殊注明。 | |
预后和预测指标
与预后明确相关的因素包括：
男性乳腺癌的总体生存期与女性患者相似。如果男性乳腺癌患者的发病年龄越晚，其预后往往越差。
参考文献
General Information About Male Breast Cancer
Incidence and Mortality
Estimated new cases and deaths from breast cancer (men only) in the United States in 2020:
Male breast cancer is rare.
Fewer than 1% of all breast carcinomas occur in men.
The mean age at diagnosis is between 60 and 70 years; however, males of all ages can be affected with the disease.
Anatomy
Anatomy of the male breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, fatty tissue, ducts, and other parts of the inside of the breast are also shown.
Risk Factors
Predisposing risk factors for male breast cancer appear to include the following:
Clinical Features
Signs of breast cancer in men may include the following:
Diagnostic Evaluation
When breast cancer is suspected, patient management generally includes the following:
The following tests and procedures are used to diagnose breast cancer:
(Refer to the Diagnosis section in the PDQ summary on Breast Cancer Treatment [Adult] for information about evaluating the contralateral breast and molecular profiling [estrogen-receptor and progesterone-receptor status and human epidermal growth factor receptor 2 (HER2/neu) expression status of the tumor].)
Histopathologic Classification
The pathology of male breast cancer is similar to that of female breast cancer, and infiltrating ductal cancer is the most common tumor type (refer to Table 1).
Intraductal cancer, inflammatory carcinoma, and Paget disease of the nipple have also been seen in men, but lobular carcinoma in situ has not.
Lymph node involvement and the hematogenous pattern of spread are similar to what is observed in female breast cancer.
| Tumor Location | Histologic Subtype |
|---|---|
| Carcinoma, NOS | |
| Ductal | Intraductal (in situ) |
| Invasive with predominant component | |
| Invasive, NOS | |
| Comedo | |
| Inflammatory | |
| Medullary with lymphocytic infiltrate | |
| Mucinous (colloid) | |
| Papillary | |
| Scirrhous | |
| Tubular | |
| Other | |
| Lobular | Invasive |
| Nipple | Paget disease, NOS |
| Paget disease with intraductal carcinoma | |
| Paget disease with invasive ductal carcinoma | |
| Other | Undifferentiated carcinoma |
| Metaplastic | |
| NOS = not otherwise specified. | |
Prognosis and Predictive Factors
Factors that correlate well with prognosis include the following:
Overall survival is similar to that of women with breast cancer. The impression that male breast cancer has a worse prognosis may stem from the tendency toward diagnosis at a later stage.
ReferenceSection
男性乳腺癌的临床分期信息
AJCC分期体系为不同患者人群提供了相同的预后评估方案。男性乳腺癌的分期由以下因素决定：
男性乳腺癌的临床分期及患者的一般情况是临床治疗决策的基础。
男性乳腺癌的TNM（肿瘤、淋巴结、转移灶）分期体系与女性乳腺癌的分期体系相同，（请参考关于“乳腺癌治疗【成人】”的PDQ摘要中的“乳腺癌临床分期信息的TNM定义”部分，以获取更多信息。）
Stage Information for Male Breast Cancer
The AJCC staging system provides a strategy for grouping patients with a similar prognosis. The stage of the disease is determined by the following:
Treatment decisions are based on the stage of disease and the general health of the patient.
The TNM (tumor, node, metastasis) staging system for male breast cancer is identical to the staging system for female breast cancer. (Refer to TNM Definitions in the Stage Information for Breast Cancer section in the PDQ summary on Breast Cancer Treatment [Adult] for more information.)
男性乳腺癌的治疗方法概述
男性乳腺癌的标准治疗方法如表2所述。
| 肿瘤分期（TNM定义） | 标准治疗方法选择 |
|---|---|
| 早期/局部/可切除的乳腺癌 | |
| 辅助治疗-化疗、内分泌治疗、抗HER2靶向治疗 | |
| 局部区域性复发乳腺癌 | 手术 |
| 放疗及化疗 | |
| 转移性乳腺癌 | 激素治疗和/或化疗 |
| T=原发肿瘤；N=区域淋巴结；M=远处转移；HER2=人类表皮生长因子受体2。 | |
Treatment Option Overview for Male Breast Cancer
Standard treatment options for men with breast cancer are described in Table 2.
| Stage (TNM Definitions) | Standard Treatment Options |
|---|---|
| Early/localized/operable breast cancer | |
| Adjuvant therapy—chemotherapy, endocrine therapy, HER2-directed therapy | |
| Locoregional recurrent breast cancer | Surgery |
| Radiation therapy and chemotherapy | |
| Metastatic breast cancer | Hormone therapy and/or chemotherapy |
| T = primary tumor; N = regional lymph node; M = distant metastasis; HER2 = human epidermal growth factor receptor 2. | |
男性乳腺癌的治疗方法
男性乳腺癌的治疗方法与女性乳腺癌相似。由于男性乳腺癌较为罕见，针对各种治疗方法，均缺乏有效的随机数据支持。
早期/局部/可切除乳腺癌的治疗手段
与女性乳腺癌类似，早期男性乳腺癌的标准治疗包括：
手术联合/不联合放疗
主要的标准治疗是乳房改良根治性切除术联合腋窝淋巴结清扫术。
通常，男性乳腺癌的临床疗效与女性患者相似。
保乳手术联合淋巴结切除和放疗也已用于男性乳腺癌患者，临床疗效与女性患者相似。
（请参考关于“乳腺癌治疗【成人】”的PDQ摘要中的“早期/局部/可切除乳腺癌手术”部分，以获取更多信息。）
辅助治疗
尚未见辅助治疗用于男性乳腺癌的对照研究。早期/局部/可切除的男性乳腺癌的辅助治疗，详见表3。
| 辅助治疗的类型 | 临床用药 |
|---|---|
| 化疗 | 环磷酰胺联合甲氨蝶呤和5-氟尿嘧啶（CMF） |
| 环磷酰胺联合阿霉素和氟尿嘧啶（CAF） | |
| 阿霉素联合环磷酰胺联合/不联合紫杉醇（AC、AC-T） | |
| 内分泌治疗 | 他莫昔芬 |
| 芳香化酶抑制剂和LHRH激动剂 | |
| HER2靶向治疗 | 曲妥珠单抗 |
| 帕妥珠单抗 | |
| HER2 = 人类表皮生长因子受体2；LHRH = 黄体酮激素释放激素。 | |
淋巴结阴性的男性乳腺癌制定辅助治疗的决策基础应与女性乳腺癌相同。目前，尚未有循证依据证明辅助治疗在男性和女性乳腺癌患者的应用中具有临床疗效的差异。
与女性乳腺癌患者相似，化疗联合他莫昔芬和其他激素治疗临床上已被用于淋巴结阳性的男性乳腺癌，同样有助于延长患者生存期。
男性乳腺癌的雌激素受体阳性率约为85%，孕激素受体阳性率约为70%。
激素治疗的临床疗效与激素受体的阳性表达有关，所有受体阳性的乳腺癌患者均应采用激素治疗。
然而，男性乳腺癌患者使用他莫昔芬后，常容易出现治疗相关的副作用，如潮红、阳痿。
临床疗效与女性乳腺癌患者相似。
（请参考关于“乳腺癌治疗【成人】”的PDQ摘要中的“早期/局部/可手术切除的乳腺癌的术后和术前系统治疗”部分，以获取更多信息。）
尚未有足够的临床数据支持芳香化酶抑制剂（AI）在男性乳腺癌患者的应用，因此，常采用他莫昔芬作为内分泌治疗，而不用AI。 一项回顾性研究对257例临床I期到III期的男性乳腺癌患者进行分析，其中50例采用AI治疗，207例采用他莫昔芬治疗。结果显示：
有文献报道，已有数例男性乳腺癌患者采用芳香化酶抑制剂和LHRH激动剂治疗。
德国乳腺癌小组正在进行一项随机II期临床试验（NCT01638247），将他莫昔芬联合/不联合促性腺激素释放激素（GnRH）衍生物与AI联合GnRH衍生物用于早期激素受体阳性的乳腺癌进行对比研究，尚未得出研究结果。
局部区域性复发男性乳腺癌的治疗
局部区域性复发男性乳腺癌的标准治疗方法，包括：
其临床疗效与女性乳腺癌患者相似。
（请参考关于“乳腺癌治疗【成人】”的PDQ摘要中的“局部区域性乳腺癌”部分，以获取更多信息。）
转移性男性乳腺癌的治疗
转移性男性乳腺癌的标准治疗方法，包括：
激素治疗作为初始治疗，其临床疗效与女性乳腺癌患者相似。
（请参考关于“乳腺癌治疗【成人】”的PDQ摘要中的“转移性乳腺癌”部分，以获取更多信息。）
参考文献
Treatment Options for Male Breast Cancer
The approach to the treatment of breast cancer in men is similar to that in women. Because male breast cancer is rare, there is a lack of randomized data to support specific treatment modalities.
Treatment of Early/Localized/Operable Male Breast Cancer
As in women, standard treatment options for men with early-stage breast cancer include the following:
Surgery with or without radiation therapy
Primary standard treatment is a modified radical mastectomy with axillary dissection.
Responses are generally similar to those seen in women with breast cancer.
Breast conservation surgery with lumpectomy and radiation therapy has also been used, and results have been similar to those seen in women with breast cancer.
(Refer to Surgery in the Early/Localized/Operable Breast Cancer section in the PDQ summary on Breast Cancer Treatment [Adult] for more information.)
Adjuvant therapy
In men, no controlled studies have compared adjuvant treatment options. Adjuvant therapies used to treat early/localized/operable male breast cancer are outlined in Table 3.
| Type of Adjuvant Therapy | Agents Used |
|---|---|
| Chemotherapy | Cyclophosphamide plus methotrexate and 5-fluorouracil (CMF) |
| Cyclophosphamide plus doxorubicin and fluorouracil (CAF) | |
| Doxorubicin plus cyclophosphamide with or without paclitaxel (AC, AC-T) | |
| Endocrine therapy | Tamoxifen |
| Aromatase inhibitors with LHRH agonist | |
| HER2-directed therapy | Trastuzumab |
| Pertuzumab | |
| HER2 = human epidermal growth factor receptor 2; LHRH = luteinizing hormone-releasing hormone. | |
In men with node-negative tumors, adjuvant therapy should be considered on the same basis as for women with breast cancer because there is no evidence that response to therapy is different between men and women.
In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal therapy have been used and are believed to increase survival to the same extent as in women with breast cancer.
Approximately 85% of all male breast cancers are estrogen receptor–positive, and 70% of them are progesterone receptor–positive.
Response to hormone therapy correlates with the presence of these receptors. Hormonal therapy has been recommended in all patients with receptor-positive cancers.
Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence, in male breast cancer patients.
Responses are generally similar to those seen in women with breast cancer.
(Refer to Postoperative Systemic Therapy and Preoperative Systemic Therapy in the Early/Localized/Operable Breast Cancer section in the PDQ summary on Breast Cancer Treatment [Adult] for more information.)
Regarding endocrine therapy, tamoxifen is generally used instead of an aromatase inhibitor (AI) because the data supporting the use of an AI in men with breast cancer are limited. A retrospective analysis of 257 men with stage I to stage III breast cancer included 50 men treated with an AI and 207 men treated with tamoxifen. The following results were observed:
The use of AI therapy with a luteinizing hormone-releasing hormone agonist has been reported in several cases in the literature.
The German Breast Group is conducting a randomized phase II clinical trial (NCT01638247) of tamoxifen with or without gonadotropin-releasing hormone (GnRH) analogue versus AI plus GnRH analogue in men with early-stage, hormone receptor–positive breast cancer; results are pending.
Treatment of Locoregional Recurrent Male Breast Cancer
Standard treatment options for men with locoregional recurrent breast cancer include the following:
Responses are generally similar to those seen in women with breast cancer.
(Refer to the Locoregional Recurrent Breast Cancer section in the PDQ summary on Breast Cancer Treatment [Adult] for more information.)
Treatment of Metastatic Male Breast Cancer
Standard treatment options for men with metastatic breast cancer include the following:
Hormonal therapy is used as the initial treatment. Responses are generally similar to those seen in women with breast cancer.
(Refer to the Metastatic Breast Cancer section in the PDQ summary on Breast Cancer Treatment [Adult] for more information.)
ReferenceSection
本摘要更新(01/23/2020)
PDQ癌症信息定期评估和及时更新最新内容。这一部分会收录相关内容的最新信息（截至更新日期）。
2020年新发病例和死亡病例均采用最新资料（摘自美国癌症学会，见参考文献1）。
本篇内容由PDQ儿科治疗编委会进行撰写和维护，编委会独立于NCI。本篇内容的选取立场公正，不代表NCI和NIH任何政治观点。有关本篇内容的政策及编委会在PDQ维护中的作用等更多信息，请参考PDQ摘要以及PDQ®-NCI综合癌症数据库页面内容。
Changes to This Summary (01/23/2020)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2020 (cited American Cancer Society as reference 1).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Male Breast Cancer Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”
The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Male Breast Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Disclaimer
Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s Email Us.
About This PDQ Summary
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Male Breast Cancer Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”
The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Male Breast Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Disclaimer
Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s Email Us.