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Kasus Kanker Payudara
Kasus Kanker Payudara
Abstract
Male breast cancer accounts for 1% of all breast cancer cases, and men tend to be diagnosed at an older age than
women (mean age is about 67 years). Several risk factors have been identified, such as genetic and hormonal
abnormalities.
The present study reported the case of a 25-year-old man who was diagnosed with an advanced invasive ductal
carcinoma; however, he did not have any important risk factors.
Even though more data is emerging about this disease, more efforts to understand risk factors, treatment options
and survival benefits are needed. In this case, we discussed the risk factors as well as the impaired fertility
associated with breast cancer therapies.
© 2011 Madeira et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Madeira et al. World Journal of Surgical Oncology 2011, 9:16 Page 2 of 5
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Figure 3 Surgery. Modified radical mastectomy (right breast) and retroareolar lumpectomy (left breast).
of infiltration into the dermis, which was reported in the participation [14-16]. Other conditions that have been
present case. associated with the occurrence of breast neoplasms in
Treatment strategies for male breast cancer are not men are cirrhosis [17], testicular trauma, obesity, radia-
based on data from randomized clinical studies in men tion therapy exposure, and the use of exogenous estro-
and most treatment recommendations are extrapolated gen [18]. In addition to the very young age of the
from data in women [8]. patient in the present report, this patient did not have a
Men with breast carcinoma have a poor prognosis, family, hormonal, or genetic history that could justify
especially in the younger age group, because most breast the high risk for breast cancer. Although gynecomastia
enlargements in young men are dismissed as gyneco- has been suggested to be present in 6-38% of breast
mastia [9,10]. This potential misdiagnosis can result in cancer cases in men [19], it was not evident in our
an unnecessary delay in treatment. The median age of patient.
breast cancer diagnosis in men is approximately 65 It is fundamental to consider the history of breast
years old [11]. Reports of breast cancer in young male tumors in first-degree relatives because that can be an
patients are rare. Nielsen and Jakobsen described a indicator for increased breast cancer risk. Indeed,
breast cancer case in a 32-year-old man [12]. More genetic diseases such as Klinefelter’s syndrome and
recently, an invasive cancer case was reported in a Cowden’s disease have been shown to be related to
30-year-old patient [9]. In 2008, Chang et al. described breast cancer in men [1].
the case of a 16-year-old male with unilateral ductal There is no evidence that suggests that all men need
carcinoma in situ and gynecomastia [13]. breast magnetic nuclear resonance imaging (MRI). But
There is a close relation between the BRCA2 gene suspicious MRI lesions in the contralateral breast should
mutation and male breast cancer. It has also been be examined. Furthermore, male breast cancer survivors
observed, however, that some cases involve BRCA1 have an increased risk of developing a second primary
Madeira et al. World Journal of Surgical Oncology 2011, 9:16 Page 4 of 5
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cancer. The risk of a contralateral breast cancer appears older and present other comorbidities. Due to the smaller
to be higher for men than it is for women [20]. Some size of male mammary parenchyma, the elected surgical
studies indicate that men with breast cancer have a 30- treatment is modified radical mastectomy.
fold increased risk of contralateral breast cancer, much
greater than the two- to fourfold risk among women Conclusions
with breast cancer [21]. The risk of subsequent contral- Invasive ductal carcinoma in young men is extremely
ateral breast cancer was highest for men aged less than rare; the peak incidence is around the seventh decade of
50 years at the time of the first cancer diagnosis, which life. Risk factors for male breast cancer include genetic
is consistent with studies of women with breast cancer factors and hormonal abnormalities. Despite an absence
[22,23]. of a familial history of breast cancer, hormonal abnorm-
Estrogen receptors and progesterone receptors have alities, or a genetic disease, the male patient in the pre-
been suggested to play a role in breast cancers in men, sent study developed breast cancer at a very young age.
and they are present in about 90% and 81% of breast The causative factors in this patient were unable to be
cancers in males, respectively [4]. Furthermore, overex- definitively identified. The pathophysiology of breast
pression of the proto-oncogene HER-2 has been shown cancer in males is not adequately understood. As more
to present the worst prognosis for a patient [24]. Other cases of breast cancer in young male patients are inves-
markers that have been recently studied are p27, MIB-1 tigated, we may be able to gain a better understanding
and Bcl-2 genes. of the mechanism.
Similar to breast cancer cases in women, earlier detec-
tion of male breast cancer is correlated with the success Consent
of the treatment. Although males have considerably less Written informed consent was obtained from the
mammary parenchyma than women, the investigation patient’s family for publication of this case report and
must be a combination of a clinical exam, mammogra- accompanying images. A copy of the written consent is
phy, cytology, and percutaneous biopsies [25,26]. The available for review by the Editor-in-Chief of this journal.
core needle biopsy is important because it enables a
definitive diagnosis of invasive breast cancer and the
evaluation of estrogen receptors, progesterone receptors, Author details
1
Senology Discipline, São Paulo Federal University, São Paulo, Brazil.
and Her-2 status [3]. 2
Senology Discipline, UNINOVE University, São Paulo, Brazil. 3Centro de
Tamoxifen should still be considered as the optimal Referência da Saúde da Mulher (CRSM), São Paulo, Brazil.
adjuvant therapy option for male patients with endo-
Authors’ contributions
crine responsive disease. The effect regarding rate and AM, RJBP, CDM and RES took part in the care of the patient. MM, LHBVM,
overall survival by adjuvant chemotherapy is also far less VHK, TZMT and AFRS were responsible for the literature review, design, and
well studied [8]. Some studies have demonstrated an writing of the manuscript. LHG was responsible for the manuscript
completion and critical review. All authors read and approved the final
improved disease-free and overall survival compared manuscript.
with historical controls using adjuvant anthracycline-
based therapies [4,5,27]. Competing interests
The authors declare that they have no competing interests.
Because of the high probability of an indefinite period
of infertility following chemotherapy, sperm cryopreser- Received: 5 July 2010 Accepted: 3 February 2011
vation should be recommended for all young patients Published: 3 February 2011
with cancer prior to the start of chemotherapy.
References
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