男性乳癌较少见 诊断时多已恶化


  【24drs.com】根据发表于美国乳房外科协会第13届年会的研究,男性乳癌只占所有乳癌的1%,不过,肿瘤比女性大且恶化,整体存活率明显低于女性。
  
  为了进行研究,研究者使用国家癌症资料库1998-2007年所有乳癌病患的数据, 他们比较各性别、年纪、种族、组织学、等级、肿瘤大小、有影响淋巴结、荷尔蒙受体状态、初次疗程、整体存活。
  
  加州奥克兰的Jon Greif医师表示,这篇研究和其它研究的不同之处在于它的样本数,这是迄今最大型的男性乳癌研究,包括了13,457名乳癌男性,占所有乳癌的0.9%,以及1,439,866名女性乳癌案例。
  
  与女性乳癌相比,男性乳癌发生率在黑人较高(11.7% vs 9.9%;胜算比[OR],1.19)、西班牙裔较低(3.6% vs 4.5%;OR,0.74),年长者较高(63岁 vs 59岁)。
  
  整体而言,男性癌症比女性癌症恶化,男性肿瘤较大(中位数20.0 vs 15.0 mm);男性比较不会是等级1肿瘤(16.0% vs 20.7%),比较可能有淋巴结转移(41.9% vs 33.2%;OR,1.45),比较可能有远端转移(4 vs 3;OR,1.39)。
  
  此外,男性的叶状癌比率较低(10% vs 18%;OR,0.51),雌激素受体(ER)阳性的比率较高(88.3% vs 78.2%;OR,2.10),黄体素受体阳性比率也是较高(76.8% vs 67.0%;OR,1.63)。
  
  男性比女性不会进行部份乳房切除(33% vs 62%;OR,0.31)与接受放射线治疗(35.9% vs 50.4%;OR,0.55)。
  
  男性和女性之间的化疗比率差异并不显著,荷尔蒙治疗比率只有一点差异。
  
  不过,整体存活率有显著差异,女性乳癌的5年存活率显著较佳,不论是第0期(94% vs 90%)、第I期(90% vs 87%)与第II期(82% vs 74%)乳癌(全部P<.0001);但第III期(56.9% vs 56.5%;P= .99)或第IV期(19% vs 16%;P= .20)的整体存活率在男性和女性则无显著差异。
  
  对于各种昂贵的乳癌警觉努力,这些结果提供证据显示,男性对这些讯息依旧充耳不闻。
  
  Greif医师表示,男性和他们的健康照护者确实警觉性较低。
  
  许多人甚至不知道男性会发生乳癌,若有可以提高警觉的计画、发展高风险男性筛检机制(根据基因、家族史、放射线曝露或其它已知致癌因子、曾患病之病史)将会有所帮助。预防的基础为健康的生活型态:健康饮食、运动、维持健康体重、不抽菸、限量饮酒等等。
  
  他指出,这篇研究有一些限制,包括缺乏死因和某些筛检细节的资料。主要的研究限制是,资料库无法让我们实际地了解这些男性研究对象的死因;有些可能是死于乳癌之外的其它疾病。
  
  另一个限制是,我们分析时未排除筛检发现乳癌的女性,产生所谓的前导期偏差。这是她们发现初期肿瘤且有较佳结果的主要原因,这一点是研究限制,但也是要强调的重点:我们必须提高男性乳癌的警觉。
  
  根据加州乳癌中心主任、乳房外科Deanna Attai医师指出,有许多因素可以解释这个趋势。男性研究对象出现比较末期的疾病,或许是因为他们比较不会有等级1肿瘤,也或许是因为还没有一般可接受的男性筛检指引。
  
  Attai医师解释,如果依各个肿瘤阶段比较存活差异,男性和女性之间有存活差异,这或许是因为几项因素或者同时有多种因素,较高等级的肿瘤和比较无法用tamoxifen治疗的肿瘤,虽然大多是ER阳性肿瘤,我们并无法从资料库中得知为何tamoxifen比较无效,或许有使用此药,但是因为副作用导致耐受不佳,或者是没有使用该药。
  
  或许是因为男性平均寿命比女性短。
  
  Attai医师表示,尽管有许多尚待解答的问题,这仍是篇重要的研究。
  
  这是回顾男性乳癌的最大型研究,提高男性与其医师的警觉,最起码定期自我检查和医师临床检查是重要的。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6816&x_classno=0&x_chkdelpoint=Y
  

Male Breast Cancers Less Common, More Advanced at Diagnosis

By Nancy A. Melville
Medscape Medical News

May 9, 2012 (Phoenix, Arizona) — Breast cancer in men represents only about 1% of all breast cancers; however, the tumors tend to be larger, the cancer more advanced, and overall survival is substantially lower than for women, according to research presented here at the American Society of Breast Surgeons 13th Annual Meeting.

For their study, investigators used data from the National Cancer Data Base on all patients with breast cancer from 1998 to 2007. They first compared the cases for differences in sex, then for age, race/ethnicity, histology, grade, tumor size, lymph node involvement, hormone-receptor status, course of first treatment, and overall survival.

"This study differs from others mainly in its magnitude," lead author Jon Greif, DO, a breast surgeon from Oakland, California, told Medscape Medical News. "It is, by far, the largest series of male breast cancer ever studied."

The study involved 13,457 cases of male breast cancer, representing 0.9% of all breast cancers, and 1,439,866 cases of female breast cancer.

The incidence of male breast cancer, compared with female breast cancer, was higher among blacks (11.7% vs 9.9%; odds ratio [OR], 1.19), lower among Hispanics (3.6% vs 4.5%; OR, 0.74), and higher among older patients (63 vs 59 years).

Overall, male cancers were more advanced than female cancers, and male tumors were larger (median, 20.0 vs 15.0 mm). Males were less likely to have grade 1 tumors (16.0% vs 20.7%), more likely to have lymph node metastasis (41.9% vs 33.2%; OR, 1.45), and more likely to have distant metastasis (4 vs 3; OR, 1.39).

In addition, males had lower rates of lobular carcinoma (10% vs 18%; OR, 0.51) and a greater likelihood of being estrogen-receptor (ER) positive (88.3% vs 78.2%; OR, 2.10) and progesterone-receptor positive (76.8% vs 67.0%; OR, 1.63).

Males were less likely than females to have a partial mastectomy (33% vs 62%; OR, 0.31) and to receive radiation (35.9% vs 50.4%; OR, 0.55).

Chemotherapy rates were not significantly different between males and females, and there were only small differences in hormonal therapy rates.

Overall survival rates, however, were significantly different. Females with breast cancer had significantly better 5-year overall survival for stage 0 (94% vs 90%), stage I (90% vs 87%), and stage II (82% vs 74%) breast cancer (P < .0001 for all).

However, there were no significant differences between females and males in overall survival for stage III (56.9% vs 56.5%; P = .99) or stage IV (19% vs 16%; P = .20) disease.

The findings provide evidence that, for all of the expansive breast cancer awareness efforts, the message still falls largely on deaf ears when it comes to men.

"Absolutely there is less awareness among men and their healthcare providers," Dr. Greif said.

"Many are unaware that men even get breast cancer," he said. "A program of increasing awareness, and developing screening for men at high risk — genetically, by family history, by exposure to radiation or other known carcinogens, and by having had the disease before — would all be helpful."

"The basics of prevention are a healthy lifestyle — eat healthy, exercise, maintain a healthy weight, don't smoke, limit alcohol, etc."

He noted that the study has several limitations, including a lack of data on cause of death and certain screening specifics.

"The major limitation of our study is that the database does not let us see exactly what the men in the study are dying of; certainly some are dying of diseases other than breast cancer," he said.

"Another limitation is that we don't exclude from analysis the women whose cancers were detected by screening — so-called lead-time bias. This is a major reason that they have earlier tumors and do better. It's a limitation, but it also underscores our point — we need to raise awareness about male breast cancer."

According to breast surgeon Deanna Attai, MD, head of the Center for Breast Care in Burbank, California, several factors could explain the trends.

"Men in the study presented with more advanced-stage disease, possibly because they were less likely to have grade 1 tumors, and possibly because there are no generally accepted screening guidelines for men," she said.

Survival differences were seen "even when men were compared stage-for-stage with women. That might be due to several factors, or a combination of factors — higher-grade tumors and tumors that are less likely to be treated with tamoxifen even though most of the tumors are ER-positive. We don't know from the database why tamoxifen was less likely to be used. Maybe it was offered and the side effects made it intolerable, or maybe it was not offered," Dr. Attai explained.

"Perhaps there is even the issue that men generally don't live as long as women."

Despite several unanswered questions, the research is significant, Dr. Attai said.

"It's the largest review of male breast cancer, and it raises awareness — in men and their physicians — that, at the very least, periodic self-exams and clinical exam by the physician are important."

Dr. Greif and Dr. Attai have disclosed no relevant financial relationships.

American Society of Breast Surgeons (ASBS) 13th Annual Meeting. Abstract 0104. Presented May 4, 2012.

    
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