medwireNews: Men with early-stage, hormone receptor (HR)-positive breast cancer remain at risk for breast cancer-specific mortality (BCSM) even 20 years after diagnosis, indicates a population-based study.
“Much like in women, the risk varies by tumor size, grade, and nodal status,” write José Leone (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and co-researchers in JAMA Oncology.
They explain that women with early-stage, HR-positive breast cancer “face a continuous risk of distant recurrence and death for decades,” but data on long-term risk in their male counterparts have not been reported thus far.
“[P]ublished studies on BCSM beyond 5 years in men […] have been limited to case series of patients treated at individual institutions,” highlights the team.
Leone and associates therefore collated data from the US Surveillance, Epidemiology, and End Results (SEER) program on 2836 men diagnosed with stage I–III, HR-positive breast cancer between 1990 and 2008. Patients were diagnosed at a median age of 67 years and the majority (80.5%) were non-Hispanic White. A total of 34.5% had stage I disease at diagnosis, 46.0% were stage II, and 19.5% were stage III.
The cumulative risk for BCSM at 20 years after diagnosis was 12.4% among stage I patients, 26.2% among stage II patients, and 46.0% among stage III patients. The respective risk for non-BCSM was 52.4%, 51.2%, and 42.8%.
“Since the age distribution at time of diagnosis is approximately the same for patients with stage I, II, or III disease, this reflects the higher risk of BCSM for men with higher stage disease,” point out Leone and colleagues.
The findings were similar for nodal status and tumor grade. For instance, the cumulative 20-year risk for BCSM rose from 15.2% for men with N0 disease to 59.8% for those with N3 disease, while the risk for non-BCSM declined from 55.5% to 32.9%.
The research team also calculated smoothed hazard estimates for BCSM, which “revealed distinct annual mortality patterns based on stage and nodal status.” For example, the BCSM risk for stage I and II patients peaked at approximately 7 and 6 years after diagnosis, respectively, “with minimal decline thereafter.”
But the analysis revealed a bimodal distribution for stage III patients, with a first peak at approximately 4 years after diagnosis, followed by a decline and then a second peak at around 11 years, a finding that differs from the pattern reported in women with stage III disease, for whom the risk continues to decline following a peak approximately 5 years after diagnosis, say Leone et al.
They suggest that there could be various reasons for this discrepancy, such as differences in tumor biologic factors or tumor dormancy between men and women, as well as the fact that “[m]en have more limited evidence-based endocrine therapy options than women.”
The team summarizes that these “results suggest that patients with [male breast cancer] face a long-term risk of recurrence and death, which warrants further investigation into better adjuvant treatment options in men with HR-[positive] disease.”
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