SYSTEMIC THERAPY

The stage, age at diagnosis, and hormone receptor status are three distinguishing variables that affect adjuvant systemic therapy decisions for male breast cancer patients. Men have a more advanced stage on presentation,13 increasing the risk of systemic relapse and the potential benefits of adjuvant treatment. However, they also present at a later age and therefore have more frequent comorbidities that may limit choices of systemic therapy. Fortunately, most male breast cancers are estrogen receptor positive, allowing for the use of hormone therapy, which leads to an improvement in survival.83 Chemotherapy has a more limited frequency of use in men (26.7%) compared with women (40.6%, P = 0.001)124 But has a role in more aggressive disease, providing the patient has an adequate performance status.139,140 To date, there has been only one prospective study evaluating systemic therapy in male breast cancer patients. In this report of 24 stage II patients receiving cyclophosphamide (Cytoxan), methotrexate, and 5-fluorouracil, the median survival was 98 months.139 In a retrospective review of 156 male breast cancer patients treated at the University of Texas M. D. Anderson Cancer Center, 51 of 135 patients with nonmetastatic breast cancer received either adjuvant chemotherapy, hormonal therapy, or both. For men with lymph node-positive disease, adjuvant chemotherapy was associated with a lower risk of death (hazard ratio [HR] of 0.78), although this difference was not statistically significant. However, overall survival was significantly better for men who receiVed adjuvant hormonal therapy (HR 0.45,

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