cancer of male breast: part ii

True nipple discharge was a surprisingly frequent symptom and should beconsidered as an important early manifestation of breast cancer in the male.The median duration of symptoms before the first medical consultation wassought was seven months. This wouldsuggest that most male patients andmany physicians are not aware of thesignificance of a breast mass or tend tominimize breast symptoms in the male.

About two thirds of the patientsseen were classified as operable andpresented a reasonable hope for cure.

The disclosure of a mass in the adultmale breast warrants suspicion of amalignant tumor. When the mass isassociated with a nipple abnormality,the diagnosis of cancer should be seriously considered. In either case immediate biopsy is indicated.

The great majority of the cases wereinfiltrating duct carcinoma. With theexception of lobular carcinoma and cystosarcoma phyllodes, all of the pathologic types found in the female breastare encountered in the male. Nippledischarge was more often associatedwith infiltrating duct carcinoma thanwith papillary carcinoma.

Radical mastectomy was performedon all patients whose medical statuspermitted major surgery. There wasone postoperative death.

A review of total experience showsthat if one classifies as successful results only those patients who were observed to be clinically free of cancerfive years after treatment and if allothers (inoperable, lost to follow-up,died of other causes, died of cancer,refused treatment, and so on) areclassified as failures, a minimum survival rate of 29.8 percent is achieved.

If only the operable cases are considered and the same failure factorsare used, the five-year survival rate is42.7 percent. When the “¿�determinate―cases (see text) within the primaryoperable group are evaluated, the five

Summary of an article titledCancer of Male Breast: Part II,by Arthur I. Holleb, M.D., F.A.C.S.,Harold P. Freeman, M.D., andJoseph H. Farrow, M.D., F.A.C.S.

Reprinted from New York State Journal ofMedicine 68: 656-663, 1968; pages 661-662.

A review of 198 histologically confirmed cases of cancer of the malebreast is presented.

Cancer of the male breast accountsfor less than one percent of cancer ofthe breast seen in patients of bothsexes at Memorial Hospital, New YorkCity.

The patient's average age in thisseries was 56 years. The range extended from 24 years to 85 years.

White patients made up 96 percentof the group; the remainder were Negroes.

European-born Jews, the majoritybeing Russian, predominated.

The left breast was involved morefrequently than the right. Bilateralbreast cancer was found in 2.5 percentof the cases.An associatedsignificantprimary

cancer of another anatomic siteoccurred in 7.5 percent of the group.

No relationship could be establishedbetween the development of breastcancer and trauma or a pre-existingbenign breast lesion.

There was also no significant relationship between cancer of the malebreast and Klinefelter's syndrome orwith simple gynecomastia.

In most cases the first symptomnoted by the patient was the presenceof a breast mass and nothing more.

244 Ca —¿�A Cancer Journal far Clinicians

year survival rate rises to a maximumof 57.1 percent.

The number of operable patientstreated ten years ago or more is toosmall to be statistically significant. Evidence indicates that the critical periodis the first five years after therapy andthat many patients will continue to dowell once they have passed the five-yearmark.

Almost all the patients in the inoperable category died within two years ofadmission to the hospital.

Papillary breast cancer in the maleseems to offer an excellent prognosis.

The five-year survival pattern of the

more common infiltrating duct carcinoma parallels breast cancer in the female. When the homolateral axillarylymph nodes are invaded by cancer, thefive-year clinical cure rate dropped to27 percentas opposedto 80 percentwhen the tumor was confinedto thebreast. This hiatus should lend addedsignificancetotheimportanceofearlydiagnosis and prompt therapy.

The age of the patient does not seemto influence the end result. The prognosis for all ages is more dependent onthe histologic type of the cancer andthe presence or absence of metastasesin the axillary lymph nodes.

Our Father,we respectfullyinterrupttheseproceedingsfor a few extended moments

of prayerfulreflectionand petitionto You. Inecho of a plaintivechant of the day, may

we ask the question: WHO WILLANSWER,LORD?Who will answer, Lord, the lonely cries of the abject massof countlesscancer victims?

The silent cry of those whose very voices have wasted away—ofthose for whom an eyehas been darkened—a jaw—a lung—a breast—or a limb has been removed? Who willanswer, Lord, such who cry? The soulful cry of those, who now inside, are only part ofwhat they once were—and—those who are terrified by the fears of the uncertainty ofthe cause of their pain.

Who? YOU will answer, Lord. It is no small comfort to know that you promised:“¿�COMETO ME, YOU WHO ARE HEAVILY BURDENED, I WILL REFRESH YOU.―HOW,then, will You, do You answer, Lord? As you have for many others, many times, in manyplaces. You have answered through Your servants, our own human fellows. Throughprofessional and volunteer hands that answer phones—write letters—ring bells—drivecars; hands that X-ray—count cells—incise—amputate—suture—handsthat nurse—comfort—¿�research—andalso hands that pray.

Thank You, Lord, for answering. And thanks for those whose willingness makes themYour way of answering those prayers of pain.

May we ask You, please, to bless—to empower—to guide—and to hold tightly eachof those helping hands in Your own caring, almighty hand.

AMEN.

—¿�Invocationby the Right Reverend Austin L. Healy, at the AmericanCancer Society Executive Committee Meeting, Baltimore, Maryland,July 18, 1968.

Vol. 18, No. 4, July-August 1968 245

HELPING HANDS