Male Breast Cancer Management: Special ASCO Guideline 2020

The chances of men getting breast cancer in their lifetime are about 1 in 833. And that accounts for only 1% of breast cancer incidence worldwide, which is why the detection and management information can seem a little lacking. At ASCO, the American Society of Clinical Oncology, management of male breast cancer has been discussed at length, and here we will talk about just that. 

This is an important discussion for male breast cancer treatment in India because although India has some of the best cancer doctors like Dr. Manish Singhal, the best oncologist in Delhi NCR, handling the disease, many patients and professionals may not have a clear idea about the same because of the scarcity of the disease. 

So, let’s get into it.

New ASCO guidelines for male breast cancer 2020

Many of the recommendations for male breast cancer and male breast cancer treatment were similar to female breast cancer. For example, according to the management recommendations, men who have hormone receptor-positive breast cancer and who are candidates for adjuvant endocrine therapy should be offered tamoxifen for an initial duration of five years.

However, those with a contraindication with the drug may be offered gonadotropin-releasing hormone agonist/antagonist plus aromatase inhibitor, the recommendations cited. This is an important recommendation for male breast cancer treatment.

Having completed 5 years of tamoxifen as a male breast cancer treatment and having tolerated the therapy, if there is still a high risk of recurrence, that may be an indicator for cancer specialists to offer the patients an additional 5 years of therapy. 

Also, according to the recommendations, for men with early-stage disease, cancer should not be treated with bone-modifying agents to prevent a recurrence. However, it could still receive these agents to prevent future osteoporosis. 

It is also suggested that men with advanced or metastatic disease can and should be offered endocrine therapy as the first-line therapy, except in cases of visceral crisis or rapidly progressive disease. 

Targeted systemic therapy, on the other hand, may be used to treat advanced or metastatic cancer using the same indications and combinations offered to women, as per the recommendations, to the delight of top cancer specialists in Delhi and around the world.

It is also widely accepted by the best cancer doctors in the meeting that an ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy. This is regardless of genetic predisposition. Not only that but a contralateral annual mammogram may also be offered to men with a history of breast cancer and a genetic mutation that predisposes him to cancer. 

Breast magnetic resonance imaging was not something that was recommended as a routine procedure. Genetic counseling and germline genetic testing of cancer predisposition genes should be offered to all men with breast cancer, according to the experts. 

So, as you can see, there were plenty of similarities between the recommendations for female and male breast cancer treatment and management. The primary similarities, as depicted, included the use of gene-expression profile testing to guide adjuvant treatment decision-making, the use of primary surgery, the use of adjuvant radiation therapy, and the use of chemotherapy in adjuvant and advanced/metastatic disease settings. 

The differences were primarily seen in the use of endocrine therapy, the recommended use of routine genetic testing for inherited risk factors, survivorship care, and routine mammography for men treated with lumpectomy.

Importance of ASCO guidelines for breast cancer in men

The reason or goal behind the recommendations is to urge the best cancer doctors to implement these into routine practice. However, the hope is to help instigate research initiatives into the rare disease. The idea is to make male breast cancer mainstream so that more research is done into it because most breast cancer studies take only women into account when they can easily take both men and women into account unless the treatment involves an aspect of endocrine treatment only relevant to women. 

According to the specialists and best cancer doctors who worked on the recommendations, such trials are necessary because there is limited data available about male breast cancer, and these can generate the much-needed data upon which formal guidelines can be based. 

Ending the discussion…

The expert panel by ASCO that laid down the recommendations does it in hopes of raising awareness of male breast cancer, not only among patients but also among oncologists who are not well equipped to handle such patients because of the lacking information. However, if you need more information or need to consult a specialist, there are some expert oncologists like Dr. Manish Singhal, the best breast cancer doctor in Delhi NCR, who can guide you in the right direction and keep you updated about the different recommendations consistently. 

ALSO READ: Latest Breast Cancer updates from ASCO Annual Meeting 2020