A 50-YEAR EXPERIENCE OF MALE BREAST-CANCER - IS OUTCOME CHANGING

During the period 1933-1983, 124 men (median age 62.5 years, range 33- 86 years) were treated for breast carcinoma. Median length of follow-u p was 6.7 years and was complete for 93% of patients. Presenting compl aints were most frequently a mass (95%) or pain (31%) while physical e xamination revealed the tumour to be central in 95% of patients with n ipple or skin retraction in 36% and associated gynaecomastia in 12%. T wenty-seven per cent of the patients had a positive family history of breast cancer, 6% noted previous breast trauma and 7% had prior chest wall irradiation. Mean tumour size was 2.5 cm, and the pathological st age was 0 in 3%, I in 17%, II in 22%, III in 35%, IV in 11%, and unkno wn in 12%. Ninety-four per cent were ductal carcinoma. Histological gr ading of tumours was 2% grade 1, 10% grade 2, 33% grade 3 and 48% grad e 4. Ninety-two per cent of patients underwent mastectomy (41% radical , 39% modified radical and 12% simple), while adjuvant irradiation was used in 44% and chemotherapy in 9%. Median disease-free patient survi val was 5 years (36% of patients developed tumour recurrence). Median overall patient survival was 6.3 years (57% at 5 years and 31% at 10 y ears). Tumour size (P < 0.05), pathological stage (P < 0.04), and tumo ur grade (P=0.007) were adverse factors for recurrence, while patholog ical stage (P < 0.02), tumour size (P < 0.03), pain (P < 0.05) and age (P < 0.02) were associated with a decreased survival. Duration of sym ptoms or type of mastectomy had no effect on recurrence or survival. W hen data for the first 25 years were compared to those of the second 2 5 years, no differences were observed in patient survival, tumour recu rrence, duration of symptoms, stage of disease or size of tumour, thou gh the use of adjuvant radiation and the performance of radical mastec tomy decreased from 78 and 82 to 15 and 12, respectively. Breast carci noma in males affects an older population, is often advanced at diagno sis, and is frequently fatal. Despite changes in therapy over the last 50 years, no effect on survival or recurrence was observed.