DUCTAL CARCINOMA IN-SITU OF THE MALE BREAST - ANALYSIS OF 31 CASES

From 1970 to 1992, 31 pure ductal carcinoma in situ (DCIS) of the male breast treated in 19 French Regional Cancer Centres were reviewed. Th ey represent 5% of all breast cancers treated in men in the same perio d. The median age was 58 years, but 6 patients were younger than 40 ye ars. TNM classification (UICC, 1978) showed 12 T0 (discovered only by bloody nipple discharge), 10 T1, 5 T2 and four unclassified tumours (T x). 11 patients (35.5%) had clinical gynecomastia, and three (10%) had a family history of breast cancer. 6 patients underwent lumpectomy, a nd 25 mastectomy. Axillary dissection was performed in 19 cases. 6 cas es received postoperative irradiation. 15 out of 31 lesions were of th e papillary subtype, pure or associated with a cribriform component. T he size of the 12 measured lesions varied from 3 to 45 mm. All lymph n odes sampled were negative. With a median follow-up of 83 months, 4 pa tients (13%) presented a local relapse (LR), respectively, at 12, 27, 36 and 55 months. 3 of these patients had been initially treated by lu mpectomy. In one case LR was still in situ, but already infiltrating i n the 3 others. Radical salvage surgery was performed in 3 cases, but one patient developed metastases and died 30 months later. The last pa tient was treated by multiple local excisions and tamoxifen. One 43-ye ar-old patient developed a contralateral DCIS and three others develop ed a metachronous cancer. The aetiology and risk factors of male breas t cancer remain unknown. Gynecomastia, which implies an imbalance betw een androgen and oestrogen, may be a predisposing factor. As in women, DCIS in the male breast has a good prognosis. Total mastectomy withou t axillary dissection is the basic treatment. Frequently, the first sy mptom is a bloody nipple discharge. The age of occurrence is younger t han for infiltrating carcinoma, suggesting that DCIS is the first step in the development of breast cancer. (C) 1997 Elsevier Science Ltd.