Male Breast Cancer: It's All About the Estrogen

Summary and Comment |
July 9, 2015

Male Breast Cancer: It's All About the Estrogen

  1. William J. Gradishar, MD

Men with the highest versus lowest quartile levels of circulating estrogen had an odds ratio of 2.47 for developing the disease.

  1. William J. Gradishar, MD

Male breast cancer is difficult to study because of its relative rarity compared with breast cancer in women; it is 100-fold more frequent in women. Similar risk factors have been noted for men and women who develop breast cancer, including the effect of hormones manifested by obesity, physical inactivity, diabetes, and exogenous hormone use. In men with Klinefelter syndrome — a condition characterized by the 46-XXY karyotype and an increase risk for breast cancer — gynecomastia and an altered ratio of estrogen to androgens (high) have been reported, highlighting the role of estrogen as a risk factor. There have also been reports suggesting low levels of androgens and excess ratio of estrogen to androgens as risk factors for male breast cancer.

Now, academic investigators for the Male Breast Cancer Pooling Project collected prediagnostic serum or plasma samples for 101 men with breast cancer and 217 matched controls (males without breast cancer).

Androgens or the ratio of estrogen to androgens was not found to enhance risk for developing the disease. However, men with the highest quartile of estrogen compared to the lowest had an odds ratio of 2.47.

Comment

These findings are consistent with an elevated risk of breast cancer in women with the highest level of circulating estrogen, whereas androgen levels were less-important predictors. In men, in contrast to women, body-mass index did not appear to influence estrogen levels. Whether there was an interaction with free testosterone levels and risk for breast cancer could not be determined in this analysis because sex-hormone–binding globulin was not evaluated.

Editor Disclosures at Time of Publication

  • Disclosures for William J. Gradishar, MD at time of publication Consultant / Advisory board Biologics, Inc. Editorial boards Clinical Breast Cancer; Journal of Clinical Oncology; Oncology Leadership positions in professional societies National Comprehensive Cancer Network (Chair, Breast Cancer Panel)

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