Drs Fatima Cardoso, Sharon Giordano, and Oliver Bogler explore the myriad of special considerations involved in optimizing the plan of care for male patients with breast cancer.
Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit.Fatima Cardoso, MD:
Many of the patients I met had that experience, difficulty convincing their primary care physician or even their first-line oncologist that this could be the case. I just want to connect to what you both said, which is that 10 years ago, inclusion of men in clinical trials was not standard. It is a fantastic development to see that because unless we include men, we won't learn about that type of breast cancer.
Just because it was a man, there was no need to pay attention to the aesthetic outcome. That is wrong, in my perspective. I'm very happy to see that now there are surgeons considering other types of breast surgery to conserve as much as possible the aesthetic outcome.I have to say that I was offered reconstruction at MD Anderson. I declined it. It wasn't that big a part of my body image.
I will say that I was treated by Dr Giordano and her colleagues very much like a woman would have been with my disease, and actually, very similarly to my wife. I've done well with it, so I would say, in most cases, the current standard of care is very effective but it falls a little short of personalized medicine, particularly when it comes to the hormone component.
Having said that, I will sometimes order the test in my practice. If somebody comes back with a score of 5 or a very low-risk score, I will use that in my decision-making.There is something we didn't exactly mention in the diagnosis that may be important. We discussed most men not knowing that they can have breast cancer, and Oliver, you mentioned that sometimes the first-line physicians can think that very often. Usually, we have late diagnosis and that means a higher tumor burden.
Sometimes I also use the argument with my patients that the alternative is even worse because if you use an aromatase inhibitor, and you have to use an LHRH agonist, then the implications for your sexual life are even worse. That's how I try to convince them to stay on tamoxifen. We have a little less experience with the PI3K inhibitor, but that's just because of accessibility to the drug. I think this combination is also something to keep in mind that can be quite effective in these patients.I agree. Those findings are exciting in the context of dealing with something as difficult as metastatic breast cancer. It's good to know that there's some information coming and opportunities and options, hopefully, down the road for men facing that problem.
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