Metastatic male breast cancer

Breast cancer of female is common but rare in male. It is diagnosed in advanced stage due to the limited amount of breast tissue and lack of awareness. Most cases occur over the age of 60 years. Male breast cancer is treated like female breast cancer. The outcome of the disease is worse, 5-4 year’s survival in about 40% cases.


Introduction
2][3][4][5] Men are more likely than women to have a delay between the onset of symptoms and diagnosis of breast cancer, possibly due to low public awareness and the rarity of breast carcinoma in men.
It is reported that male breast cancer is associated with worse outcome compared to female breast cancer. 4,67][8] Many of these studies suffered from small sample sizes, short follow-up time, and a non-population-based design, limiting their interpretability.
Over the last few decades, survival of female breast cancer has improved significantly.This is due to combined result of earlier detection and improvements in treatment. 9,10Given the 1.MK Sarker, Associate Professor of Radiotherapy, Khulna Medical College, Khulna 2. PK Chowdhury, Assistant Professor of Respiratory Medicine, Khulna Medical College, Khulna 3. DK Mondal, Professor of Anatomy, Gazi Medical College, Khulna scarcity of male breast cancer, data on risk and outcome for male disease is lacking.A study of gender and age-specific incidence rate curves reported by Anderson et al showed stable incidence rates among men, compared with increasing trends among women. 11A comparison of prognostic factor led to the conclusion that male breast cancer is more similar to post-menopausal female breast cancer than premenopausal breast cancer. 11 The case Hasan Ali aged 70 years old coming from Morolgonj, Bagerhat got admitted in Khulna Medical College Hospital on June, 2012 with the complaints of multiple nodules on right chest wall and persistent cough for one year.He was diagnosed with a right-side ductal invasive carcinoma about 3 years back.He was treated with right simple mastectomy.He did not receive any adjuvant therapy.Recurrence occurred after 1.5 years and treated at the same way.The patient was found ill-looking, anxious.On examination,

Mediscope
The Journal of GMC The patient was found ill-looking, anxious.On examination, multiple nodular growth along with ulcer was found on his right chest wall.Axillary and supraclavicular lymph nodes were also present.Posterior-anterior view chest X-ray shows the presence of multiple metastatic foci in both lung fields.
There was no pleural effusion.A CT scan of whole abdomen was advised but patient could not afford it.Ultrasonogram of whole abdomen shows normal studies.Other routine examinations were normal.It is a case of recurrent breast cancer with metastasis to the lung.We treated him by systemic chemotherapy with FAC schedule.

Discussion
Breast cancer in men is rare only representing 1% of breast cancer.Most cases occur over the age of 60.Presentation is typically with locally advanced disease.The advance stage of male breast cancer at the time of diagnosis is probably due to the limited amount of breast tissue and the lack of awareness among men.
Breast cancer is diagnosed on average 5 to 10 years later in men than in women. 12Because of the lack of early detection by mammography and awareness of early signs of breast cancer, the duration of symptoms before diagnosis has been reported to be longer in men, with a median of 4 to 6 month. 13e improvement in male breast cancer survival is not pronounced.Lack of evidence-based treatment guideline and differences in compliance with treatment may explain the less survival benefit than women.Most clinicians treated the male breast cancer base on guide lines for female breast cancer.[16] In conclusions, over the last 40 years male breast cancer risk has remained constant.In male patients onset is late and diagnosis is done at advanced level of the disease than in female patients.The outcome of the disease is worse, 5-4 year's survival in about 40% cases.

Fig
Fig. 1.A recurrent case of male breast cancer.