Year : 2017 | Volume
: 8 | Issue : 2 | Page : 98--102
Male breast cancer: An overview
Deepti Sharma1, Garima Singh2,
1 Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
2 Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi
Male breast cancer (MBC) is extremely rare, with an incidence of about 1% but the incidence has increased over the past 25 years. Most data on MBC come from small single-institution studies, and because of the paucity of data, the optimal treatment for MBC is not known. In the present article, we reviewed MBC and its risk factors, recommendations for screening and diagnosis, and management of patients with MBC.
|How to cite this article:|
Sharma D, Singh G. Male breast cancer: An overview.J Radiat Cancer Res 2017;8:98-102
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Sharma D, Singh G. Male breast cancer: An overview. J Radiat Cancer Res [serial online] 2017 [cited 2019 Dec 16 ];8:98-102
Available from: http://www.journalrcr.org/text.asp?2017/8/2/98/208026
Breast cancer in men is a very rare cancer, accounting 1% of all breast cancer with an incidence ratio of 1:100 of men to women and about 1% of all malignancies in men., It accounts for <0.2% of all cancer-related deaths among men. Because this disease is rare, no randomized trials have been possible. Most information on male breast cancer (MBC) has been collected from retrospective studies spanning several decades, and treatment recommendations have been extrapolated from results of trials in female patients. Because the incidence of MBC is rising, there has been an increasing interest in this disease. Because this disease is rare, no randomized trials have been possible, most information on breast cancer in men has been collected from retrospective studies spanning several decades, and treatment recommendations have been extrapolated from results of trials in female patients. However, this enormous volume of data on female breast cancer may not be completely relevant to men, particularly with regard to differences concerning the hormonal environment, gender differences, medical and/or psychosocial side effects, and survival priorities. The purpose of this review is to examine systematically all recently published data regarding risk factors, biological characteristics, presentation and prognosis, appropriate evaluation, and treatment in MBC patients.
A database search was conducted on Google Scholar, PubMed, and MEDLINE using phrase words, male breast carcinoma, risk factors, in combination with terms such as “treatment,” “features,” “diagnosis,” and “prognosis.” References of all publication were also searched. All relevant publications were collected, reviewed, and were analyzed in detail to summarized in this paper.
Although MBC accounts for <1% of all cancers in men. Its incidence is variable in different regions. Incidence of MBC in Northwest Europe and North America is approximately 1/100,000 as compared to <0.5/100,000 in Japan., MBC patients are usually a disease of sixties, but in the Middle East, China, and South Asia and also in Africa, they are more often in their 50s; symptom duration before diagnosis has decreased. However, there are large geographical differences, i.e., <8 months in Western countries. and at least 1 year in Asia and in Africa. Disease frequency is higher among Jewish men at 2.3/100,000 and in countries with a high incidence of parasitic liver disease such as Egypt and Zambia.,
The etiology of MBC is unclear, but hormonal levels may play a role in the development of this disease. Testicular abnormalities such as undescended testes, congenital inguinal hernia, orchiectomy, orchitis, and infertility have been consistently associated with elevations in breast cancer risk. Klinefelter's syndrome, in which patients carry XXY chromosomes, may be present in 3%–7% of men with breast cancer, giving males with Klinefelter's syndrome a 50-fold greater risk over the general male population. Men with a family history of breast cancer in a female relative have 2.5 times the odds of developing breast cancer. Prior radiation as in case of mantle field for Hodgkin lymphoma also increases the risk of a subsequent breast cancer. Alcohol use, liver disease, obesity, electromagnetic field radiation, and diet have all been proposed as risk factors, but findings have been inconsistent across studies.,,,
Approximately 15%–20% of men with breast cancer report a family history of breast or ovarian cancer. It is estimated that approximately 10% of men with breast cancer have a genetic predisposition, and BRCA2 is the most clearly associated gene mutation., BRCA1 mutation is also associated with PTEN, P53, and CHEK2.,,, Among male BRCA2 mutation carriers, the estimated lifetime risk of breast cancer is 5%–10% compared with a general population risk of 0.1%. The lifetime risk of MBC with BRCA1 mutations is approximately 1%–5%. CHEK2 1100 del C increases the risk of both male and female breast cancer, particularly among individuals with a family history and a CHEK2 mutation. At all ages, black men have a higher incidence than white men. Black men also tend to have poorer prognostic features such as advanced-stage disease, larger tumor sizes, more nodal involvement, and higher tumor grade, compared with their white counterparts.
The most common presenting symptoms in MBC patients are a painless subareolar lump, nipple retraction, and bleeding from the nipple.,,, Nipple is involved in about 50% of cases at presentation. Due to lack of awareness, >40% of men present with stage III or IV disease.,,
Mammographic characteristics of MBC are subareola and eccentric to the nipple., Margins of the lesions are usually well defined; calcifications are rarer and coarser than those occurring in female breast cancer.,, In one study, the sensitivity and specificity of mammography was 92% and 90%, respectively; i.e., mammography detected malignancy in 92% of known malignant cases and ruled out malignancy in 90% of known benign cases.
On ultrasound, it appears as a hypoechoic area whose edges are angled or with microchannels and points on the surface., The appearance of a complex cystic mass in a male breast with ultrasound suggests possible malignancy, and biopsy is required. Ultrasound is important for demonstrating axillary lymphadenopathy.
Biopsy is required for definitive diagnosis in most breast cancer cases in men., Fine-needle aspiration (FNA) biopsy of the male breast has high sensitivity and high specificity, and with almost 100% positive predictive value for the diagnosis of malignancy.,,, FNA biopsy allows accurate diagnosis in many medical changes that occur in the male breast. However, this technique is less helpful with ductal carcinoma in situ(DCIS), especially in lesions that are cystic, such as papillary DCIS, which has been described as having a strong cystic component. Core needle biopsy or FNA biopsy should be used more often because these procedures can help to avoid unnecessary surgery and may help in the planning of any surgeries for cancer cases.
Histopathologically, the majority of tumors are invasive ductal carcinoma (85%–95%), followed by DCIS (5%–10%). Invasive papillary carcinoma is more common in males than in females, accounting for approximately 2%–4% of breast cancers in men compared with up to 1% in women.
Estrogen receptors are expressed in 90% of MBCs, a higher proportion than in women and up to 96% are progesterone receptor positive., Human epidermal growth factor receptor 2 overexpression has been reported in 16%, on average slightly lower than in females but its effects on prognosis are unclear.,,
Management options for MBC patients are based mainly on information from the treatment of full blood count.,, Surgery as a form of therapy is generally a key part of the treatment of breast cancer and is a “gold standard” for MBC treatment.,, Modified radical mastectomy with subcutaneous reconstruction is commonly done surgical procedure, whereas simple mastectomy is done in those patients who are inoperable and are with very poor prognosis and/or are at high risk for wide surgery., Axillary node dissection may be performed even though it is associated with other complications such as lymphedema and paresthesia (9). Sentinel node biopsy is now accepted as a reliable method to establish axillary node status for invasive MBC, avoiding complications associated with axillary node dissection.,,
Postoperative radiotherapy should be given if there is involvement of the skin and/or pectoral muscle and areola along with metastatic involvement of the axillary lymph nodes., Postoperative radiotherapy reduces the incidence of local recurrence in males as well as in female cancer patients., In 55 Turkish patients, controlling for other disease and treatment factors, receipt of radiotherapy was found to prolong disease-free survival. A case series of 75 men treated with curative intent in Ontario found significantly improved local recurrence-free survival in 46 patients who received postmastectomy radiation, but their overall survival was not different.
Most cases of MBC respond favorably to hormonal manipulation since the majority are estrogen receptor positive. Although no clinical trials have assessed the use of tamoxifen in MBC, men who have been treated with it show improved disease-free and overall survival rates, with the 5-year disease-free rate improving from 28% to 56%, and the 5-year overall survival rate improving from 44% to 61%.,, In a Chinese retrospective single-institution study of 72 male patients over 40 years, multivariate regression found that receipt of endocrine therapy was associated with better survival. For this reason, tamoxifen has an important role in the treatment of most MBC cases. Studies have demonstrated that male patients experience more side effects from tamoxifen, such as weight gain, sexual dysfunction, nausea, depression, and hot flushes, which may affect their compliance with the prescribed treatment.,,, There are insufficient data on the use of aromatase inhibitors to treat MBC. Orchidectomy, adrenalectomy, and hypophysectomy, once used for hormonal manipulation, are no longer used due to the associated severe side effects.
Chemotherapy appears to benefit survival and prevent recurrence although data are most established for node positive men.,,, It has been suggested that chemotherapy is used in patients with stage II or greater disease., A 2004 retrospective study showed that additional adjuvant therapy in the form of radiation, hormones, and chemotherapy, either alone or in combination, have doubled the survival rate in men with breast cancer. The retrospective study by Giordano et al. showed that 51 patients, including 66% with positive lymph node status, were treated with tamoxifen, chemotherapy, or both. Patients who received adjuvant systemic treatment had 43% lower risk of death, compared with patients who received no form of adjuvant therapy. During tumor progression in male breasts, a combined hormonal and cytostatic treatment can be used with considerably good results.
Due to low incidence of MBC in the general population, there are no guidelines or formal recommendations for screening mammography, nor are there recommendations for clinical breast examination or breast self-examination in asymptomatic men with no other risk factors.
For individuals at increased risk for developing breast cancer, that is individuals with a strong family history of breast cancer, a genetic predisposition (mutations identified that are known to increase risk of breast cancer such as BRCA1 and BRCA2), and prior personal history of breast cancer (particularly MBC), there are clear surveillance and screening guidelines.,
For men in the increased risk category, monthly breast self-examinations, semi-annual clinical breast examinations, and baseline mammography followed by annual mammography if gynecomastia and/or breast density are seen on baseline are recommended., Guidelines also recommend that both men and women in the increased risk category are tested for genetic mutations (if mutation status is unknown), are advised of the risk to other relatives, and consider genetic testing for at-risk relatives.,,
Hill et al. reported an overall 5-year and 10-year survival rate in patients with localized disease to 86% and 64%, respectively. With positive lymph nodes, the 5 and 10-year survival rate decreased to 73% and 50%, respectively. The prognosis is worse if four or more lymph nodes are involved (10-year survival drops to 14%). The old age, comorbidity at presentation, and shorter life expectancy in men also affect prognosis.
MBC, though very rare, does exist. Efforts to increase awareness among patients and physicians will lead to earlier presentation and therefore, diagnosis before spreading to the axilla and other organs. Like the majority of cancers, MBC can be cured or controlled if diagnosed and treated properly at its early stages. We need a greater awareness of MBC to guide evidence-based treatment and to encourage enrollment in future studies aiming at optimizing management of this rare disease. The role of adjuvant hormonal treatment and chemotherapy deserves more researches, especially to determine which subgroup of men will benefit.
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|1||La Pinta M, Fabi A, Ascarelli A, Ponzani T, Di Carlo V, Scicchitano F, et al. Male breast cancer: 6-year experience. Minerva Chir 2008;63:71-8.|
|2||Yoney A, Kucuk A, Unsal M. Male breast cancer: A retrospective analysis. Cancer Radiother 2009;13:103-7.|
|3||Weiss JR, Moysich KB, Swede H. Epidemiology of male breast cancer. Cancer Epidemiol Biomarkers Prev 2005;14:20-6.|
|4||Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: A population-based study. Cancer 2004;101:51-7.|
|5||Hodgson NC, Button JH, Franceschi D, Moffat FL, Livingstone AS. Male breast cancer: Is the incidence increasing? Ann Surg Oncol 2004;11:751-5.|
|6||Waterhouse J, Muir CS, Shanmugaratnam K, Powell J, editors. Cancer Incidence in Five Continents. IARC Scientific Publications No. 42. Vol. IV. Lyon: IARC; 1982.|
|7||Agrawal A, Ayantunde AA, Rampaul R, Robertson JF. Male breast cancer: A review of clinical management. Breast Cancer Res Treat 2007;103:11-21.|
|8||Borgen PI, Wong GY, Vlamis V, Potter C, Hoffmann B, Kinne DW, et al. Current management of male breast cancer. A review of 104 cases. Ann Surg 1992;215:451-7.|
|9||Shukla NK, Seenu V, Goel AK, Raina V, Rath GK, Singh R, et al. Male breast cancer: A retrospective study from a regional cancer center in Northern India. J Surg Oncol 1996;61:143-8.|
|10||El-Gazayerli MM, Abdel-Aziz AS. On bilharziasis and male breast cancer in Egypt: A preliminary report and review of the literature. Br J Cancer 1963;17:566-71.|
|11||Bhagwandeen SB. Carcinoma of the male breast in Zambia. East Afr Med J 1972;49:89-93.|
|12||Sasco AJ, Lowenfels AB, Pasker-de Jong P. Review article: Epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiological factors. Int J Cancer 1993;53:538-49.|
|13||Hultborn R, Hanson C, Köpf I, Verbiené I, Warnhammar E, Weimarck A. Prevalence of Klinefelter's syndrome in male breast cancer patients. Anticancer Res 1997;17:4293-7.|
|14||Rosenblatt KA, Thomas DB, McTiernan A, Austin MA, Stalsberg H, Stemhagen A, et al. Breast cancer in men: Aspects of familial aggregation. J Natl Cancer Inst 1991;83:849-54.|
|15||Sørensen HT, Friis S, Olsen JH, Thulstrup AM, Mellemkjaer L, Linet M, et al. Risk of breast cancer in men with liver cirrhosis. Am J Gastroenterol 1998;93:231-3.|
|16||Rosenblatt KA, Thomas DB, Jimenez LM, Fish B, McTiernan A, Stalsberg H, et al. The relationship between diet and breast cancer in men (United States). Cancer Causes Control 1999;10:107-13.|
|17||Erren TC. A meta-analysis of epidemiologic studies of electric and magnetic fields and breast cancer in women and men. Bioelectromagnetics 2001;22 Suppl 5:S105-19.|
|18||Hsing AW, McLaughlin JK, Cocco P, Co Chien HT, Fraumeni JF Jr. Risk factors for male breast cancer (United States). Cancer Causes Control 1998;9:269-75.|
|19||Couch FJ, Farid LM, DeShano ML, Tavtigian SV, Calzone K, Campeau L, et al. BRCA2 germline mutations in male breast cancer cases and breast cancer families. Nat Genet 1996;13:123-5.|
|20||Haraldsson K, Loman N, Zhang QX, Johannsson O, Olsson H, Borg A. BRCA2 germ-line mutations are frequent in male breast cancer patients without a family history of the disease. Cancer Res 1998;58:1367-71.|
|21||Brose MS, Rebbeck TR, Calzone KA, Stopfer JE, Nathanson KL, Weber BL. Cancer risk estimates for BRCA1 mutation carriers identified in a risk evaluation program. J Natl Cancer Inst 2002;94:1365-72.|
|22||Anelli A, Anelli TF, Youngson B, Rosen PP, Borgen PI. Mutations of the p53 gene in male breast cancer. Cancer 1995;75:2233-8.|
|23||Fackenthal JD, Marsh DJ, Richardson AL, Cummings SA, Eng C, Robinson BG, et al. Male breast cancer in Cowden syndrome patients with germline PTEN mutations. J Med Genet 2001;38:159-64.|
|24||Meijers-Heijboer H, van den Ouweland A, Klijn J, Wasielewski M, de Snoo A, Oldenburg R, et al. Low-penetrance susceptibility to breast cancer due to CHEK2(*) 1100delC in noncarriers of BRCA1 or BRCA2 mutations. Nat Genet 2002;31:55-9.|
|25||Breast Cancer Linkage Consortium. Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst 1999;91:1310-6.|
|26||Tai YC, Domchek S, Parmigiani G, Chen S. Breast cancer risk among male BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst 2007;99:1811-4.|
|27||CHEK Breast Cancer Case-Control Consortium. CHEK2* 1100delC and susceptibility to breast cancer: A collaborative analysis involving 10,860 breast cancer cases and 9,065 controls from 10 studies. Am J Hum Genet 2004;74:1175-82.|
|28||Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat 2004;83:77-86.|
|29||Giordano SH, Buzdar AU, Hortobagyi GN. Breast cancer in men. Ann Intern Med 2002;137:678-87.|
|30||Bloom KJ, Govil H, Gattuso P, Reddy V, Francescatti D. Status of HER-2 in male and female breast carcinoma. Am J Surg 2001;182:389-92.|
|31||Contractor KB, Kaur K, Rodrigues GS, Kulkarni DM, Singhal H. Male breast cancer: Is the scenario changing. World J Surg Oncol 2008;6:58.|
|32||Goss PE, Reid C, Pintilie M, Lim R, Miller N. Male breast carcinoma: A review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955-1996. Cancer 1999;85:629-39.|
|33||Ribeiro GG, Swindell R, Harris M, Banerjee SS, Cramer A. A review of the management of the male breast carcinoma based on an analysis of 420 treated cases. Breast 1996;5:141-6.|
|34||Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet 2006;367:595-604.|
|35||Chantra PK, So GJ, Wollman JS, Bassett LW. Mammography of the male breast. AJR Am J Roentgenol 1995;164:853-8.|
|36||Mathew J, Perkins GH, Stephens T, Middleton LP, Yang WT. Primary breast cancer in men: Clinical, imaging, and pathologic findings in 57 patients. AJR Am J Roentgenol 2008;191:1631-9.|
|37||Korde LA, Zujewski JA, Kamin L, Giordano S, Domchek S, Anderson WF, et al. Multidisciplinary meeting on male breast cancer: Summary and research recommendations. J Clin Oncol 2010;28:2114-22.|
|38||Dershaw DD, Borgen PI, Deutch BM, Liberman L. Mammographic findings in men with breast cancer. AJR Am J Roentgenol 1993;160:267-70.|
|39||Appelbaum AH, Evans GF, Levy KR, Amirkhan RH, Schumpert TD. Mammographic appearances of male breast disease. Radiographics 1999;19:559-68.|
|40||Evans GF, Anthony T, Turnage RH, Schumpert TD, Levy KR, Amirkhan RH, et al. The diagnostic accuracy of mammography in the evaluation of male breast disease. Am J Surg 2001;181:96-100.|
|41||Draghi F, Tarantino CC, Madonia L, Ferrozzi G. Ultrasonography of the male breast. J Ultrasound 2011;14:122-9.|
|42||Reis LO, Dias FG, Castro MA, Ferreira U. Male breast cancer. Aging Male 2011;14:99-109.|
|43||Yang WT, Whitman GJ, Yuen EH, Tse GM, Stelling CB. Sonographic features of primary breast cancer in men. AJR Am J Roentgenol 2001;176:413-6.|
|44||Fentiman I. Male breast cancer: A review. Ecancermedicalscience 2009;3:140.|
|45||Joshi MG, Lee AK, Loda M, Camus MG, Pedersen C, Heatley GJ, et al. Male breast carcinoma: An evaluation of prognostic factors contributing to a poorer outcome. Cancer 1996;77:490-8.|
|46||Rosen DG, Laucirica R, Verstovsek G. Fine needle aspiration of male breast lesions. Acta Cytol 2009;53:369-74.|
|47||Lilleng R, Paksoy N, Vural G, Langmark F, Hagmar B. Assessment of fine needle aspiration cytology and histopathology for diagnosing male breast masses. Acta Cytol 1995;39:877-81.|
|48||Westenend PJ. Core needle biopsy in male breast lesions. J Clin Pathol 2003;56:863-5.|
|49||Meijer-van Gelder ME1, Look MP, Bolt-de Vries J, Peters HA, Klijn JG, Foekens JA. Clinical relevance of biologic factors in male breast cancer. Breast Cancer Res Treat 2001;68:249-60.|
|50||Rayson D, Erlichman C, Suman VJ, Roche PC, Wold LE, Ingle JN, et al. Molecular markers in male breast carcinoma. Cancer 1998;83:1947-55.|
|51||Dakin Haché K, Gray S, Barnes PJ, Dewar R, Younis T, Rayson D. Clinical and pathological correlations in male breast cancer: Intratumoral aromatase expression via tissue microarray. Breast Cancer Res Treat 2007;105:169-75.|
|52||Zhou FF, Xia LP, Guo GF, Wang X, Yuan ZY, Zhang B, et al. Changes in therapeutic strategies in Chinese male patients with breast cancer: 40 years of experience in a single institute. Breast 2010;19:450-5.|
|53||Ottini L, Palli D, Rizzo S, Federico M, Bazan V, Russo A. Male breast cancer. Crit Rev Oncol Hematol 2010;73:141-55.|
|54||De Cicco C, Baio SM, Veronesi P, Trifirò G, Ciprian A, Vento A, et al. Sentinel node biopsy in male breast cancer. Nucl Med Commun 2004;25:139-43.|
|55||Cutuli B. Strategies in treating male breast cancer. Expert Opin Pharmacother 2007;8:193-202.|
|56||Chakravarthy A, Kim CR. Post-mastectomy radiation in male breast cancer. Radiother Oncol 2002;65:99-103.|
|57||Bratman SV, Kapp DS, Horst KC. Evolving trends in the initial locoregional management of male breast cancer. Breast 2012;21:296-302.|
|58||Atalay C, Kanlioz M, Altinok M. Prognostic factors affecting survival in male breast cancer. J Exp Clin Cancer Res 2003;22:29-33.|
|59||Yu E, Suzuki H, Younus J, Elfiki T, Stitt L, Yau G, et al. The impact of post-mastectomy radiation therapy on male breast cancer patients – A case series. Int J Radiat Oncol Biol Phys 2012;82:696-700.|
|60||Lanitis S, Rice AJ, Vaughan A, Cathcart P, Filippakis G, Al Mufti R, et al. Diagnosis and management of male breast cancer. World J Surg 2008;32:2471-6.|
|61||Zhou FF, Xia LP, Wang X, Guo GF, Rong YM, Qiu HJ, et al. Analysis of prognostic factors in male breast cancer: A report of 72 cases from a single institution. Chin J Cancer 2010;29:184-8.|
|62||Anelli TF, Anelli A, Tran KN, Lebwohl DE, Borgen PI. Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 1994;74:74-7.|
|63||Pemmaraju N, Munsell MF, Hortobagyi GN, Giordano SH. Retrospective review of male breast cancer patients: Analysis of tamoxifen-related side-effects. Ann Oncol 2012;23:1471-4.|
|64||Visram H, Kanji F, Dent SF. Endocrine therapy for male breast cancer: Rates of toxicity and adherence. Curr Oncol 2010;17:17-21.|
|65||Miao H, Verkooijen HM, Chia KS, Bouchardy C, Pukkala E, Larønningen S, et al. Incidence and outcome of male breast cancer: An international population-based study. J Clin Oncol 2011;29:4381-6.|
|66||Meguerditchian AN, Falardeau M, Martin G. Male breast carcinoma. Can J Surg 2002;45:296-302.|
|67||Giordano SH, Perkins GH, Broglio K, Garcia SG, Middleton LP, Buzdar AU, et al. Adjuvant systemic therapy for male breast carcinoma. Cancer 2005;104:2359-64.|
|68||Patel HZ 2nd, Buzdar AU, Hortobagyi GN. Role of adjuvant chemotherapy in male breast cancer. Cancer 1989;64:1583-5.|
|69||El-Tamer MB, Komenaka IK, Troxel A, Li H, Joseph KA, Ditkoff BA, et al. Men with breast cancer have better disease-specific survival than women. Arch Surg 2004;139:1079-82.|
|70||Sulyok Z, Köves I. Male breast tumours. Eur J Surg Oncol 1993;19:581-6.|
|71||National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Screening and Diagnosis V.I.2010; 2008. Available from: http://www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdf. [Last accessed on 2009 Nov 17].|
|72||Nemec CF, Listinsky J, Rim A. How should we screen for breast cancer? Mammography, ultrasonography, MRI. Cleve Clin J Med 2007;74:897-904.|
|73||Petrucelli N, Daly MB, Culver JO, Feldman GL. Gene Reviews: BRCA1 and BRCA2 Hereditary Breast/Ovarian Cancer; 19 June, 2007. Available from: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene and part=brca1. [Last accessed on 2009 Mar 03].|
|74||National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Breast and Ovarian V.I.2015; 2015. Available from: http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf. [Last accessed on 2015 Nov 17].|
|75||U.S. Preventive Services Task Force. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement. Ann Intern Med 2005;143:355-61.|
|76||ASCO Working Group on Genetic Testing for Cancer Susceptibility. American Society of Clinical Oncology policy statement update: Genetic testing for cancer susceptibility. J Clin Oncol 2009;21:2397-06.|
|77||Hill A, Yagmur Y, Tran KN, Bolton JS, Robson M, Borgen PI. Localized male breast carcinoma and family history. An analysis of 142 patients. Cancer 1999;86:821-5.|