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REPLY
Breast Cancer in Men
Sharon H. Giordano, MD;
Aman U. Buzdar, MD; and
Gabriel N. Hortobagyi, MD
19 August 2003 | Volume 139 Issue 4 | Page 305
IN RESPONSE:
We appreciate Dr. Jackson's interest in our article and will address his questions with pleasure. First, with regard to the role of sentinel lymph node biopsy in men, limited data are available. Several case reports of sentinel node biopsies performed in men have been published (1). However, the correlation between sentinel node biopsy and standard axillary dissection has not been established in men. We recognize that the rarity of male breast cancer makes the collection of a sufficient number of cases difficult, and thus it may not be possible to conclusively answer this question. Given that we would not expect a difference in the accuracy of this procedure by sex, sentinel node biopsy is a reasonable, although unproven, approach.
In answer to the second question, we would not recommend positron emission tomography or bone marrow aspiration as tools to decide whether a patient with early-stage disease should undergo adjuvant therapy. We do not routinely use these tests to determine whether women will benefit from adjuvant chemotherapy and are aware of no data to support their routine use in men with breast cancer.
The third question inquires about the relationship between adjuvant tamoxifen and the risk for prostate cancer. Tamoxifen is a selective estrogen receptor modulator (SERM) that has both estrogenic and antiestrogenic properties and appears to have some activity against prostate cancer. Tamoxifen and raloxifene (another SERM) have been shown to induce apoptosis in human prostate cancer cell lines (2, 3). However, in clinical trials, tamoxifen has had only limited activity in treating metastatic androgen-independent prostate cancer. Whether tamoxifen is effective as a chemopreventive agent for prostate cancer is unclear. In a rat model, tamoxifen prevented cancer of the seminal vesicle and prostate (4). Because of the promising results in animal models, a phase II clinical trial using another SERM (GTx-006) for chemoprevention of prostate cancer is under way (5). We will have to await the results of this and other clinical trials and epidemiologic studies to definitively answer this question.
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Author and Article Information
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University of Texas M.D. Anderson Cancer Center; Houston, TX 77030 (Giordano, Buzdar, Hortobagyi)
1. Hill AD, Borgen PI, Cody HS 3rd. Sentinel node biopsy in male breast cancer Eur J Surg Oncol. 1999;25:442-3. [PMID: 10419720].[Medline]
2. Kim IY, Kim BC, Seong do H, Lee DK, Seo JM, Hong YJ, et al. Raloxifene, a mixed estrogen agonist/antagonist, induces apoptosis in androgen-independent human prostate cancer cell lines Cancer Res. 2002;62:5365-9. [PMID: 12235008].[Abstract/Free Full Text]
3. Liang Y, Eid MA, El Etreby F, Lewis RW, Kumar MV. Mifepristone-induced secretion of transforming growth factor beta1-induced apoptosis in prostate cancer cells Int J Oncol. 2002;21:1259-67. [PMID: 12429976].[Medline]
4. Lucia MS, Anzano MA, Slayter MV, Anver MR, Green DM, Shrader MW, et al. Chemopreventive activity of tamoxifen, N-(4-hydroxyphenyl)retinamide, and the vitamin D analogue Ro24-5531 for androgen-promoted carcinomas of the rat seminal vesicle and prostate Cancer Res. 1995;55:5621-7. [PMID: 7585644].[Abstract/Free Full Text]
5. Steiner MS, Raghow S, Neubauer BL. Selective estrogen receptor modulators for the chemoprevention of prostate cancer Urology. 2001;57:68-72. [PMID: 11295598].[Medline]
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Breast Cancer in Men
Sharon H. Giordano, Aman U. Buzdar, AND Gabriel N. Hortobagyi
- Annals 2002 137: 678-687.
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