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Carcinoma of the Male Breast
- Ishmael A. Jaiyesimi, MD;
- Aman U. Buzdar, MD; and
- Merrick A. Ross, MD
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IN RESPONSE:
We agree with Dr. LeBlond's recommendation of regular follow-up of male patients with breast cancer, which should include self-examination, physical examination, and an annual mammogram of the contralateral breast. We also concur that the emotional trauma associated with prophylactic mastectomy in men may be less than in women. We disagree, however, with the suggestion of an elective subcutaneous mastectomy of the uninvolved breast at the time of initial diagnosis. Subcutaneous mastectomy involves an inframammary skin incision through which most breast tissue beneath the overlying skin and nipple-areolar complex is removed. This procedure, however, does not eliminate all breast tissue [1] and therefore does not prevent the development of a new primary breast cancer [2-4]. For a mastectomy to achieve effective prophylaxis, all of the breast tissue must be removed. If an elective prophylactic mastectomy of the contralateral breast is recommended, a total or simple mastectomy, in which the nipple-areolar complex is removed along with all of the underlying breast tissue, should be the procedure of choice.
The incidence of synchronous or metachronous bilateral breast carcinoma in men, however, is less than 2% [5]. It is, therefore, not advisable to recommend a prophylactic procedure that benefits only a few of the male patients with carcinoma of the breast, especially with little existing evidence that the procedure affects survival. Prophylactic mastectomy, however, may be justified in selected patients who are cancer-phobic or in patients with familial breast cancer.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
