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Breast Cancer in Men
- Sharon H. Giordano, MD;
- Aman U. Buzdar, MD; and
- Gabriel N. Hortobagyi, MD
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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.
Sharon H. Giordano, MD
Aman U. Buzdar, MD
Gabriel N. Hortobagyi, MD
University of Texas M.D. Anderson Cancer Center; Houston, TX 77030
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
