Hereditary Breast and Ovarian Cancers Meeting 2011, New York, USA
Multi-centre male breast cancer study
Dr Laura Ottini – University of Rome La Sapienza, Italy
I have a peculiar field in breast cancer, that is the breast cancer in men and not in women. Because breast cancer is also in men and, although it’s rare, it exists. So it’s to try to say to people that breast cancer is a disease that can happen also in men.
How is it working on a multi-centre study?
Working with a rare disease you have a lot of problems, so to overcome these problems very recently we have started in Italy a first multi-centre study of male breast cancer and we have at least ten centres participating into this study, covering the whole country from northern to southern Italy. So we have a picture of what is breast cancer, at least in one single country. It’s one of the first experiences, at least as far as I know, in Europe to try to collect a unique service from one single country. It’s hard work but we have experienced a very, very good collaboration because people know that if we want to make a nice study, or important study, we have to pool all together our efforts and of course data and of course biological samples. And this is the spirit of the multi-centre study. This also is in line with what is going on at an international level where there are a lot of calls to try to say that we have to pool together our data at a national, but also at an international level.
Are there any social issues affecting male breast cancer?
I’ve been working in this field, male breast cancer, since 2003 and in that period you couldn’t see a lot of papers like this literature. It was a field that was very restricted to some people working in this field. But in the last, I would say, three or four years you can see now a lot of papers in the literature about male breast cancer. Why it is, for sure, is because now we know a little bit better the risk factors for male breast cancers, in particular the role of one gene that is called the BRCA2 gene, this breast cancer susceptibility gene in women but we also know that it is in men. So now you know a little bit better so a lot of people started to work in this field but also because, from an epidemiological point of view, we have observed that, although rare, male breast cancer is increasing in its incidence, at least in Western countries. So I think that more people are becoming conscious of this problem and, although it occurs rarely, it occurs and the problem is that we don’t know how to cope with this. So also at clinical and psychological aspects we don’t know how to do it. So this is also important because a man can come to your hospital and the problem is first how to say to him that he has breast cancer. He cannot imagine that he can have this kind of disease first, and then the problem is that you have your experience with working with breast cancer in women but, of course, it’s not the same. It’s not the same for the psychological aspects but also we don’t know exactly if the therapy that we use in women can be also useful in men. So there’s a lot of work.
Different sets of hormones?
Yes, different sets of hormones. Of course, what we can say now, that probably breast cancer in men is more similar to what happens in post-menopausal breast cancer in women. Of course it’s different because in men there are not all the variables that are in women associated with hormonal variations that the women have of the cycle in the month; the women also have pregnancy, lactation, so the mammary gland in women goes through a differentiation that the mammary gland in men doesn’t go. So there are important differences in the actual pathogenesis of the disease and also in the response to therapy. But we think that working with male breast cancer can also help in understanding the pathogenesis of breast cancer in general and also in women because we work with a model that is a little bit more simple than the mechanisms that are involved in women.
The main conclusion from this study is first that I would like really to say that it is a very good experience and to try to make a big effort to pull together all cases of the data that we have because this is the only way to solve the problem, to overcome the problem of working with a rare disease first. And we have done this in Italy for the first time and I can say that is a very good experience and I’m really confident that we can have important results in this field. Indeed, we have observed right now all the preliminary results that we have a picture, as I told you, of what is breast cancer in men and we can say that although it’s rare, it’s a disease that has social aspects, very important. And although we can think that breast cancer in men is one disease, it’s not like that, it’s a heterogeneous disease and with this kind of molecular and pathological study and the association we are trying to do with the genetic basics, but also the epidemiological factor, we have identified specific sub-groups of male breast cancer. In particular, we have characterised male breast cancer linked to the BRCA2 gene and we have identified a specific sub-group of cancer that seems to have an aggressive behaviour. This is an important fact for the understanding of this cancer.
On the other hand, what I think is that also these kind of findings can help to understand what is BRCA2 associated breast cancer in women because, at the moment, we know very well which are tumours associated with the BRCA1 gene in women but it’s not so clear which are tumours associated with the BRCA2 in women. What we think is that maybe looking at men with breast cancer and picking up the BRCA2 associated tumours and look at them we can have a way to follow, also to identify this phenotype in women.