2013 San Antonio Breast Cancer Symposium (SABCS)
Male breast cancer: Opportunities for increased research funding and clinical trial access
Dr Oliver Bogler - MD Anderson Cancer Center, Houston, USA
I was diagnosed in September of 2012 and finished my active treatment in June of this year and have become very interested in advocacy for male breast cancer. About 1% of breast cancer patients are men, that varies a little bit between countries between about 0.7% and 1.2% as far as we know, in many countries we have no data. Most of the male breast cancers are ductile invasive carcinomas, they’re often ER/PR positive and the treatments that men receive are very much modelled on what women receive. My wife is actually also a breast cancer survivor, she preceded me by about five years and our treatment plans were essentially identical. So I had six months of neoadjuvant chemotherapy, surgery and then radiation and now I’m taking Tamoxifen.
As I became interested in this area I wondered about the fact that my treatment was identical to that of my wife; although my expectations are that it’s very effective, I can’t help wondering about the biological differences. Particularly in a hormone driven cancer I can’t help thinking that there must be some differences. So I was interested in finding out how much research was out there. I took a look at some databases of funded grants and, to my surprise, I found that there’s really very little primary mechanistic biology being done in male breast cancers. I was able to find only about $7.5 million of grants over ten years for male breast cancer, that’s less than a million dollars a year when the NCI alone spends $620 million a year on breast cancer. So it works out to be about $330 per newly diagnosed man and over $2,000 per newly diagnosed woman. I feel if we dedicated just 1% of the resources that go to breast cancer research to the male disease we would be able to fund five or so R01 grants and really learn something about the disease.
Clinical trials are the other area of research, the one that patients very often think most about so I took a look at the clinicaltrials.gov website and I found that men were only eligible for about one in three breast cancer clinical trials. Of course, there are many clinical trials where it doesn’t make sense to include men for maybe disease variance that we don’t get or surgical approaches that we don’t benefit from or something like that. But I did learn by talking to some of my colleagues that very often the reason men are excluded is just because they don’t think about it very much when they write a clinical trial; very often physicians use a template for a trial. So it’s not by design, really, it’s just that it doesn’t occur so I’m very interested in raising the awareness of that particular issue because very often men could benefit from those trials. I should say that I’m participating in a prevention recurrence trial at MD Anderson from Dr Mittendorf, it’s an immunotherapy trial so I clearly found a trial that’s very suitable for me and I’m delighted to be part of that trial. So there are trials out there but there could be more.
As an advocate what else would you like to see change?
I would be delighted to see if some of the very strong and effective advocacy organisations in the world of breast cancer who have done a fantastic job at raising awareness about the female disease and have done a fantastic job at getting resources for this cancer could consider including some of the neglected breast cancer types including male but also including triple negative and inflammatory and metastatic. In those areas too additional resources, particularly for research and clinical trials, could be tremendously beneficial.