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Abstract(s)
Introdução: O Cancro da Mama no Homem é uma doença rara que abrange cerca de 1% de todos os cancros da mama diagnosticados. A incidência, à semelhança da mulher, tem vindo a aumentar durante as últimas décadas. A idade média de diagnóstico é de 67 anos.
Objetivos: O objetivo desta monografia foi recolher as evidências científicas atuais relativamente ao cancro da mama no homem, abrangendo a epidemiologia, fatores de risco, patologia e perfil molecular, rastreio, diagnóstico, estadiamento, tratamento, prognóstico, seguimento e sequelas psicológicas.
Métodos: Foi realizada pesquisa bibliográfica na base de dados PubMED, de artigos exclusivamente em português e inglês.
Discussão: Os fatores de alto risco associados ao cancro da mama no homem são: idade avançada, mutação BRCA2, história familiar de cancro da mama, Síndrome de Klinefelter, balanço hormonal com altos níveis circulantes de estrogénio, anormalidades testiculares, toma de estrogénio, exposição a radiação ionizante. O subtipo histológico mais frequente é o carcinoma ductal invasivo não específico (86,6%). A grande maioria dos cancros apresenta-se com positividade para os recetores de estrogénio e progesterona. O subtipo molecular mais frequente é o luminal B HER-2 negativo (48,6%). O sintoma de apresentação inicial na maioria dos homens é a sensação de um nódulo ou massa indolor subareolar. A recomendação standart para o diagnóstico inclui o exame objetivo da mama seguido de um exame de imagem (mamografia e ultrassonografia) e biópsia, no caso de suspeita de cancro. A mastectomia radical tem sido o tratamento cirúrgico tradicional e a cirurgia conservadora da mama tem sido usada com menor frequência. A terapêutica endócrina adjuvante é provavelmente o componente mais importante e a recomendação standart para o cancro com recetor de estrogénio positivo é o tamoxifeno, com uma duração compreendida entre os 5 e 10 anos. Testes genómicos, como o Oncotype DX, um ensaio de 21 genes que produz um score de recorrência, e MammaPrint, são cada vez mais usados para determinar o prognóstico e a probabilidade de a quimioterapia ser benéfica, na mulher. É provável que também venham a ser utilizados para a determinação do prognóstico do cancro da mama no homem.
Conclusão: É evidente a necessidade crescente de compreender melhor o cancro da mama, particularmente na identificação das diferenças entre o homem e a mulher, e na deliberação das implicações terapêuticas que as mesmas podem acarretar. Sempre que possível, investigações e ensaios clínicos sobre o tratamento devem incluir os homens, de forma a construir evidência científica que suporte futuras recomendações de tratamento.
Introduction: Male breast cancer is a rare disease that covers about 1% of all breast cancers. The incidence, like women, has been increasing during the last decades. The mean age at diagnosis is 67 years. Objectives: The objective of this monograph was to collect current scientific evidence regarding epidemiology, risk factors, pathology and molecular profile, screening, diagnosis, staging, treatment, prognosis, follow-up and psychological sequels of male breast cancer. Methods: A bibliographic research was conducted in PubMED database of articles exclusively in Portuguese and English. Discussion: The high-risk factors associated with breast cancer in men are: old age, BRCA2 mutation, family history of breast cancer, Klinefelter syndrome, hormonal balance with high circulating levels of estrogen, testicular abnormalities, estrogen intake, radiation exposure ionizing agent. The most frequent histological subtype is non-specific invasive ductal carcinoma (86.6%). Most cancers are positive for estrogen and progesterone receptors. The most frequent molecular subtype is HER-2 luminal B (48.6%). The initial presenting symptom in most men is the sensation of a painless nodule or subareolar mass. The standard recommendation for diagnosis includes examination of the breast followed by imaging exam (mammography and ultrasound) and biopsy, in case of suspected cancer. Radical mastectomy has been the traditional surgical treatment and conservative breast surgery has been used less frequently. Adjuvant endocrine therapy is probably the most important component and the standard recommendation for cancer with estrogen receptor positive is tamoxifen, with a duration of between 5 and 10 years. Genomic tests, such as Oncotype DX, a 21-gene assay that produces a recurrence score, and MammaPrint, are increasingly being used to determine the prognosis and likelihood of chemotherapy being beneficial in women. It is likely that they will also be used to determine the prognosis of male breast cancer. Conclusion: There is a growing need for a better understanding of breast cancer, particularly in the identification of differences between men and women, and in the deliberation of the therapeutic implications they may entail. Whenever possible, investigations and clinical trials on treatment should include men to build scientific evidence that supports future treatment recommendations.
Introduction: Male breast cancer is a rare disease that covers about 1% of all breast cancers. The incidence, like women, has been increasing during the last decades. The mean age at diagnosis is 67 years. Objectives: The objective of this monograph was to collect current scientific evidence regarding epidemiology, risk factors, pathology and molecular profile, screening, diagnosis, staging, treatment, prognosis, follow-up and psychological sequels of male breast cancer. Methods: A bibliographic research was conducted in PubMED database of articles exclusively in Portuguese and English. Discussion: The high-risk factors associated with breast cancer in men are: old age, BRCA2 mutation, family history of breast cancer, Klinefelter syndrome, hormonal balance with high circulating levels of estrogen, testicular abnormalities, estrogen intake, radiation exposure ionizing agent. The most frequent histological subtype is non-specific invasive ductal carcinoma (86.6%). Most cancers are positive for estrogen and progesterone receptors. The most frequent molecular subtype is HER-2 luminal B (48.6%). The initial presenting symptom in most men is the sensation of a painless nodule or subareolar mass. The standard recommendation for diagnosis includes examination of the breast followed by imaging exam (mammography and ultrasound) and biopsy, in case of suspected cancer. Radical mastectomy has been the traditional surgical treatment and conservative breast surgery has been used less frequently. Adjuvant endocrine therapy is probably the most important component and the standard recommendation for cancer with estrogen receptor positive is tamoxifen, with a duration of between 5 and 10 years. Genomic tests, such as Oncotype DX, a 21-gene assay that produces a recurrence score, and MammaPrint, are increasingly being used to determine the prognosis and likelihood of chemotherapy being beneficial in women. It is likely that they will also be used to determine the prognosis of male breast cancer. Conclusion: There is a growing need for a better understanding of breast cancer, particularly in the identification of differences between men and women, and in the deliberation of the therapeutic implications they may entail. Whenever possible, investigations and clinical trials on treatment should include men to build scientific evidence that supports future treatment recommendations.
Description
Keywords
Cancro da Mama Masculino. Cancro da Mama No Homem Carcinoma da Mama Masculino