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Stage 1 Early Stage Male Breast Cancer

Stage 1b Breast Cancer

Early Stage Breast Cancer An Introduction

Stage 1b breast cancer can signify one of two possibilities:

  • There is no tumor in the breast. Instead, groups of cancer cells between 0.2 millimeter and 2 millimeters are found in the lymph nodes.
  • There is a tumor in the breast smaller than 2 centimeters. There are also groups of cancer cells between 0.2 millimeters and 2 millimeters found in the lymph nodes.

Causes Of Breast Cancer In Men

The exact cause of breast cancer in men is not known, but there are some things that increase your risk of getting it.

These include:

  • genes and family history inheriting faulty versions of genes called BRCA1 or BRCA2 increases your risk of breast cancer
  • conditions that can increase the level of oestrogen in the body including obesity, Klinefelter syndrome and scarring of the liver
  • previous radiotherapy to the chest area

It’s not certain that you can do anything to reduce your risk, but eating a balanced diet, losing weight if you’re overweight and not drinking too much alcohol may help.

Page last reviewed: 18 March 2020 Next review due: 18 March 2023

Survival Rates And Prognosis

The outlook for breast cancer is often described in terms of relative survival rates.

Relative survival rates are an estimate of the percentage of people who will survive their cancer for a given period of time after diagnosis. Survival among people with cancer is compared to survival among people of the same age and race who have not been diagnosed with cancer.

Five-year relative survival rates tend to be lower for triple-negative breast cancer than for other forms of breast cancer.

According to the American Cancer Society, the overall 5-year relative survival rate for TNBC is 77 percent. However, an individuals outlook depends on many factors, including the stage of the cancer and the grade of the tumor.

Your healthcare professional will be able to give you a more precise outlook based on:

  • the stage of your TNBC

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N Categories For Breast Cancer

N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.

Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has improved. Newer methods have made it possible to find smaller and smaller collections of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells affect outlook.

Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.

If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to affect outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.

NX: Nearby lymph nodes cannot be assessed .

N0: Cancer has not spread to nearby lymph nodes.

N1c: Both N1a and N1b apply.

N3: Any of the following:

N3a: either:

N3b: either:

Treatment For Stage 3 Breast Cancer

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Treatment for people with stage 3 breast cancer includes chemotherapy, surgery, and radiation. Typically, doctors administer the chemotherapy before performing the surgery in an attempt to shrink a tumor.

People with stage 3 breast cancer will probably need radiation therapy to kill off any remaining cancer cells. Doctors may also recommend hormone therapy, as well as additional targeted therapies, if necessary.

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Certain Factors Affect Prognosis And Treatment Options

The prognosis and treatment options depend on the following:

  • The stage of the cancer .
  • The type of breast cancer.
  • Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
  • Whether the cancer is also found in the other breast.
  • The mans age and general health.
  • Whether the cancer has just been diagnosed or has recurred .

How Is Stage 1a Breast Cancer Treated

Patients with stage 1 breast cancer typically undergo surgery upfront, Mouabbi said, which may be a breast-conserving surgery or a mastectomy.

Surgery essentially “puts the patient in a cancer-free state because the cancer is removed already,” Mouabbi said. “So I tell my patients, everything that comes after that step is prevention making sure the cancer does not come back.”

But the exact treatments involved depend on a few factors. For instance, if a patient opted for a lumpectomy, they will likely receive radiation after surgery, Zeidman said. And if the patient’s cancer did spread to nearby lymph nodes they may receive radiation to “the regional lymph nodes around the breast,” Mouabbi explained.

And, in a subset of patients with specific types of breast cancer, chemotherapy may be recommended, Mouabbi said.

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Treatment Of Breast Cancer In Men By Stage

This information is based on AJCC Staging systems prior to 2018 which were primarily based on tumor size and lymph node status. Since the updated staging system for breast cancer now also includes the ER, PR and HER2 status, the stages may be higher or lower than previous staging systems. Whether or not treatment strategies will change with this new staging system are yet to be determined. You should discuss your stage and treatment options with your physician.

Because there have been few clinical trials on treatment of male breast cancer, most doctors base their treatment recommendations on their experience with the disease and on the results of studies of breast cancer in women. With some minor variations, breast cancer in men is treated the same way as breast cancer in women.

The stage of your breast cancer is an important factor in making decisions about your treatment options. In general, the more the breast cancer has spread, the more treatment you will likely need. But other factors can also be important, such as:

  • If the cancer cells contain hormone receptors
  • If the cancer cells have large amounts of the HER2 protein
  • Your overall health and personal preferences
  • How fast the cancer is growing

Talk with your doctor about how these factors can affect your treatment options.

Why Is Staging Important

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During your initial diagnosis, you and your cancer team will work together to develop a treatment plan. Staging allows you to answer the following questions:

  • How does this cancer typically progress?
  • Which treatments may work?

Some of the staging may be even more in-depth, but in general, its designed to prepare a more tailored approach to your disease. Your care team will be able to explain any new terms and what they mean for you.

Expert cancer care

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Stage 1 Breast Cancer: Treatment And Prognosis

Breast cancer is classified into different stages ranging from 0 to 4. Staging is based on the tumors size and whether tumor cells have spread to other parts of the body. Determining your cancers stage can help your doctor determine your prognosis and the best treatment options.

The TNM staging system which stands for tumor, node, and metastasis is generally used for breast cancer staging. The system stages tumors based on:

  • Tumor How large is the primary tumor?
  • Node Are there cancer cells in lymph nodes?
  • Metastasis Has the cancer metastasized, or spread, to other parts of the body?

Each letter is assigned a number, often with a letter following it. A lower number corresponds to early stage breast cancer, and a higher number indicates more advanced breast cancer.

Other information is also used to better understand the stage of the cancer. This can include:

  • Hormone receptor status Whether the cancer contains estrogen receptors or progesterone receptors, proteins that respond to hormones in the body
  • Tumor grade A measure of how abnormal the cancer cells look compared to normal cells
  • HER2 status Whether the cancer has high levels of a protein called HER2
  • Oncotype DX score Results of a genetic test used to predict if a cancer might progress to a more serious form of cancer

Following breast cancer diagnosis, a doctor will determine the most effective treatment based on the cancers stage.

Surgical Treatment Approach And Axillary Lymph Node Dissection

Up until the 1970s, the main surgical method was radical mastectomy as in women. Considering the lesion size, this approach was replaced by less invasive procedures such as modified radical mastectomy over time . Currently, modified radical mastectomy and axillary lymph dissection or sentinel lymph node biopsy is recommended if the tumor is not fixed to the pectoral muscle . Actually, American Society of Clinical Oncology guidelines state that SLNB is appropriate for men . Radical mastectomy is performed if there is extensive involvement of the chest wall and Rotter ganglions . Breast-conserving surgery may be performed in elderly patients, with a serious concomitant disease, who has gynecomasty along with a small tumor since the male breast is small and most tumors have a subareolar location, but this procedure is rarely preferred . Adjuvant RT is also added to the treatment of such patients. Surgeries that are more radical do not contribute to survival. In cases with high tumor burden, preoperative CT may be useful. Patients with a metastatic disease or a poor overall condition may receive a combined treatment with simple mastectomy or local tumor excision with postoperative RT .

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Men With Breast Cancer Usually Have Lumps That Can Be Felt

Lumps and other signs may be caused by male breast cancer or by other conditions. Check with your doctor if you have any of the following:

  • A lump or thickening in or near the breast or in the underarm area.
  • A change in the size or shape of the breast.
  • A dimple or puckering in the skin of the breast.
  • A nipple turned inward into the breast.
  • Fluid from the nipple, especially if it’s bloody.
  • Scaly, red, or swollen skin on the breast, nipple, or areola .
  • Dimples in the breast that look like the skin of an orange, called peau dorange.

How Breast Cancer Cells Are Graded

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  • G1. Cells are well differentiated this is considered low grade.
  • G2. Cells are moderately differentiated this is considered intermediate grade.
  • G3. Cells are poorly differentiated this is considered high grade.

Your healthcare team will also test the cancer cells for receptors that are located on the outside of the cells. Knowing which receptors are present can help determine what type of treatment is likely to be more effective.

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Enhancing Healthcare Team Outcomes

Male breast cancer is rare, and often the diagnosis is delayed, leading to very high mortality. To improve outcomes, an interprofessional team approach that consists of an oncologist, surgeon, radiation therapist, dietitian, and mental health counselor is recommended. The majority of these patients initially present to their primary care provider or nurse practitioner. Unlike females, there may not be any risk factors, and hence any mass should be worked up, and a malignancy ruled out. The primary care providers should never assume that breast growth is simply benign gynecomastia. Men who are more than 50 years of age should be worked up to rule out breast cancer if there is a lesion.

Once diagnosed, the pharmacist should educate the patient on chemotherapeutic drugs, and the oncology nurse and clinician should discuss radiation therapy and its benefits.

An aspect of male breast cancer that is frequently overlooked is the negative stigmas that these patients routinely face, which leads them to feel quite isolated and vulnerable. Psychosocial support through various interprofessional teams should be offered to allow for a more normalization of their condition and experience as well as to create an atmosphere of nonjudgmental dialogue to address their concerns and potential stigmas.

Outcomes

Stage for stage the prognosis for male breast cancer is the same as in females.

What Causes Male Breast Cancer

Anyone can get breast cancer. Overall health, family history and genetic factors increase the risk of developing the disease. Risk factors of male breast cancer include:

  • Age: Men over 60 are more likely to develop breast cancer.
  • Overall health: Men with obesity may have gynecomastia . Gynecomastia increases the risk of developing breast cancer.
  • Estrogen levels: Certain drugs that contain estrogen cause estrogen levels to rise. Cirrhosis can also increase estrogen levels. A genetic disorder called Klinefelter syndrome increases the risk of several health issues, including breast cancer.
  • Family history: Men who have a first-degree relative with breast cancer have a higher chance of the disease.
  • Genes: Genetic mutations increase the risk of developing breast cancer. These include changes in the BRCA gene . Mutations in these genes also increase the risk of pancreatic cancer and prostate cancer.
  • Radiation therapy: Men who had radiation therapy in the chest or torso have a higher risk of developing breast cancer.
  • Testicular issues: People who have had surgery to remove their testicles have a higher risk of breast cancer. Testicle injuries also increase the risk.

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When To Talk With A Doctor

A person should talk with their doctor if they develop any unusual symptoms in or around their breasts. Though it is possible the symptoms are related to another condition, a doctor can help rule out other causes and determine what may be causing the issue.

People assigned female at birth should also follow recommendations for screenings. The recommends the following for screenings:

  • 40 to 44: High-risk people in this age group should get screened.
  • 45 to 54: Yearly screening.
  • Over 55: Screening every 2 years.

Should Men At Higher Risk For Breast Cancer Get Screening Mammograms

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Breast cancer is rare in men and according to the National Cancer Institute, screening is unlikely to be beneficial. Men who are higher risk for breast cancer, such as those who have BRCA mutations or a family history of breast and/or ovarian cancer should talk to their doctor about screening mammograms.

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Symptoms Of Breast Cancer In Men

The most common symptom for men with breast cancer include:

  • lump in the breast that is nearly always painless
  • oozing from the nipple that may be blood stained
  • a nipple that is pulled into the breast
  • swelling of the breast
  • a sore in the skin of the breast
  • lump or swelling under the arm
  • a rash on or around the nipple

If you have any of these symptoms it is important to go to your GP straight away. Finding a cancer early gives the best chance of successful treatment.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you or a loved one been diagnosed with stage 1 breast cancer? Share your experiences in the comments below, or start a conversation by posting on MyBCTeam.

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Biomarkers And Disease Biology

HR-positive, HER2-negative breast cancer

The addition of CDK4/6 inhibitors to endocrine therapy has also been explored in the neoadjuvant setting for patients with HR-positive, HER2-negative early-stage breast cancer. These trials revealed a low pCR rate but also demonstrated that CDK4/6 inhibitors induced more profound reductions in Ki67 levels from baseline to 2 weeks and to surgery,,,,,.

The search for gene expression signatures that might enable patients receiving endocrine therapy to safely avoid chemotherapy has been another area of intense research interest. Owing to the more widespread use of screening, which has modified the epidemiology of breast cancers, the question of de-escalation has become crucial. The risk of disease relapse can now be characterized by transcriptomic signatures, two of which have proven clinical utility in the selection of patients who will have excellent outcomes on adjuvant endocrine therapy alone,,.

The intrinsic tumour subtype is also being investigated as a potential predictive biomarker. In a retrospective, exploratory analysis of data from patients with luminal metastatic breast cancer from the MONALEESA phase III studies, all PAM50 intrinsic subtypes were associated with a consistent OS benefit with the addition of ribociclib to endocrine therapy, except for the basal-like subtype. Similar data from patients with early-stage disease are not yet available.

HER2-positive breast cancer

Triple-negative breast cancer

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This means women with the most common type of breast cancer, called estrogen-positive or hormone-positive breast cancer, need to think carefully about whether they want to stop taking the pills, even if they cause side-effects, doctors said.

These breast cancers have a lingering smoldering quality and carry substantial risk of late recurrence after five years of therapy, said Dr. Harold Burstein of the Dana Farber Cancer Institute, who was not involved in the study.

Many patients think. OK, I made it to five years. I know Im safe, said Dr. Jennifer Litton, an oncologist at the MD Anderson Cancer Center. But for estrogen-receptor positive breast cancer, its a continued lifelong risk.

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Breast cancer is the second-biggest cancer killer of American women, after lung cancer. The American Cancer Society says every year, itâs diagnosed in 200,000 women and a few men, and kills around 40,000.

Most breast cancers are fueled by estrogen, and drugs called hormone blockers are known to cut the risk of recurrence in such cases.

Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors sold as Arimidex, Femara, Aromasin and in generic form do the job with less risk of causing uterine cancer and other problems. The longer women take them, the lower their risk of having the cancer come back.

However, they do cause side-effects.

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