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Breast Cancer Res Treat. 2019 May;175(1):1-4. doi: 10.1007/s10549-018-05117-4. Epub 2019 Jan 21.

Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk?

Author information

1
Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA. scoopey@mgh.harvard.edu.
2
, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA. scoopey@mgh.harvard.edu.
3
Department of General Surgery, Koc University Hospital, Istanbul, Turkey.
4
Department of Electrical Engineering and Computer Science, CSAIL, MIT, Cambridge, MA, USA.
5
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA.
6
Department of Surgery, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
7
Department of Hematology-Oncology, Pontificia Universidad Catolica de Chile, Santiago, Chile.
8
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
9
Department of Pathology, Newton-Wellesley Hospital, Newton, MA, USA.
10
Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.

Abstract

PURPOSE:

Atypical ductal hyperplasia (ADH) significantly increases the risk of breast cancer in women. However, little is known about the implications of ADH in men.

METHODS:

Review of 932 males with breast pathology was performed to identify cases of ADH. Patients were excluded if ADH was upgraded to cancer on excision, or if they had contralateral breast cancer. Cases were reviewed to determine whether any male with ADH developed breast cancer.

RESULTS:

Nineteen males were diagnosed with ADH from June 2003 to September 2018. All had gynecomastia. Surgical procedure was mastectomy in 8 patients and excision/reduction in 11. One patient had their nipple areola complex removed, and 1 required a free nipple graft. Median patient age at ADH diagnosis was 25 years (range 18-72 years). Of the 14 patients with bilateral gynecomastia, 10 had bilateral ADH and 4 had unilateral. Five cases of ADH were described as severe, bordering on ductal carcinoma in situ. No patient reported a family history of breast cancer. No patient took tamoxifen. At a mean follow-up of 75 months (range 4-185 months), no patient developed breast cancer.

CONCLUSION:

Our study is the first to provide follow-up information for males with ADH. With 6 years of mean follow-up, no male in our series has developed breast cancer. This suggests that either ADH in men does not pose the same risk as ADH in women or that surgical excision of symptomatic gynecomastia in men effectively reduces the risk of breast cancer.

KEYWORDS:

Atypical ductal hyperplasia; Breast cancer; Gynecomastia; Male; Risk

PMID:
30666539
DOI:
10.1007/s10549-018-05117-4

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