Gynecomastia: Is Pathologic Examination Justified?

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Most medical centers routinely perform or require that breast tissue be sent to pathology for histologic examination.  The authors of the article (referenced below) question whether this is useful when the breast tissue excised comes from an adolescent male with gynecomastia considering the benign nature of the condition.

Furthermore, the authors point out male breast cancer is rare and when it does occur it is most often in older males, not adolescent males.

In 2009, there were an estimated 1,910 new cases and 440 deaths related to male breast cancer, accounting for just 0.25% and 0.15% of all new cases of cancer and cancer deaths for males in the entire United States, respectively, with historical cohorts demonstrating that the peak incidence of male breast cancer occurs at approximately 71 years of age.  More significantly, breast cancer becomes increasingly uncommon among younger age groups.

To look at the issue, the authors did a retrospective chart review  of their patients younger than 21 years of age who had undergone subcutaneous mastectomy for gynecomastia between 1999 and 2010.  A review of the literature was done, as was an informal survey of major children's hospitals regarding their practice of histologic examination for adolescent gynecomastia.

The authors had  81 patients during the time period.  All cases were negative for malignancy, with only one case of cellular atypia.

The literature review found only 36 articles which discussed cases of adolescent gynecomastia and the associated pathologic results, resulting in data for 615 individuals.  Of these 615 individuals, there have been six cases of cancer and five cases of ADH.  The average age of patients involved was 17.4 years (range 16-20 years) and 43% of cases presented with unilateral gynecomastia. 

Of twenty-two survey respondents, all either routinely performed or required histologic examination of breast tissue excised for gynecomastia. The out-of-pocket costs for self-pay patients to perform pathologic exam has been quoted at $1,268 for bilateral cases.

The authors conclude:

The incidence of malignancy or abnormal pathology associated with gynecomastia tissue in the adolescent male is extremely low, and given the costs associated, the histologic examination of breast tissue excised for gynecomastia in individuals 21 years of age or younger should be neither routinely performed nor required, but should be performed only when desired by either the patient, patient's family, or managing physician.

REFERENCE

Breast Cancer Incidence in Adolescent Males Undergoing Subcutaneous Mastectomy for Gynecomastia: Is Pathologic Examination Justified? A Retrospective and Literature Review; Koshy, J. C.; Goldberg, J. S.; Wolfswinkel, E.; Ge, Y.; Heller, L.; Plastic & Reconstructive Surgery., POST ACCEPTANCE, 23 September 2010; doi: 10.1097/PRS.0b013e3181f9581c

Male Breast Cancer

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

October is Breast Cancer Awareness Month.  Most of the focus is on women.  There was a wonderful essay from a male breast cancer patient/survivor.  Here’s the beginning of the essay.  Unfortunately, you need a “subscription” for full access.

I talked with a man recently about my cancer. He had trouble finding words. He didn't know what to say and looked to the ground. The "breast" part of it all made him noticeably uncomfortable.

When I first felt pain, and later a lump, below my left nipple, it didn't sink in that I, a man, could actually have breast cancer. Years from now I may very well be able to count myself as a cancer survivor simply because the tumor in my breast caused pain. (Something very rare, in fact, for both men and women.) The pain, like a pin being driven into my nipple, drove me back to the doctor for a second, then a third time over a four-month period. My unwillingness to accept my physician's assurances that no further tests were warranted may have saved my life. As devastating as it was . . . [Full Text of this Article]

Mr. Wright laments the “pink” color attached to breast cancer:

Breast cancer: The pink disease; a woman's problem; a girlie, nonmasculine thing.

Most of the general public thinks of breast cancer as only a woman’s disease.  This misconception delays diagnosis for the too many.  Men need to be educated that they do in fact have breasts.  They can in fact get breast cancer.  There will be ~2000 men diagnosed with breast cancer this year in the United States. In the U.S., the ratio of female to male breast cancer is approximately 100:1 in whites, but lower (70:1) in blacks. 

The essay brought to my attention the John W. Nick Foundation.  Their website has some great information, resources, and personal stories.  I hope you will check it out and spread the word.

REFERENCES

Oh, to Live in an Age When Men Had Breasts . . .; JAMA. 2009;302(14):1511-1512; Scott W. Wright