Male Breast Cancer: An Unfolding Challenge in Recurrence and Treatment Gaps
Authors: Dr Purnopama Puja, Prof. Dr. Ashim Kumar Ghosh
Institution: Rajshahi Medical College Hospital
Introduction
Male breast cancer is a rare malignancy, accounting for less than 1% of all breast cancer cases. Due to its rarity, clinical management is often extrapolated from female breast cancer treatment protocols. However, male breast cancer can exhibit an aggressive course, with a high risk of recurrence and distant metastases. Limited access to treatment and financial constraints further complicate patient outcomes, particularly in resource-limited settings. This case report highlights the prolonged, recurrent, and metastatic course of male breast cancer in a 45-year-old patient, emphasizing the challenges of treatment discontinuation, the role of multimodal therapy, and the impact of financial limitations on long-term survival.
Methods
Case presentation: A 45-year-old male presented with a right breast lump 15 years ago and was diagnosed with Invasive Ductal Carcinoma. After the diagnosis, he underwent a modified radical mastectomy, followed by six cycles of adjuvant chemotherapy with 5-fluorouracil (5FU), Adriamycin, and Cyclophosphamide. Hormonal therapy was initiated and continued for 5years but due to financial constraints, the patient did not receive the recommended radiotherapy and discontinued follow-up. Seven years later, he developed a recurrent right axillary lump, which was confirmed as metastatic recurrence. He was started on second-line chemotherapy with six cycles of Docetaxel and Carboplatin. However, he discontinued treatment and follow up again after completing chemotherapy due to financial issues. One year later, he presented with another recurrence in the same breast(right side). This time, he received third-line chemotherapy with Cyclophosphamide, Methotrexate, and 5FU, followed by external beam radiotherapy (EBRT) of 30Gy in 15 fractions. Three years after the last recurrence, he developed bilateral lung metastases. Fourth-line chemotherapy with six cycles of Docetaxel and Cyclophosphamide was administered. Following completion of this therapy, when he was on follow up, he developed bone metastases, prompting a fifth-line chemotherapy with six cycles of Gemcitabine and Carboplatin, alongside eight cycles of Zoledronic acid for bone metastasis management. The patient remained on regular follow-up, receiving palliative care interventions for bone pain and respiratory distress. Despite continued medical support, he eventually developed acute respiratory distress. He declined further treatment at this stage and succumbed to the disease shortly thereafter.
Results
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Conclusion
Conclusion: This case illustrates the aggressive nature of recurrent male breast cancer and the impact of treatment discontinuation on long-term outcomes. The lack of financial resources resulted in gaps in treatment, which may have contributed to multiple recurrences and metastatic progression. The case emphasizes the need for structured financial support systems for cancer patients to ensure adherence to complete treatment protocols. Additionally, it highlights the importance of multimodal therapy, including surgery, chemotherapy, radiotherapy, and palliative interventions, in improving patient survival and quality of life. Further research is needed to optimize management strategies for male breast cancer, particularly in low-resource settings where financial constraints pose a significant challenge. keywords: Male breast cancer, recurrent breast cancer, metastatic breast cancer, chemotherapy.
