ABSTRACT: Male breast carcinoma in Israel: Higher incidence but
possibly better prognosis in Ashkenazi Jews
BACKGROUND: Little information is available regarding
male breast carcinoma. However, cumulative data have suggested
a propensity for the disease among Ashkenazi Jews.
Jews comprise one of the major ethnic groups in Israel, the authors
conducted a local study to shed more light on the features of
this rare disease.
CONCLUSIONS: Analyses of two independent data bases, patient charts, and
a cancer registry indicate that breast carcinoma seems to be more prevalent
among Ashkenazi Jewish men.
At the same time, affected Ashkenazi patients
may have a more favorable outcome than their Sephardic counterparts.
MORE from Artemis: Johns Hopkins online journal:
Male Breast Cancer in Ashkenazi and Sephardic Jews
Men of Ashkenazi origin are more likely to have male breast carcinoma (MBC) and seem to have a more favorable outcome compared to men of Sephardic origin.
Findings in a recent study published in the April 15, 2002, issue of Cancer indicate that the incidence of MBC is almost two times greater among Ashkenazi men compared to Sephardic men. However, Sephardic men with MBC had poorer 5-year survival rates and were diagnosed at an earlier age and with more advanced tumors than Ashkenazi men with MBC.
MBC is a rare disease, accounting for less than 1% of all male malignancies and for 1% of all incidents of breast carcinoma. Women of Ashkenazi origin have a high risk of breast carcinoma in part due to associated mutations in BRCA1 and BRCA2 genes.
Epidemiological studies have demonstrated that men of Ashkenazi origin also have a high incidence rate of MBC compared to the general population. A recent survey demonstrated that Ashkenazi men have a five-fold higher prevalence of MBC than Sephardic men. However, there is little epidemiological and clinical information characterizing MBC.
Brenner et al analyzed clinical and epidemiological characteristics of MBC between Ashkenazi and Sephardic men. In this retrospective study the investigators reviewed 131 cases of MBC diagnosed between 1960 and 2000 from the Rabin and the Rambam Medical Centers in Israel and 470 cases of MBC recorded in The Israel Cancer Registry from 1980 to 1997.
Data was collected on age at diagnosis, place of birth, ethnic origin, personal and family medical histories, duration of symptoms prior to diagnosis, stage of the disease, histologic grade, hormone receptor status, and date and cause of death. Data was analyzed for various variables, including ethnic origin, tumor stage and grade, age at diagnosis, and survival rates.
Data demonstrated that men of Sephardic origin with MBC tended to be younger and have more advanced tumor size at the time of diagnosis than men of Ashkenazi origin. The mean age at diagnosis was 64 years in Sephardic men and 68 years in Ashkenazi men; 24% of tumors in Sephardic men were of more advanced size-greater than 5-cm in dimension or direct extension into the chest wall or skin (T3 or T4 tumors, respectively)-compared to only 13% of Ashkenazi men.
While Sephardic origin was associated with poorer survival rates and disease-free survival rates, differences between the ethnic groups did not reach statistical significance. However, on multivariate analysis of disease-specific survival curves, Sephardic origin was associated with a risk ratio of 4.3, indicating a statistically significant worse outcome for Sephardic men than Ashkenazi men with MBC.
Ashkenazi Jewish men were at 80% greater risk of developing MBC than Sephardic Jewish men. The average age-standardized rate (ASR) for patients with MBC was 1.3 per 100,000 people for Ashkenazi Jews and 0.76 per 100,000 people for Sephardic Jews. Moreover, the difference in ASR was relatively constant during the study period.
"The current study clearly demonstrated a higher incidence of MBC among Ashkenazi Jews compared with Sephardic Jews," the authors concluded. "Affected Ashkenazi patients may have a more favorable outcome than patients with MBC who are of Sephardic origin," an observation that may be attributed to "a trend toward more advanced tumors, a major predictor of poorer outcome, among the Sephardic patients."
Cancer, April 15, 2002; 94(8):2128-2133
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