Gender disparity in breast cancer: A population-based study in the U.S. Department of Veterans Affairs.

Abstract

e12549 Background: Over the last several decades, the mortality for breast cancer has improved, however, there remains a large gender disparity with male patients having worse overall survival. Recent studies have identified increased mortality in male breast cancer (MBC) despite adjusting for age and other clinical factors necessitating a need to evaluate both screening and treatment patterns for MBC. The survival trends in MBC have not been studied across the VA population. Methods: Male and female breast cancer cases between 2000-2018 were identified in National VA Cancer Cube Registry. A total of 1511 cases of MBC and 8081 cases of female breast cancer (FBC) were identified. IRB approval was obtained. Statistical significance was set to 0.05, with significant results noted with an asterisk (*). Results: Our data showed that the number of new MBC cases per year remained stable over the study period while the FBC cases rose by 13.6* per year. The racial distribution of Caucasian and African American (AA) patients was comparable among the two groups. For FBC, the peak incidence was between ages 50-60, while for MBC, the peak incidence was at age greater than 70 years. Males were more likely to present at a later disease stage (stage III and IV) compared to females, (26.94% vs 13.8%) *. They also had a worse performance status (ECOG 3 or higher) at presentation compared to female patients, (3.72% vs 1.32%) *. The survival characteristics and first course of treatment received are summarized in the table below. Our findings show that males have a worse 5-year survival both in early and late-stage disease and across both Caucasian and AA races. This poor survival difference remains when comparing MBC patients older than 50 years but not when comparing the younger subset in both groups. These findings suggest that the overall poor survival of MBC may be related to late detection, advanced age at presentation and subsequent increased comorbidities and poor performance status. Conclusions: Patients with MBC present at a later disease stage and have a worse overall survival when compared to FBC. This difference in survival remained when stratified by age, race and stage at presentation. These results imply the possible underutilization of screening in males as well as differences in the clinical and pathological behavior of male and female breast cancer.[Table: see text]