Male Breast Cancer: Answer to Multiple Choice Question

The correct answer is A: Male breast cancer is associated with the BRCA-I gene mutation (though BRCA2 is far more common).

Detailed Analysis of Each Option

Male breast cancer is definitively associated with germline BRCA mutations, though the distribution differs significantly from female breast cancer:

BRCA2 mutations are found in 4-16% of men with breast cancer, making it the predominant genetic association 1, 2
BRCA1 mutations occur in 0-4% of male breast cancer cases, which is substantially less common than BRCA2 but still represents a real association 1, 2
The cumulative risk of breast cancer by age 70 years is 1.2% for BRCA1 carriers and 6.8% for BRCA2 carriers 1, 3
Collectively, over 20% of male breast cancer patients carry an identifiable inherited risk factor when including other genes like CHEK2, PALB2, and PTEN 1, 2
All men with breast cancer should be offered genetic counseling and testing due to this high prevalence 1

Male breast cancer can arise from multiple histological subtypes, not exclusively ductal:

Approximately 76.7% are invasive ductal carcinoma of no special type (IDC-NST) 4
3.3% are invasive lobular carcinomas 4
6.7% are invasive papillary carcinomas 4
13.3% show micropapillary differentiation 4
10% are ductal carcinoma in situ 5
The limited development of lobular elements in male breast tissue contributes to the rarity (but not absence) of lobular carcinoma 6

This statement is completely incorrect—the opposite is true:

Male breast cancer is predominantly hormone receptor-positive, with approximately 90% being estrogen receptor-positive 2, 6, 5
This high prevalence of hormone receptor positivity makes endocrine therapy highly effective 2, 6
Tamoxifen is the standard adjuvant therapy specifically because of this hormone receptor positivity 2, 6
Most tumors are of the luminal phenotype (89.7%), with infrequent HER2 (8.6%) and basal (1.7%) phenotypes 4

Male breast cancer actually develops at an older age than female breast cancer:

The average age of diagnosis for male breast cancer is 67 years 2, 6
This is approximately 5 years older than the average age for women (62 years) 2, 6
Occurrence peaks at age 71 years 5
Incidence rates rise steadily with age in men, similar to women, but with a later onset 2

The genetic association with BRCA mutations has important treatment implications:

Identification of inherited risk factors influences screening recommendations for other cancers 1
It enables testing of family members for inherited risk factors 1
It identifies treatment opportunities for metastatic disease, such as PARP inhibitors 1
Men with genetic predisposing mutations may be offered contralateral annual mammography 1