Awareness is the key to conquering male breast cancer.

While it might sound obvious, breast cancer can also occur in males, and, while the rarity of the disease does not represent a social issue, as in females, it can be a private and personal drama for some patients and their families. Male breast cancer (MBC) is a rare disease in the western world, accounting for less than 1% of all breast cancers. The incidence of MBC in Northwest Europe and North America is approximately 1 per 100,000, but it is increasing. The disease is more common among Jewish men (2.3 per 100,000) and in countries with a high incidence of parasitic liver disease, such as Egypt and Zambia. The overall prognosis is equivalent to that in stagematched female patients, but men with breast cancer tend to not fare as well because of late presentation, which is associated with more advanced disease. The mean time interval between symptom onset to diagnosis has been reported to be 6–10 months and over 40% of male patients have stage III–IV disease at diagnosis. Also, because MBC tends to occur at an older age than in female patients, there is an increased incidence of comorbidities, which can adversely affect prognosis. Therefore, just like in female counterparts, early diagnosis is fundamental to improving the survival rate and minimizing treatments and their related morbidity. As it is not conceivable to set up a screening program in males, the only way to avoid a delayed diagnosis is awareness of the disease. In the paper published in this issue, a rare and atypical presentation with an axillary lump is described, highlighting that the key to curing male patients with breast cancer is early detection with prompt and appropriate treatment. Breast-conserving surgery is rarely performed in men but early diagnosis can minimize surgical treatment by allowing sentinel node biopsy, which is now a standard procedure for nodal staging, rather than complete axillary dissection, which can sometimes be burdened by unpleasant consequences. In our experience at the European Institute of Oncology on 75 males with breast cancer, 32 were considered suitable for sentinel lymph node biopsy since there was no clinical involvement of the axilla. Furthermore, only 6 of 32 had positive sentinel nodes suggesting an early diagnosis in a considerable proportion of patients. We would like to conclude by agreeing with the closing remark of the paper by Schneider and Sariego. The authors state that the concept of early detection “remains true for male patients and female alike. ” We would add that treatment recommendations should also be the same so that the therapeutic approach for the single person and the single disease is the same regardless of gender. In fact, despite the fact that breast cancer in men is more endocrine-responsive compared to female breast cancer, the biological behavior should be identical. Furthermore, male patients with breast cancer are not usually included in clinical trials enrolling women, and the few small studies performed in male patients with breast cancer are obviously underpowered. From our personal point of view, we would recommend that male patients with breast cancer be included in clinical trials along with women.