It is estimated that 1% of breast cancer occurs in men: the American Cancer Society estimates 2,240 male breast cancer cases vs 234,580 female cases in 2013. However, the male disease remains understudied and access to clinical trials for men is lags behind, as will be shown by analysis of grants, papers and trials.
Examination of grants in the SciVal Funding database found about $7.5M over 10 years of funded projects that even consider male breast cancer. They mostly include male breast cancer alongside other diseases. This works out at an average of $750,000 a year, well below 1% of the $620M annually committed by NCI to breast cancer overall. It works out to be less than $330 per newly diagnosed man vs $2,600 per newly diagnosed woman. Funding male breast cancer research at 1% would commit $6.2M a year, or sufficient to support 15 RO1 grants, providing significant opportunity for discovery.
While nothing forces a strict proportionality between incidence and funding, an analysis of National Cancer Institute (NCI) research dollars vs estimated cases (American Cancer Society) shows that there is a positive trend amenable to linear regression. In this analysis, breast cancer receives about $200M more than would be expected simply on the basis of its incidence. This is due in part to strong community advocacy. Even if male breast cancer were funded more in line with the other cancers which are closer to the trend line, a case can be made for $4M a year or 10 RO1 grants.
Another way of looking at this question is to examine research publications. PubMed returned 2,047 hits for the MeSH term ‘male breast cancer’ as compared to 201,952 for the MeSH term ‘breast cancer’ (5/7/13), or about 1%, in proportion with the incidence. However, the male breast cancer literature shows a much greater proportion of case reports and a focus on genetic predisposition and familial cancer syndromes. This is in contradistinction to the field at large which is rich in experimental biology, model systems and –omics analyses, many of them grant supported.
Lastly I examine clinical trials. An analysis of enrollment eligibility of 4,826 trials found at ClinicalTrials.gov (5/14/13) showed that about 1/3rd recruit both men and women. This suggests that there are opportunities for improvement of access. Of course, some trials are not relevant to men, but this is unlikely to be true for 2/3rds. Encouragingly a look at 42 interventional breast cancer trials that had reported results and for which men were eligible, showed that accrual of men across was 0.8%, close to the relative incidence of the male disease.
In summary, a case will be made that by including research on male breast cancer alongside the female disease, and providing direct targeted funds has the opportunity to fill in important gaps in knowledge. Furthermore, raising awareness and improving trial eligibility has the important potential to improve the outcome for men with breast cancer.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-10-03.