Table 1 Data extraction on the experiences and management approaches of MBC from included studies

1. Adekolujo et al. 2017 [39]

USA

Aimed to establish the impact of MS on tumour stage at the time of diagnosis and survival in male breast cancer

Quantitative

Men with breast cancer who are with 18 years and above, diagnosed from 1990 to 2011 and with confirmed histological invasive breast cancer

N/A

N/A

Not reported

Future study on male breast cancer should verify the outcomes of this study and comprehensively test the psychosocial program of support, which is tailored to the needs of unmarried males with breast cancer in addition to the implementation

High (95)

2. Ahmed et al. 2012 [40]

Nigeria

Aimed to report the clinical and pathological characteristics and treatment in addition to outcomes of male breast cancer observed over a decade from 2001 to 2010

Quantitative

57 male breast cancer patients diagnosed between January 2001 and December 2010. The mean age was 59 with 31(54.4%) and 26(45.6%) being affected in their left and right breasts respectively. Symptoms lasted mediumly for 11 months with 28(49.1%) patients mainly presenting to the institution while 12 patients were managed by traditional healers from 7 to 36 months. 45(79%) commonly presented with breast lump, 25(43.9%) with breast ulceration and (8.8%) with nipple discharge

N/A

N/A

Surgery,

Radiotherapy

Chemotherapy

Hormonal therapy

Educating male breast cancer patients and their healthcare providers is crucial to increasing awareness of male breast cancer and ensuring patients present early for timely referral, diagnosis and treatment. Multidisciplinary treatment approach should be adopted still following female breast cancer recognized pattern

Moderate (55)

3. Avila et al. 2023 [41]

USA, UK, Spain, Australia, Canada, Italy, South Africa, Switzerland, and Netherlands

To evaluate the presence of cancer-related symptoms and treatment side effects from the perspective of MBC patients

Quantitative

127 participants completed the survey with age ranging from 33 to 88 years (median 64). Age at diagnosis ranged from 29 to 74 years (median 55) and time since diagnosis n = 40 was diagnosed 1—5 years prior to their entry in the study; n = 50 in the previous 6 to 10 years, and n = 33 were more than 10 years. Participants were at different stages of the disease and from 9 different countries: USA, UK, Spain, Australia, Canada, Italy, South Africa, Switzerland, and Netherlands

N = 91 MBC patients reported experiencing late effects of their cancer or treatment including n = 71 experiencing physical symptoms (mostly fatigue); n = 51 had psychological effects (mostly fear of recurrence); n = 63 had hot flashes relating to their treatment; n = 69 felt less masculine as a result of their illness or treatment; n = 100 reported an impacted on their interest in sex; n = 75 were bothered about hair loss related to treatment; n = 70 had pain in the scar area lasting longer than usual surgery recovery; n = 42 had some degree of swollen arm or hand; n = 66 had some difficulty with their arm or shoulder movement as a result of their surgery; and n = 20 (15.7%) did not feel their medical team had experience in treating MBC

N/A

Mastectomy; systemic chemotherapy and endocrine therapy

Our study provides critical information on several side effects and late effects that are experienced by male patients with breast cancer. Further research is necessary to mitigate the impact of these effects and improve quality of life in men

High (79)

4. Bootsma et al. 2020 [42]

Netherlands

Aimed to evaluate the unmet information needs of healthcare providers and male breast cancer patients

Mixed methods

12 focus groups with male breast cancer patients and 2 partners. Of 107 (72%) male breast cancer patients, 77 questionnaires were completed

65% and 56% of male breast cancer patients lacked information about acute or late side effects respectively, especially sexual side effects

Delay of diagnosis and symptoms

“After I discovered a lump, I went [to the GP] right away. First, I ended up with a replacement (for my GP) and he said it [breast cancer] wasn't possible”

Follow-up and treatment options

“Didn't you use Adjuvant online?” “For me, for instance, chemo still provided 4% better chances. I deliberately chose, precisely because of neuropathy, not to opt for chemo. I thought of the gain. Chemo can also go so wrong that you cannot even do your grocery shopping as a 45-year-old man. That's a choice, and it was made jointly”. Coping and psychological impact

“[The diagnosis] hit me hard, emotionally”. “It hits you hard. More surgery. You just have to wait and see if [cancer] comes back”. “It's not that I go around and tell people I was in the hospital, oh, what for? What I mean is, a lot of people do not know about my surgery at all”

Not reported

Male breast cancer specific information tool in the form of a targeted website is required to improve timely diagnosis, treatment, quality of life and survival

High (95)

5. Brain et al. 2006 [43]

UK

Aimed to assess psychological

distress prevalence in male breast cancer including factors that influence increased distress

Quantitative

161 male breast cancer patients with an average age of 67yrs. Majority of the participants were married or living with a partner, had at least a secondary level education with 2.9yrs mean time since diagnosis and 35% reported having a family history of breast cancer

N/A

N/A

a) Depressive symptoms and anxiety,

b) Cancer-specific distress,

c) Body image,

d) Doping,

e) Support and information needs, including

f) demographic and clinical variables

About 1/4 of male breast cancer patients experienced symptoms of traumatic stress specific to breast cancer with low prevalence of depressive symptoms and clinical anxiety. Factors influencing distress included negative body image, fear and uncertainty regarding breast cancer

Moderate (61)

6. Chichura et al. 2022 [44]

USA

To assess MBC patients’ opinions and perspectives about the surgical approach for their breast cancer and to compare their experiences with surgeon recommendations for MBC

Quantitative

63 MBC patients and n = 438 surgeons were surveyed online. The mean age of patients was 62 ± 11 years (range 31–79 years), and the majority reported their race/ethnicity to be non-Hispanic white (n = 55). Most patients (n = 52) had been treated in the United States, with representation from the Northeast (n = 10), the Midwest (n = 9), the South (n = 19), and the West (n = 11). Of the 438 surgeons survey, n = 298 were female, n = 215 were fellowship-trained, and n = 244 had been practicing for 16 years or longer

N/A

N/A

Types of surgeries offered: Majority of surgeons routinely offered breast cancer support to eligible men, while others routinely offer reconstruction, and some offered reconstruction only if the patient requests it

The study found discordance between MBC patients’ satisfaction with their surgery and surgeon recommendations and experience. These data present an opportunity to optimize the MBC patient experience. We also advocate for the inclusion of men in clinical trials, the creation of trials specific for MBC, and the enrolment of patients in a prospective international registry similar to the International Programme of Breast Cancer in Men, a global effort aiming to characterize MBC biology and develop clinical trials

High (72)

7. Co et al. 2020 [7]

Hong Kong

To investigate the reasons for late diagnosis of male breast cancer

Quantitative

56 men with breast cancer, with a median onset age of 61 ranging from 33 to 95yrs, a positive family history of breast cancer and managed from January 1998 till December 2018

31 male breast cancer patients were interviewed via telephone of which 18 and 11 patients reported experiencing “very” to “extremely” severe and mild to moderate embarrassment at symptom onset respectively: only 2 having no experience of embarrassment. In addition to experiencing "extreme" or "very" severe embarrassment, 19 patients also reported prolonged clinic waiting times, they again disclosed and discussed with their spouses when they first discovered the symptoms of breast cancer with 3 and 1 patient discussing with friends and sibling respectively. Finally, 8 patients reported never talking to anyone before medical consultation

N/A

Palliative treatment- 6

Mastectomy with axillary dissection- 36

Mastectomy with sentinel node biopsy- 14

As male breast cancer is rare patients mostly delay in seeking medical attention due to lack of knowledge, public education and embarrassment hence there is the need for improved psychosocial support for patients

Low (45)

8. Crew et al. 2007 [45]

USA

Aimed to assess race and factors predicting treatment

and survival of men with stage 1 to 3 breast cancer

Quantitative

510 male breast cancer patients made up of 356 whites and 34 blacks. Of these, 94% of patients had mastectomy with 28% and 29% receiving chemotherapy, and radiation therapy

N/A

N/A

Mastectomy, lumpectomy, chemotherapy, and radiotherapy

An association has been found between the black race and increased in male breast cancer specific mortality after adjusting for known clinical, demographic, and treatment factors. Future study should examine these disparities

Moderate (62)

9. Cronin et al. 2018 [46]

USA

To understand the relationship between age and male breast cancer regarding how it presents, managed, clinical outcomes in addition to other factors such as clinical, pathological as well as patient-related factors

Quantitative

152 males with breast cancer; median age reported as 64 years (range, 19–96 years)

N/A

N/A

Surgical intervention and chemotherapy with chemotherapy receipt more likely among men up to age 65 years

Men aged up to 65 years received more chemotherapy with improvements in overall survival but no breast cancer specific survival, compared with men older than 65 years

Moderate (67)

10. Donovan & Flynn 2007 [31]

UK

To elicit the lived experience of MBC patients regarding their psychosocial and psychosexual challenges

Qualitative

15 participants; 5 from UK and 10 overseas

Four major emerging themes were described:

a. MBC constituting a distinctive experience with the thought of living with an illness associated with women causing distress and stigma among men

b. Also, there was an overwhelming change in the notion of their embodiment, constituting a substantial change to their body image and sexuality, reinforcing the experience of erectile dysfunction among men with tamoxifen therapy

c. Unfortunately, some care providers could not provide psychosocial support resulting in marginalization regarding the possible effects of the environment of treatment

d. Nevertheless, there were some men who adjusted through reassert and

renegotiation of masculinity as they found opportunities of accommodating life with the stigma

and the alteration in their body image

Making Sense of Male Breast Cancer: “(Doctor) said to me it was Estrogen amenable. I

assumed it was caused by an excess of estrogen in me which is a female hormone. (Doctor) told me that it is a female gene that I’ve got in me”

The Context of Masculinity: “This has killed my sex life; I can no longer get an erection. I’m on this Tamoxifen which I’ve got to take for 5 years

You know it’s driving me mad. I got free Viagra but there is nothing there. There’s no

feelings or anything like that and it’s terrible. I don’t know what it was, I just felt (silence) I just felt so embarrassed.”

The Stigma of Male Breast Cancer: “I want to prove to everybody that male breast cancer is not a women’s disease and that a normal man can have it”

Not reported

The experiences of male breast cancer depict a

contestation of masculinity and the legitimacy of owning the disease. Nonetheless, men

adopt and adapt characteristics of masculinity such as patience, self-determination, and courage to overcome these challenges. Care providers have the chance of offering possible endorsement of renewing the masculinity of men with breast cancer instead of upholding possible emasculation

High (86)

11. Duarte et al. 2017 [47]

Brazil

Aimed at knowing the context being

sick and surviving breast cancer among men

Qualitative

Two men (66 & 74yrs) who survived breast cancer. A 74-year-old was widowed, childless, retired, Catholic, did not complete elementary school and was diagnosed in 2007. A 66-year-old, married with three children, retired, a farmer, protestant, did not complete elementary school and was diagnosed in 2007

After the diagnosis of cancer, men managed to lead a normal life with limitations and changes in daily life, including suspension of work. It was perceived that optimism, and the acceptance of the disease were fundamental to face and adapt to these adversities. In relation to coping and survival, while one of them resorted to denial as a way of dealing with this situation, the other sought acceptance. Regarding support network, family and friends contributed to obtaining positive effects in the treatment of one participant

The discovery of breast cancer: “No, I never felt anything, I was shaving in a big mirror and when I saw blood came out through my breast. Funny. Did it break a vein? I thought, and that's when I went to get medical help. But I did not imagine it was cancer, because I did not know about it"

Coping with a breast cancer survivor: “You have to accept what it is like I always thought positive, always forward, you do not have to warm your head I feel calm like this, I was never nervous about it, until today everything is normal. No good thinking bad things, I just thought of good things”

Sources of support for men surviving breast cancer: “My sister who was always by my side, together, she always accompanied me. They (children) always stayed by my side giving me support. At the time I needed them, they helped me (friends)”

Radiotherapy, chemotherapy & surgery

This study created awareness about the context of men when getting sick and surviving breast cancer, as it allowed to observe the steps that involve the process of discovery, treatments, coping, survival, daily life, and support networks

Moderate (69)

12. El-Beshbeshi & Abo-Elnaga 2012 [48]

Egypt

To report clinicopathological characteristics, treatment patterns, and outcomes of men with breast cancer

Quantitative

37 men with breast cancer with a median age of 57.7yrs ranging from 26 to 86yrs. 94.5% of these men reported a mass under their areola with local advancement and their tumors were invasive duct carcinomas

N/A

N/A

Treatment was mainly surgery in 91.8%, followed by adjuvant 89.2% radiotherapy, 56.7% hormonal and 91.8% chemotherapy

Male breast cancer is most often diagnosed in an advanced stage making the management of male and female breast

carcinoma is identical

High (76)

13. France et al. 2000 [49]

UK

To describe the psychological and social consequences of the diagnosis of breast cancer in men

Qualitative

6 male breast cancer patients who completed a radiotherapy/ chemotherapy course with accompanying spouses being invited for comments as appropriate

The 7 themes that emerged included:

a. “delay in diagnosis” b. “shock”, c. “stigma”, d. “body image”, “causal factors”, “provision of information” and “emotional support”

Delay in diagnosis: "Noticed the lump in April, went to the GP in August about something else. The doctor was convinced it was nothing to worry about, but I pushed the point that I did have private medical care. If I hadn’t pushed the point, he would have left it at that juncture"

Reaction to diagnosis: "I found it totally shattering. Then the Consultant suggested referral for a mammary strip and to a Consultant Oncologist and Radiotherapist, by this time of course I thought my last days had come. I said, ‘At the worst what is the prognosis?’, with this he said ‘at the worst you’ll be dead in 12 months so I thought I had better put my house in order”

Stigma: "No embarrassment, the mates don’t actually understand, they don’t ask you". Body image: "Of course it doesn’t matter to a bloke, but I wouldn’t go swimming anymore. I could tell a very good tale about how I was in the Hussars or something and get away with it. I am very conscious about it (the scar), I wouldn’t display my chest to the boys or my grandchildren". Causal factors: "I made a few trips to Abercomboi to where the Furnacite plant was I worked on the coal, but dust and nothing bothered me". Provision of information: "I wasn’t given any literature, but my friend Audrey was given a lot of literature, and she gave me several leaflets. I got more or less the idea, but you feel a bit of a ninny when you’re reading all this about putting your bra on and that sort of thing"

Emotional support and counselling: "They don’t cater for men. There is a programme coming up in Cancer Awareness week, it’s all for women you know I feel like writing to say that men can get breast cancer you know."

Radiotherapy and/ or chemotherapy

There are psychological and social issues for men with breast cancer, which impact on their management and care. It has been recommended that developing a structured education program for all primary care providers including pre and postoperative gender-specific information that can minimize the potential psychological issues that come with the diagnosis. Additionally, appropriate counselling/ support services should be provided for partners of male breast cancer patients

Moderate (52)

14. Giordano et al. 2005 [50]

USA

To describe the experience of institution-wide adjuvant systemic therapies in male breast cancer

Quantitative

There were 135 nonmetastatic male breast cancer with age ranging from 25 to 80yrs and a median age of 59yrs at diagnosis. Pre-dominantly there were 72% white, 15% black and 12% who were Hispanic

Not reported

N/A

Surgical with adjuvant therapy and chemotherapy with radiation, and hormonal therapies

Men who received adjuvant hormonal therapy experienced a significant overall survival of 0.45; P = 0.01 suggesting the benefit men derive from adjuvant therapies with a scale similar to that seen in women

High (93)

15. Halbach et al. 2020 [51]

Germany

To explore the healthcare situations of men with breast cancer from their perspectives

Mixed methods

27 males with breast cancer

Before diagnosis, men with breast cancer reported seeing their primary care physician when either they or their partners observed indicators like lumps, bleeding in the nipple or breast pain. Others reported lack of expression of suspicions on the part of primary care physicians regarding the indicators being signs of breast cancer as they were referred to physicians not providing care for breast cancer, or they were told to observe it for a while. These issues led to delays and late diagnosis with some diagnosis happening months and years after the initial indications were seen. During treatment, there were expression of satisfaction with some men feeling safe and well informed by providers. Side effects were liked with Tamoxifen treatments including sexual dysfunctions, sweating, memory loss, hot flushes, sleep disorders and joint pain among others. During rehabilitation, men reported experiencing being alone among women with some feeling isolated and excluded. Some reported a lack of aftercare guidance although others experienced trust, regular and comprehensive guidance regarding breast self-examination

“Well, my primary care physician already suspected that it could be breast cancer, and therefore, first mammography. Then the women were split up in all these other rooms and I suddenly had a four-bed room for myself. They made an insane effort there no one could tell me what the side effects were of tamoxifen. This person, it’s a man, but it’s just an affected person. At the water aerobics, I was also the only one. Because they said they do not want, that the women with breast cancer, that there is a, a man. Because some women may not want that, yes”. I say: “OKAY”, I say: “So I’m alone in the swimming pool.”

Not reported

There is the need to increase male breast cancer awareness among researchers, healthcare workers and the public so as to prevent late diagnosis, reducing stigmatization and indecisions

around its management. treatment. Also issues around access to care and aftercare guidance should be addressed

High (83)

16. Harlan et al. 2010 [52]

USA

Aimed to assess the features, management, and survival among newly diagnosed men with breast cancer between 2003 and 2004

Quantitative

Men with first diagnosis of breast cancer at the age of 20 from January to December 2003

Sample size

512 randomly selected men from the SEER database from each participating registry

Age distribution

 < 50:59 (11.5%)

50–59:118 (23%)

60–69:136 (26.7%) 70–79:115 (22.5%)

 >  = 80:84 (16.4%)

Racial distribution

non-Hispanic white- 400

non- Hispanic Black- 61

Hispanic- 32

Asian- 19

Cancer staging

Insitu: 58

Stage 1–3: 392

Stage 4: 36

Unknown staging: 26

Men who were not currently married received chemotherapy significantly less often and had higher Cancer mortality than married men

N/A

Surgery and Radiation

No surgery

Breast conserving surgery with radiation

Breast conserving surgery without radiation

Mastectomy and radiation

Mastectomy without radiation

Chemotherapy and Hormone therapy

No adjuvant therapy

Chemotherapy only

Chemotherapy + hormone therapy

Hormone therapy only

The primary predictors of mortality and therapy among men with breast cancer were marital status and tumor features. There is the need for future research to assess the association of gonadotropin releasing hormone analogues with the effect of aromatase inhibitors

High (74)

17. Hill et al. 2005 [53]

USA

Aimed at using Surveillance, Epidemiology, and End Results data (SEER) in describing male breast cancer epidemiology in comparison with gender and race-specific incidence trends in determining the association between breast cancer disease-specific survival and demographic or tumor features

Quantitative

There were 2923 male breast cancer recorded on the cancer registries participating in the SEER betweeen1973 and 1999 with an average age of 64.8 at diagnosis

Staging n(%)

In situ 157 (11.6)

Localized 622 (46.1)

Regional 486 (36.0)

Distant 85 (6.3)

Race n(%)

White 2,449 (84.6%)

Black 323 (11.2%)

American Indian 5 (0.2%) and 117 (4.0%)

Asian/ Pacific Islanders

The risk of breast cancer death is 21% higher for those who were not currently married

N/A

Not reported

After adjusting for demographic variables, gender was not a significant predictor of survival although some important gender differences were detected with respect to factors associated with tumor features. A large-scale analysis of gender-specific survival, with treatment variables and demographic factors in the current study is recommended for future research

Moderate (69)

18. Hiltrop et al. 2021 [54]

Germany

To explore the experiences of men with breast cancer as they ‘return to work’ (RTW) using an explorative qualitative approach to determine:

(a) the kind of existing RTW patterns

(b) the motivation to RTW;

(c) the experiences of RTW and

(d) the effect of male breast cancer on work after RTW?

Qualitative

N = 14 out of n = 27 interviews were analysed with a total of 100 men with breast cancer participating of an average age of 66.9 yrs and a subsample of 14 participants having an average age of 58.6 yrs. Those interviewed were first diagnosed 4yrs prior to the study with n = 8 working full or part-time and n = 6 were retired or on sick leave with all having varying levels of education during data collection

The description of RTW patterns focused on:

a. ‘working during therapy’,

b. ‘participation in medical rehabilitation’,

c. ‘occurrence and type of RTW’, and

d. ‘job changes after RTW’. Of the 14 interviewed, 11 patterns were analysed with more than one patient experiencing patterns 5 and 6, with four patterns indicating participants working while on chemotherapy and /or radiation treatment. These waived the option to RTW slowly. Changes were reported after RTW including reducing hours of work, different tasks, retirement, and taking on new roles

Handling cancer disease in the workplace—"And in my life, I have generally gotten into the habit of going on the offensive right away and putting all my cards on the table. This is because nothing is more boring than yesterday's rumour. If you try to fiddle or cover things up, they will keep asking: ‘Well, what do you have? What's that? And why isn't he showing up now?’ So, I wrote an email and took the big distribution list, everyone I could think of and sent it off." "After the reintegration, you're suddenly back in working life. It's like turning a switch. You simply have to function again. Your colleagues quickly forget that you were gone for eleven months, not long ago. Expect a lot of understanding but offer little themselves. You always have to show understanding for them and their situation, always." Changes in productivity after RTW—"And the first workday would have been the same day as my first follow-up appointment, right? But I already told my boss: ‘I can't come in then, that's when I have my follow-up appointment,’ right?" "In the beginning, oncology had actually wanted physical therapy five times a week. And now because I also travel for work, I do three times a week. And I simply don't have time for more either."

Surgery

Chemotherapy

Radiation therapy

Hormone therapy

Decisions in relation to RTW are taken in different healthcare contexts requiring various

opportunities for supporting male breast cancer survivors influencing their RTW patterns and rates. For Germany, there is a provision of 3 weeks medical rehab for patients within the health system allowing for gradual RTW options and measures of support which enables participating in work life

High (73)

19. Hoffman et al. 2020 [55]

Israel

Aimed at presenting an overview of the outcomes and experiences of men with breast cancer in Israel covering over 22 years in addition to reviewing clinical and oncological outcome changes over time

Quantitative

Men with breast cancer who had surgery from January 1993 to December 2015

Sample size: 49 with an average age of 64.1. There were Ashkenazi Jews: 66% (n = 29);

Sephardic Jews: 22.7% (n = 10);

non-Jews: 12.2% (n = 6)

Unknown: 9% (n = 4)

N/A

N/A

Mastectomy + Sentinel Lymph node biopsy + Level 1 Mastectomy + Axillary Lymph node dissection

Radical mastectomy

Radiotherapy

Hormonal therapy

Male breast cancer is a rare disease that continues to increase. Negative status of PR has been linked with better overall survival and disease-free interval

Moderate (50)

20. Iredale et al. 2006 [13]

UK

Aimed at investigating the experiences of male breast cancer throughout the UK

Mixed methods

Phase 1 is a focus group discussion with n = 27 participants made up of two groups of male breast cancer (n = 5 & n = 4), one group of female breast cancer (n = 13) and one group of care providers (n = 5)

Phase 2 is a survey with n = 161 male breast cancer participants. Phase 3 is interviews with n = 30 men from phase 2

Phase 4 is reconvening of focus groups consisting of n = 7 male breast cancer and n = 10 female breast cancer participants

Qualitative

a. Many men were rather shocked at the receipt of breast

cancer diagnosis as this was seen to be a female disease

b. Information shared with participants were through leaflets, booklets, verbal and by internet sources and photos prior to surgery although most of this information were female related

c. Formal support services were underutilized with few participants speaking to other men with breast cancer although some would have wished to have such support post diagnosis

d. Most people just do not accept the possibility of men being diagnosed with breast cancer. Participants felt the need to raise awareness on male breast cancer among care providers as well as the public especially regarding symptoms of the breasts or nipples

Quantitative

Most men disclosed their diagnosis to spouses/ partners (n = 129, 80%) and other close family and friends, with less disclosure to extended family and work colleagues (n = 60, 37%). A small number of men (n = 6, 4%) disclosed to no one

The most common source of information for participants was verbal (n = 148, 92%), with 71% (n = 114) receiving leaflets and 53% (n = 85) receiving booklets; in addition, 20% (n = 32) had used the internet, while 12% (n = 19) saw a photograph prior to their surgery. Information was primarily delivered by healthcare professionals working in hospital settings, but much of what was available in written form was inappropriate, covering topics such as menstruation, breast reconstruction, and bra fittings. Over half of participants (n = 90, 56%) wanted much more information

Demonstrated low utilisation of formal support services. Only 19% of participants (n = 31) spoke to other men who had breast cancer, but 27% (n = 43) would have liked that opportunity after their diagnosis. Most were not interested in talking to other men or women with breast or other cancers either individually or in a group and the vast majority would not attend a gender mixed support group

Diagnosis and disclosure ‘Now when I first knew that I had got it, I thought to myself well how the Dickens did I get breast cancer. I’m not a woman. I’m a man’’. ‘‘I was surprised more than anything. Women it’s an ever-present threat. Men never occurs to them’’

Information needs

‘‘No information. Nothing at all. I daresay women aren’t left like that. On leaving after the first operation the nurse gave me a leaflet with women on it doing exercises you have to do and that was it’’

Support ‘‘My wife was my support she and I talked about everything. At the beginning we talked about it and agreed that I would have her as my support and she would have her family to support her through. It worked well and I also got support from her family, mine were useless’’. ‘‘None of the guys wanted to have self-help groups I don’t think they need the psychological support that perhaps women do. I think this is, of course research I know but actually quite therapeutic in a way’’

Raising awareness ‘‘By their expression they don’t believe me. You can tell they think I am conning them you know, lying to them or whatever’. ‘‘Yes they were incredulous and then a couple of them laughed’. ‘‘I guess every article you ever read is about women with breast cancer. And nothing ever says oh by the way chaps you can get it too I don’t think raising awareness about it would be difficult it would just be about including men’’

Hormone therapy, mastectomy,

lumpectomy, chemotherapy and

Radiotherapy,

Findings show that men have valuable and constructive things to say about how their breast cancer care should be delivered if given the opportunity to share their experiences. There is therefore a need for future research with lager sample of men with breast cancer, exploring their experiences throughout the disease trajectory with its corresponding management

Moderate (62)

21. Kowalski et al. 2012 [56]

Germany

Aimed at describing health related quality of life among German men with breast cancer and to explore any significant differences among male and female

Quantitative

There were n = 84 men with breast cancer of an average age of 64.82

N/A

N/A

84.5% had

mastectomy;

7.1% had either breast-conserving therapy or partial

mastectomy, and 8.3% did not indicate the type of surgery

There was a significant health related quality of life score of 7 out of the 8 sub-scale for men with breast cancer compared to that of women with breast cancer

High (86)

22. Levin-Dagan and Baum 2021 [20]

Israel

To explore ways men cope with the threat of being stigmatised as a result of being diagnosed with what is perceived as a woman’s disease

Qualitative

N = 16 men ranging from 25 to 78 years (median = 59) and diagnosed with breast cancer within the past 10 years as well as communicated in Hebrew were interviewed with a mean interview time of 51 min (range 33–75)

Reported as verbatim quotes

Being treated in a female-patient-oriented healthcare system—'I received an instruction page written in the female gender with instructions to sleep with a bra and all sorts of things that are connected only with women, not with men. But I don’t know if there are any special instructions for men. They just don’t know, it’s like that.' Reactions to being a man diagnosed with breast cancer—'… even now in the radiation treatments, there are male nurses who take you inside and prepare you, and after 20 or so treatments we kind of bond, and finally you’re lying on the table and he touches and moves you, and says: “Tell me, bro, may I ask, how did you discover it? I’ve never heard of this before.” And I said to myself, wait a minute, you work here and you see things, so that means that it really is uncommon. Selective disclosure—[My friends] still don’t know that it’s breast cancer. Because it still somehow makes me feel ashamed … It’s still awkward. It’s inconceivable in here [pointing to his head], it doesn’t make sense. It’s as if a woman said she had prostate cancer. I don’t know. It’s contradictory. Body concealment—'I feel different in that I have only one breast. So I do my best not to take my shirt off because it makes me feel bad to be different. Look, if it’s at the Dead Sea, who else is going there? Only those who have all kinds of things. Even there I didn’t take it off, I went in the water with my shirt on because I felt ashamed. It’s not really shame. I don’t know … My feeling is that people won’t talk, there you are, all eyes are turning toward me and see that I have only one breast. There are people who don’t give a damn, but regarding this, I do

Mastectomy, chemotherapy, radiation therapy, and hormonal treatment

The study reveals MBC patients manage their discrediting position of being diagnosed with a “woman’s disease.” Our findings add to the understanding of the stigmatisation experience and address for the first time men’s coping mechanisms

High (75)

23. Miao et al. 2011 [25]

Denmark, Finland, Geneva, Norway, Singapore, and Sweden

Aimed at comparing incidence trends with relative survival and excess mortality among male and female breast cancer to understand outcomes and risks in men relating it with women breast cancer

Quantitative

Participants with breast cancer diagnosed between 1970 and 2007 except Denmark, where inclusion was up to diagnosis in 2006. A total of 2665 was included representing 677 for Denmark, 347 for Finland, 61 for Geneva, 435 for Norway, 74 for Singapore and 1,071 for

Sweden with 69 as the median age

N/A

N/A

Treatment

Surgery n (%)

Yes 728 (86.4)

No 79 (9.4)

Unknown 36 (4.3)

Radiotherapy

Yes 251 (29.8)

No 447 (53.0)

Unknown 145 (17.2)

Chemotherapy

Yes 127 (15.1)

No 542 (64.3)

Unknown 174 (20.6)

Hormonal therapy

Yes 190 (22.5)

No 508 (60.3)

Unknown 145 (17.2)

Total 843 (100)

Over the last four decades, the risk of male breast cancer continues to persist. Generally, men with breast cancer have worse survival rates but when adjusted for life expectancy, year of diagnosis, age, treatment and stage of disease, and male patients with breast cancer emerged as having a survival benefit compared with women

High (86)

24. Midding et al. 2018 [32]

Germany

Aimed at examining the feelings of men with breast cancer regarding suffering from a “woman’s disease”

Mixed methods

Qualitative interviews were conducted with n = 27 men with breast cancer in addition to n = 100 quantitative data collected using questionnaires

Qualitative

Five main categories of stigmatization were identified:

a. Experience of stigmatization describing scenarios of men with breast cancer being treated differently compared to other patients

b. Bodily dimension including facets that are linked to changes occurring in and to the body as well as the body image after surgery

c. Indirect stigmatization comprising scenarios causing shame and indisposition leading to self-stigmatization

Quantitative

there is significantly less stigmatization with close family and friends than in broader social settings, for instance, with colleagues

Most stigmatization takes place in rehabilitation settings (mean = 1.50), significantly more than during chemotherapy (p = 0.006), radiation (p = 0.019), follow-up survey (p = 0.031), and within family (p = 0.004))

In the cancer care system, the men experienced significantly higher stigmatization during hospitalization (mean = 1.20) than during chemotherapy (mean = 1.14; p = 0.049). The experienced stigmatization is higher within the cancer care system than within social surroundings

Experience of stigmatization “I remember that woman in the breast cancer center. She said: ‘What do you want here? You don’t belong here.’ “I think I was called ‘Mrs. Miller’ once. Something like this is also unpleasant.”

Bodily dimension “This is a time when the disease is also disfiguring. Nobody sees the surgery. You have your scars, but you can hide them. But when the hair is gone, mustache away, eyebrows away.”; “[While sitting in the waiting room] the women are thinking: ‘He accompanies his wife. She’s in treatment.’ And when you’re being called: ‘Mr. Miller please.’ All heads are turning, and you feel kind of observed.”

Surgery

Chemotherapy

Radiation therapy

Antihormone therapy

Findings suggest that men with breast cancer experience stigmas mostly within the care system, therefore management strategies should be developed for it. There should also be male breast cancer awareness creation to provide equality cancer care to ensure that breast cancer is seen as a disease for both men and women

High (79)

25. Midding et al. 2019 [57]

Germany

Aimed at exploring:

(a) resources for social support

(b) types of support being used, and (c) to identify the heterogeneity of the resources used by men with breast cancer

Mixed methods

127 participants; 27 qualitative interviews 100 questionnaire with patients with MBC Participants were 66.9 years on average and only 30.9% were still working (full-time and part-time)

MBC patients received three supports:

a. emotional support, usually from their informal caregivers

b. informational support from health professionals. Support needs are dependent on factors such as the level of disease, age, patient’s education, copying style

c. Instrumental support. Cancer support groups provide both informational and emotional support

Quantitative

Workplace Colleague support: social support resource of colleagues was not available for most participants

Private peer support: most men (63.2%) have contact with female Breast Cancer Patient (73.1%) for support. In comparison, 24.2% of the participants have contact with other MBCP

Group peer support: 15.3% of the participants are part of a support group; the majority (84.7%) of participants are not. Most participants who were not part of a support group stated that they do not wish to be part of a support group (96.3%)

Described 3 broad typologies of social support use among male breast cancer patients

Type 1: does not use any social support during the breast cancer dis-

ease. But the Modified Medical Outcomes Study Social Sup-

port Survey short scale (mMOS-SS) identifies that this group mostly have someone who offers them emotional (mean = 4.4) and instrumental support (mean = 4.5). Average age of 78yrs

Type 2: Majority of MBC patients fall within this group. They use different resources of social support from one to three categories of social support (emotional, informational and instrumental) during the process of disease. They use a minimum of two resources. The total score of the social support scale indicates that they mostly have someone who offers them social support, but the mean value of support received is the lowest among the groups (mean emotional support = 4.2, mean instrumental support = 4.4). They have a younger average age (66.6 years) compared to Type 1,

Type 3: receives social support from two or all three categories of social support. This type uses the most diverse resources of support and has the highest amount of used support. The availability of social support has the highest mean value of the types (mean emotional support = 4.7, mean instrumental support = 4.8). They are the youngest type with an average age of 57.5 years

Need of support from support group: “I had no interest in that I said: Okay I had it, but it’s over

Basically, I don’t want to always be confronted with it

they partly described their complaints there.” Emotional support: “My wife is also the first contact person for me, of course.” Informational support: “My sister is a doctor. That’s also my best guide. She isn’t a medical specialist. She’s an anesthesiologist, but of course has contacts. And of course, then can enlighten directly.” Instrumental support: Wife: “He can’t wash himself properly. So, I washed him. I

also put some cream at him at the moment, I cut his fingernails and toenails.”

Chemotherapy, Adjuvant radiation, Hormone

therapy

Depending on the age, occupation and severity of male breast cancer, the identification and usage of social support could differ. As older men with breast cancer whose disease is less severe use less social support and vice versa. Partners of men with breast cancer and closer social environment are key resources for inclusion within the cancer care system. Future research should assess the use of healthcare professionals as a resource of support for male breast cancer

High (81)

26. Nahleh et al. 2007 [58]

USA

Aimed at comparing the outcomes and features of male and female breast cancers

Quantitative

612 male breast cancer has been compared with 2413 female breast cancer. The average age for male and female breast cancer at diagnosis was 67 and 57 years respectively. Majority of male breast cancer were black with ductal carcinoma dominating the histology and presenting in an advanced stage

N/A

N/A

There were 36% of female breast cancer receiving

chemotherapy and 34% radiotherapy compared to 29% and 20% of male breast cancer respectively. However, both male and female breast cancer equally received endocrine hormone

therapy

Findings indicate that variations exists in terms of pathology, biology, presentation, survival and the ethnicity of male and female breast cancer

High (86)

27. Nguyen et al. 2020 [34]

Germany

Aimed at investigating male breast cancer experiences in order to ascertain their support and care needs

Qualitative

18 men with breast cancer aged between 53–83 yrs; and mean time of diagnosis being 4.5yrs ranging from 2 to 8 yrs

The participants expressed different views regarding receiving a diagnosis of a “women’s disease.”

a. While some participants thought of male breast cancer as unusual and threatening their manliness, others thought of it as “any other disease”

b. The experience of stigma was highlighted which threatened their sense of masculinity

c. With regards to their body image, the scars from the surgery didn’t seem to bother participants though some confess to hiding it initially. Although loosing hair as a result of chemotherapy became a huge worry for some participants. d. Regarding treatment, the male participants reiterated that approaches to managing the disease were designed mainly for women resulting in men feeling prevented from getting satisfactory care. The men voiced their desire at exploring the effect hormonotherapy had on them as they reported effects of hot flashes or sweat with some men considering themselves to be “menopausal women" due to the side effects. Despite these concerns, they were generally satisfied with their care

e. With regards to coping, participants who are married reported mostly receiving social and emotional support from their spouses in helping them to cope. Additionally, some confess that it was their wives that edged them on to seek medical help that resulted in the breast cancer diagnosis. They also found support groups helpful

a. Living with a “Women’s Disease”: “My biggest problem was how to tell my wife that I have a woman’s disease? Because I thought maybe you’re not a real man, perhaps half woman?”

i. Stigma “From others at work, I always (hear) ‘admit it, you’re just trying to find excuses. You’re not a real man, or you wouldn’t have such an illness’.”

ii. Body Image “It’s a different situation for women; in your mind it’s then more about losing your femininity and who knows what else. But that’s not the case for us, you see? I’ve only got one nipple left, right? That doesn’t bother me”

b. Barriers: Hormonotherapy “I would have quite liked the anti-hormone therapy to include a medication that had been tested on men, so that I could be confident that it’s suitable for me, as a man.”

c. Coping: i. Wives’ Support “I’m glad I have my wife I don’t know how it would have ended.”

ii. Support Groups “To be honest, I don’t know how I would be managing if I had never had (the support group). They gave me back the will to live and I will always be grateful for that.”

d. Supportive Care Needs: “Social and psychological support could be strengthened right at the beginning, when you get the diagnosis.”

Use of pharmacological agents and surgical intervention (mastectomy)

It is crucial raising awareness on male breast cancer including adapting management approaches with adequate information for patients and available support services aimed at improving male breast cancer care

Moderate (64)

28. Özkurt et al. 2018 [59]

Turkey

Aimed at studying the clinicopathology outcomes and features of male breast cancer in emphasizing the variations in comparison to female breast cancer

Quantitative

53 male patients diagnosed with breast cancer, underwent surgical operation attended routine follow-up from January 1993 to April 2016;

Median age 64 (34–85) with all participants at different stages of disease ranging from 0 to stage 3

N/A

N/A

Type of surgery n(%): 1 (2) breast conservation; 11 (21) mastectomy and 41 (77) underwent modified radical mastectomy

Sentinel Lymph Node Biopsy n(%)

Yes 20 (37.7)

No 33 (62.3)

Axillary Lymph Node Dissection n(%) Yes 42 (79.2)

No 11 (20.8)

Systemic treatment n(%)

7(13.2) underwent preoperative systemic chemotherapy;

25(47.2) had chemotherapy and 21(39.6) had no treatment

32(60.4) had radiotherapy and 21(39.6) did not; 45 (90) had

hormonal therapy and 5(10) did not

When compared to female breast cancer, male breast cancer had a different clinicopathological and prognostic factors. Hormonal therapy has become the main management for estrogen receptor male breast cancer due to the high rates of hormone receptor positivity

Low (47)

29. Potter et al. 2023 [60]

USA

To better understand how men experience changes in occupation when diagnosed with breast cancer

Qualitative

N = 24 MBC participated in the interview lasting 10 to 100 min. The average age of the participants was 57.75 years, the median age was 59 years, and the mode was 70 years of age

Most participants found meaning in new occupations related to advocacy. This new role centred around building awareness and support for men past, present, and future with breast cancer through public speaking, joining MBC organizations, participating in research, volunteering, and educating others. Some participants expressed the move into advocacy as a natural progression from their profession. Men described themselves in terms of becoming activists. Multiple participants started nonprofit foundations focused on meeting individual and societal needs related to male breast cancer

Social Environment—So, I found the men’s group. And even though I was the only one with breast cancer, I found it more comfortable and helpful. But I think that fact they had a specific men’s group, it was very important in my journey and in my recovery…I really found that women would react to me in a different way (P-23). Decrease in Occupational Engagement due to Side Effects—I was off for a couple weeks for my surgery and then when I was going through chemotherapy, I would take off the day of the chemotherapy initially and then towards the end of my chemotherapy um started to catch up with me. So, I was working four days a week when I began my chemotherapy and by the end, I was working three days. (P-15) Finding Meaning in New Occupations—The goal was if I can help one male through that, it was done. I achieved my goal. But one person, you know, I mean once you get that satisfaction from that, you just have to keep going. (P-16)

No specific treatment was reported in the data

Occupational therapy has the ability promote engagement in meaningful occupations and therefore promote overall health and well-being in the lives of men affected by breast cancer through understanding the unique barriers and successes men in this study described. The men in this study expressed instances where they did not feel welcome in the healthcare environment and their health care providers were not well versed in treatment of male breast cancer. Only through a client-centred and occupation-based approach will occupational therapy benefit clients to achieve optimal occupational engagement

High (76)

30. Rayne et al. 2017 [61]

South Africa

Aimed at describing and assessing the perceptions of men with breast cancer regarding their manliness and the effect of having a disease that is commonly attributed to women

Quantitative

There were 23 men with breast cancer involved at various stages of the disease and non-metastatic at diagnosis

Of the n = 23 participants, only n = 6 had knowledge of male breast cancer before they were diagnosed and only n = 1 was keen to disclose the disease and its management to their relations. Participants did not agree that breast cancer influenced their insight regarding their manliness except n = 5 that thought otherwise. Black participants and those managed in state hospitals were unlikely to have knowledge on male breast cancer but could more likely have their perceptions regarding their manliness affected

Only five (17%) respondents noted feeling embarrassed about taking off shirt in public now

All but one patient willingly disclosed their disease and treatment to their family and friends

N/A

Surgery, chemotherapy and radiation if needed

Most of the participants’ perception of their manliness and relationships were not affected by being linked to a female disease, although black participants and those receiving care in state hospitals reported differences. The likelihood of these links having substantial influence on some worried men with breast cancer is pertinent to supporting them especially those receiving care in state institutions

High (86)

31. Sanguinetti et al. 2016 [62]

Italy

Aimed at evaluating the clinicopathological features, biology and genetical impacts including the management and outcomes of male breast cancer

Quantitative

47 men with breast cancer with a mean age of 67yrs with diagnosis being established in an average time of 16 months of symptoms onset and sub areolar swelling being the key clinical complaint

N/A

N/A

Radical mastectomy; Modified radical mastectomy; and Lumpectomy. All patients received adjuvant therapy following surgery; Radiation therapy; Hormone therapy, and Chemotherapy

The prognosis of the MBC is undoubtedly worse of breast cancer

in women

High (71)

32. Sarmiento et al. 2020 [63]

USA

Aimed at comprehensively describing male breast cancer tumor and clinical features and to explore factors affecting survival

Quantitative

There were 16,498 men with breast cancer having medial age of t63yrs. Over 75% of men presenting with breast lesion were found to be malignant with an invasive ductal carcinoma

N/A

N/A

Primary resection surgery was commonly used; Lymphadenectomy; hormonal therapy was also commonly used. Chemotherapy was used and radiation therapy in patients

As found in female breast cancer, there was a significant association between surgery and improved survival in men with breast cancer. Factors noted for affecting male breast cancer survival include increase in age, being black, access to state insurance, multimorbidity and tumor stage being high

High (79)

33. Shah et al. 2012 [64]

India

To analyse the clinicopathological profile of men with breast cancer

Quantitative

N = 42 men with breast cancer having average age of 56yrs ranging from 31 to 78yrs and various stages of cancer diagnosis

N/A

N/A

Most men with breast cancer had surgery at different stages of the disease, some had modified radical mastectomy and radical mastectomies. Men who had surgery were also given chemotherapy as well as radiotherapy. Those who had failed tamoxifen were given chemotherapy and the rest had both chemotherapy and palliative radiotherapy where there was metastatic bone

The majority of MBC are found to be hormone receptor positive, hence hormonal therapy should be strongly considered

High (79)

34. Shin et al. 2014 [65]

USA

Aimed at comparing overall survival and racial variations in the management of men with breast cancer

Quantitative

There were 4,279 men with breast cancer of with 3,266 being White, 552 Black, 246 Hispanic,

and 215 Asian

N/A

N/A

Not reported

Overall, the findings indicate that Blacks are disadvantaged in comparison with Whites, Hispanics, and Asians in relation to survival have a survival, which could partly result from variations in the way the disease presents. Additionally, it was discovered that lymph node dissection, which could be beneficial to patients were less likely to be received by Blacks after stratifying for disease stage

as an underlying factor which contributes to the

disparities in survival outcome. Future research is required to explore whether racial disparities in men with breast cancer have any association

with access to care, socioeconomic status, genetics and biologic etiologies as well as limiting medical comorbidities

High (90)

35. Sineshaw et al. 2015 [18]

USA

Aimed at examining the extent of the differences in the receipt of treatment and survival for black or white men with breast cancer at an early stage

Quantitative

There were 5,972 men comprising 725 blacks and 5,247 whites of age 18 and above, whose diagnosis ranged from stage 1 to 3 between 2004 to 2011. Age distribution

18–39 159 (2.7%)

40–54 1308 (21.9%)

55–64 1607 (26.9%)

65–69 874 (14.6%)

70–79 1351 (22.6%)

 >  = 80 673 (11.3%)

Cancer staging

Stage 1—2549 (42.7%)

Stage 2—2523 (42.2%)

Stage 3—900 (15.1%)

N/A

N/A

Definitive locoregional therapy including surgery and radiotherapy

Adjuvant hormonal therapy

Adjuvant chemotherapy

Although black and white men have similar rates of treatment receipt at an early stage of breast cancer, the risk of death is higher among black men of age18 to 64yrs however this is not the case for those aged 65yrs onwards, who have moderate Medicare insurance coverage. These findings suggest the importance of ensuring that men with breast cancer have access to care in order to reduce ethnic/ cultural differences in mortality among men with breast cancer

Moderate (69)

36. Skop et al. 2018 [66]

Canada

Aimed to understand the experiences of men who had mutation of BRCA and were screened for breast cancer

Qualitative

15 men with breast cancer with an average age of 55 ranging from 40 to 76. They were all Caucasian with children. N = 13 were married and n = 2 divorced with most of the being Jewish or Catholic and working as teachers, health professionals owning business, as well as n = 4 retired

Findings: Body appearance is important (“Guys don’t have breasts.”), for example, using the word chest as opposed to breast “chest” rather than breasts

Themes emerged include:

a. Body talk—"If I talk to my friends, and I haven’t because I don’t have cancer, but if I did I would talk about it as chest cancer. I wouldn’t use breast cancer. So that would be the term I would use and, in the conversation, I would say that it is the same as breast cancer. It’s exactly the same thing; it’s just it’s in my chest". b. Changing awareness of breasts: "I was getting a little soft in the area I joke with my son and say “they’re my moobs” my man boobs right because the pectoral muscles, if you don’t stay on it and keep them firm, they start to look a little more like breast I don’t really think about [chest] too much other than that fact I probably should do some toning" (laughs)

c. Experiences of undergoing mammography "I wandered into the waiting area, the breast exam area and sat down there with the women and when they came out they asked for Mrs. Smith, Mrs. This, Mr. and s o I stood up and there were a couple of giggles and titters and then we wandered in and they separated the women to one side and I went to the other"

Mammograms

The findings of this study showed that there is limited research male breast cancer in association with masculinity, which has the potential to lead in the improvement of men with breast cancer’s BRCA experience in addition to improvement in they are screened

High (73)

37. Thompson and Haydock 2020 [67]

USA

To listen

to men’s breast cancer career stories with the guiding question “What are men’s dis/embodied experiences as they journeyed their breast cancer career?” Looking beyond

the expected assault-disruption story

Qualitative

17 MBC patients were interviewed from different

locations within the USA: n = 7 from New

England, n = 3 each from Southern and Western states, n = 2 each from the Midwest, and East coast states. Their age ranged from 37 to 82

All the men were partnered/married at diagnosis and were predominately White (n = 15), with one each African American and Native American. All but three men

(82%) had gone beyond a high school education; six (35%) had earned post-bachelor’s degrees

16 out of the 17 men reported being surprised and did not believe their diagnosis of breast cancer, which demonstrates the near invisibility of MBC. Two overarching themes were identified within their narrative

experiences: body talk and embodiment of their breast. Men’s body talk centered on their discovery of having breasts, the implications of their surgical wound and hormonally unruly bodies, and living with a cancer-injured body, with narratives equally conferring how they came to embody having breasts. Renegotiated embodiment describes navigating foreign

(women’s) spaces, telling others about their breast cancer,

and reformulating their subjective masculinities

a. Body talk—Having breasts: “I didn’t even want to think that I have breasts let alone have a cancer in my breast.” Surgical wound: “I didn’t have a shirt on; I do that on the beach. You know, after the surgery there’s obviously a scar there and no hair, you know, cause of the radiation. But I don’t care, you know.” Unruly bodies: “First of all my hair fell out because of the chemo, and I immediately cut the rest of it off. I told the people at work that I just liked to have a bald head.”

b. Embodiment of their breast—Navigating foreign spaces: “We’re men in this pink world and it’s uncomfortable. So you read some of the websites, you read some of the brochures that are available in the clinics and um, you know, you have a hard time even knowing that this is a disease that men can get.” To tell or not: “Socially, I don’t bring it up. But obviously everybody knows, my circle of friends, everybody knows.” Reformulating masculinities: “For the first several months I was wary about not wearing a shirt. Now, on the beach I didn’t have a shirt on; I do that on the beach. You know, after the surgery there’s obviously a scar there and no hair, you know, cause of the radiation. But I don’t feel a concern, you know.”

Mastectomy

The men shared narratives on men’s agency and their widening of traditional masculinities. MBC patients volunteered to provide testimony at breast cancer events, urging clinics and their physicians to give men the opportunity to mentor new MBC patients, or pushed pink ribbon organisations to be more inclusive and include men as “poster boys” in breast cancer calendars or for newspaper articles

High (71)

38. Visram et al. 2010 [68]

Canada

To examine the rates of adherence to and toxicity from endocrine treatments in male breast cancer patients treated at a single institution

Quantitative

There were n = 40 men with breast cancer in their early and advanced stages with a median age of 68 ranging from 46 to 84 at the Ottawa Hospital Cancer Centre from 1981 to 2003

N/A

N/A

a. Primary surgery

b. Adjuvant radiation therapy

c. Adjuvant chemotherapy

d. Hormonal therapy

The study found toxicity association with endocrine therapy in male breast cancer as reported in female breast cancer

This imply that men are are as likely to stop their endocrine therapy as early as did women with breast cancer

Moderate (57)

39. Wang et al. 2019 [69]

China

Aimed at analysing and comparing clinicopathological features, incidence trends, and survival outcomes in male and female breast cancer

Quantitative

2,254 men with breast cancer and 390,539 women with breast cancer were involved with median age of 65yrs and 59yrs for men and women respectively. Compared with

N/A

N/A

Mastectomy, radiation, and chemotherapy

Findings show that clinicopathological features, biological behavior and clinical outcomes in early male breast cancer varies from that of female breast cancer

Moderate (53)

40. Weber et al. 2021 [70]

Germany

(1) To describe defensive functioning, repressive coping, and fear of progression in a sample of male breast cancer patients, (2) To describe patterns of defensive functioning in relationship to repressive coping in male breast cancer patients, and (3) To explore the possible impact of repressive coping on an association between fear of progression and defensive functioning in male breast cancer patients

Quantitative

Participants were recruited nationwide through certified breast cancer centres, members of the MBC network, and invitations through newspaper advertisements with a median age of 60 years (ranging from 39-89 years). All participants had a confirmed breast cancer diagnosis for the first time, although the time window since diagnosis varied averaging just under 4 years. N = 100 men completed the quantitative survey, and a subsample of n = 27 took part in the qualitative interviews according to purposeful sampling

Male breast cancer males have a mean Overall Defensive Functioning (ODF) value of 5.62 (SD = 0.82) with 30% exhibiting mature defense organization (e.g., superior healthy neurotic functioning); 26.9% showing immature defense patterns regularly found in patients with personality disorders (e.g., borderline) and depressive disorders while majority of the sample showed neurotic defense patterns

46.2% of the sample (N = 12) used a non-repressing coping strategy versus 53.8% (N = 14) repressors. Both groups did not differ in age, marital status or disease duration. Use of non-repressing coping styles was associated with previous experience with breast cancer in the family (X²[1, N = 26] r = 5.60, p < 0.05)

There was higher use of mature defense patterns (superior healthy neurotic functioning) in patients who use non-repressive coping

ODF was significantly associated with fear of progression (r = 0.43, p < 0.05) i.e. the higher the fear of a worsening of cancer, the higher levels of (more adaptive) defensive functioning. Also under conditions of no repressive coping, higher levels of fear of progression were associated with higher levels of (more adaptive) defensive functioning

N/A

Surgery, chemotherapy, and radiation therapy

MBC patients are co-treated in a more feminine setting specializing in treating women with breast cancer leading to the experience of stigma. Therefore, consideration of coping with the disease including a more conscious coping strategies and a more unconscious defence mechanisms appears to be very helpful for MBC patients to recognize the distress and neediness, which may be hidden behind gender models. A better knowledge of the specific disease management could be followed by interventions, as early as possible and prospective controlled studies are needed for this purpose

High (71)

41. Williams et al. 2003 [71]

UK

Aimed at identifying issues of importance in helping men cope with breast cancer

Qualitative

Total sample of 27 also involving female breast cancer and care providers

Unclear how many of the 27 were male breast cancer

a. Prompt diagnosis as wife prompted and nudged patients to report symptoms to healthcare professional

b. Men reacting stoically to reception of diagnosis

c. Concern about disclosure

d. Concerns about appearance- some concerned and others not

e. Lack of peer support groups of males with shared lived experiences

f. Objection to mixed gender support groups

g. Lack of tailored gender-specific breast cancer information for men

h. Lack of representation within breast cancer information e.g. pictures of men with breast cancer and their surgery scars

‘She [wife] said ‘You’ve got to go. I’ve made an appointment”

‘I don’t discuss it openly with anybody unless it is directed at me’

‘I’ve been abroad and sunbathed. People do look, they do look. People don’t care. Only you care. Nobody else cares. After a while you get to know that. They just look at you and say ‘Oh’

‘One of the worst things was the fact there weren’t any men I could go to’

‘I think a male photography that way you are showing someone this is what is going to be you after the operation’

N/A

The findings of this study is a confirmation that there is limited male breast cancer specific information for them to access especially for those who may have specific issues of concern relating to their appearance after being diagnosed and managed for breast cancer

Moderate (55)

42. Yadav et al. 2020 [72]

India

To analyse outcome in MBC patients with adjuvant

treatment

Quantitative

81 MBC were retrospectively analyzed for patient‐related characteristics such as age, comorbidity, family history, pathological stage/tumor size, histology, grade, extracapsular extension, lymphovascular invasion, estrogen/ progesterone, and treatment‐related factors such as radiotherapy, chemotherapy, and hormonal therapy

N/A

N/A

Adjuvant hypo fractionated radiotherapy received by n = 51, chemotherapy by n = 35, and tamoxifen by n = 45 men with breast cancer

The adjuvant treatments used resulted in significant improvement on disease‐free survival and overall survival in men with breast cancer except

chemotherapy, which had zero effect on disease‐free survival and overall survival

Moderate (76)

43. Yoney et al. 2009 [73]

Turkey

To evaluate the general features, treatments applied, and the results obtained in male breast cancer patients

Quantitative

N = 39 men with breast cancer made up of 94.8% invasive ductal, 2.6% invasive papillary and 2.6% invasive lobular carcinomas distributed according to stages 1 (12.8%); 2 (46.2%); 3 (30.7%) and 4 (10.3%) of the disease

N/A

N/A

Patients received radiotherapy and hormonotherapy, chemotherapy, chemoradiotherapy and others received hormonotherapy in addition to surgery

As a way of improving local control, use of radiotherapy postoperatively was significant in the treatment men with breast cancer

High (71)

44. Zongo et al. 2018 [74]

Burkina Faso

Aimed at studying the diagnostic stage, modality for therapy and 5-year survival for men with breast cancer

Quantitative

51 men with breast cancer representing 2.6% of all men whose diagnosis happened around the same time. Their median age was 60.9 yrs with age groups from 61 to 70yrs being the most represented

N/A

N/A

Surgery followed by chemotherapy, radiation

and hormonal therapy

Male breast cancer diagnosis remains late. The most basic management approach is surgery. The choice of molecules and the number of cures, as a result of the cost of cytotoxic has limited the use of chemotherapy. The 5-year survival set out remains slow with median survival depending on the stage of diagnosis

Increasing awareness campaigns including the organization of screening for individuals might reduce late diagnosis thereby improving recovery

Moderate (62)