Treatment principles of breast cancer in males are derived from studies performed among females, while the low incidence in males has so far precluded such studies. The therapy recommendations for males therefore lack the solid evidence, frequently present for females with breast cancer. The primary breast cancer diagnosis in males is not infrequently in stage III/IV and at higher age, thereby requiring multiprofessional and multimodal management including preoperative therapy and adjuvant therapies based on the tumour’s biological characteristics and the clinical circumstances. The majority of male breast cancer tumours are oestrogen-receptor positive and adjuvant/neoadjuvant tamoxifen is therefore recommended, surgery is frequently radical mastectomy and adjuvant radiotherapy should likely be used on wider indications. Chemotherapy should be considered both in the adjuvant and metastatic setting for receptor-negative cancers and for patients with biologically aggressive disease. Trastuzumab should be offered to patients with Her-2/neu-positive disease, while the use of aromatase inhibitors is more uncertain due to differences in the hormonal environment in males.
