Erkek Meme Kanseri: Güncel Epidemiyoloji, Tanı ve Tedavi Yaklaşımları
Özet
Giriş: Erkek meme kanseri (EMK), tüm meme kanserlerinin %1'inden azını oluşturan nadir bir hastalıktır. Kadınlara kıyasla daha geç yaşta (ortalama 68-71) ve çoğunlukla ileri evrede tanı alması nedeniyle epidemiyolojik, biyolojik ve yönetimsel farklılıklar göstermektedir. Bu derleme, EMK'nin risk faktörleri, patolojik özellikleri, tanı süreçleri ve güncel tedavi stratejileri hakkında kapsamlı bir bakış sunmaktadır.
Yöntem ve Bulgular: EMK için en güçlü risk faktörü BRCA2 gen mutasyonu olup, Klinefelter Sendromu gibi hiperöstrojenizme yol açan durumlar da riski artırmaktadır. Vakaların büyük çoğunluğu invaziv duktal karsinom (%90) olup, yüksek oranda Hormon Reseptörü (HR) pozitif (%90 ER) profile sahiptir. Cerrahi yönetimde meme dokusunun sınırlı olması nedeniyle sıklıkla mastektomi tercih edilir. HR pozitif erken evre hastalıkta standart adjuvan endokrin tedavi Tamoksifen'dir. Aromataz İnhibitörleri (AI) ise ancak GnRH agonisti ile kombine edilerek kullanılmalıdır. Yüksek riskli ve BRCA mutasyonu taşıyan hastalarda CDK4/6 inhibitörleri (Abemasiklib) ve PARP inhibitörleri (Olaparib) dahil olmak üzere kadın hastalara yönelik kılavuzlardan elde edilen bilgiler ışığında hedefe yönelik tedaviler uygulanmaktadır. Metastatik hastalık yönetimi, HR pozitifliğin yüksek prevalansı nedeniyle endokrin tedavinin ağırlıklı olduğu, kadın meme kanseri algoritmalarına dayanır. Tedaviye bağlı yan etkiler (ör. tamoksifene bağlı cinsel disfonksiyon) ve düşük hasta uyumu, optimal tedavi süresince önemli zorluklar teşkil etmektedir.
Sonuç: Erkek meme kanseri yönetimi, nadir görülmesi nedeniyle büyük ölçüde kadın meme kanseri verilerine dayansa da, risk faktörleri ve hormon metabolizmasındaki farklılıklar nedeniyle kişiselleştirilmiş bir yaklaşım gereklidir.
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