We thank Drs. Anderson and Devesa for their interest in our recent article.1 In their letter, they provide stage-specific incidence rates. They report that the largest increase in the incidence of male breast carcinoma was observed among patients diagnosed with in situ tumors and, to a lesser extent, in patients with localized stage disease. Conversely, incidence rates for regional and distant stage disease decreased during the 1980s and 1990s.

We are in agreement that these stage-specific incidence rates reflect trends toward earlier diagnosis. However, given that men do not undergo routine screening with either mammography or physical examination, an increased rate of detection of breast carcinoma in men over time appears unlikely. Male breast carcinoma must be clinically apparent to be diagnosed. Certainly, the continued monitoring of breast carcinoma incidence trends is of importance to determine whether male breast carcinoma incidence rates continue to rise.


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Sharon H. Giordano M.D., M.P.H.*, Aman U. Buzdar M.D.*, Gabriel N. Hortobagyi M.D.*, * Department of Breast Medical Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas.