Male Breast Cancer: Managing Endocrine Therapy and Survivorship Care

Most men with breast cancer have hormone-driven disease and may take endocrine therapy such as tamoxifen for 5 to 10 years, so adverse effects including hot flashes, mood changes, and sexual dysfunction can shape quality of life long after surgery and radiation are complete. Yet much of the evidence that guides symptom management for men is extrapolated from studies conducted predominantly in women.

In part 2 of an interview with Oncology Nursing News, Brianne Whitley, CNP, a nurse practitioner who practices primarily in breast oncology at Dana-Farber Cancer Institute in Boston, Massachusetts, described the interventions she relies on for endocrine therapy–related symptoms, including venlafaxine, gabapentin, lifestyle modification, and acupuncture, and explained why proactively asking about mood and sexual health matters. She also outlined survivorship priorities for men, including contralateral screening mammography, lymphedema surveillance, adherence support, and education on symptoms of recurrence.

Whitley closed by addressing clinical trial access. The US Food and Drug Administration (FDA) issued final guidance in August 2020 with recommendations for the development and labeling of breast cancer drugs for male patients, and Dana-Farber's Program for Breast Cancer in Men, directed by Jose Pablo Leone, MD, conducts research on the causes, treatments, and treatment adverse effects of breast cancer in men.

About 2,670 men are expected to be diagnosed with invasive breast cancer in the United States in 2026. Earlier Oncology Nursing News coverage featured a male survivor who credited his nurses with educating him at a time when few people knew the disease existed.

What targeted nursing interventions are most effective for managing the unique adverse effect profiles, such as endocrine therapy–related hot flashes or sexual dysfunction, that male patients may face during long-term treatment?

Most of our interventions are extrapolated from what we know in our female breast cancer population, because there are such limited male-specific, large sample size trials on this.

That being said, when we think about the potential side effects of endocrine therapy—whether it's hot flashes, weight changes, mood changes, sexual dysfunction—a few of the interventions from a nursing standpoint that are most helpful [include] venlafaxine, which is an SNRI. That can be used for hot flashes and the vasomotor symptoms that can come from tamoxifen administration, for example. I think that can be a particularly helpful intervention when someone is also noticing that maybe their mood is not as level as it was before taking tamoxifen.

I also think, along those lines, just opening the discussion with the patient [is important]. Sometimes our male patients may not be as likely to bring that up to you, like saying, "Yes, I am feeling a little bit more down or more irritable than my baseline." So I think it really is up to us to assess and talk about that and make room for the discussion. So that's one option.

Another option, if the hot flashes or night sweats are worse at night and impacting quality of sleep, is gabapentin. That's one we use a lot. Along with medication options, there are also lifestyle modifications that can be helpful and [that are] important to counsel our male patients on—for example, limiting alcohol, trying to manage stress, making sure that you are having a cool sleeping environment, [and] that you're exercising regularly. There's also a lot of data for acupuncture, which could also be helpful.

And then in terms of any sort of sexual dysfunction or low libido, including that in your discussion and really asking about it—in particular, if you are going to start a medication such as venlafaxine or possibly even an SSRI, acknowledging that that could also play a role in sexual dysfunction and have that negative side effect. So it's really balancing risks and benefits, [and] referring to our sexual health team or provider, or even urology, to consider PDE5 inhibitors if not contraindicated, or maybe pelvic floor PT.

So I think there's a lot that can be done, but one of the big takeaways I would say is just making sure that you are asking about it, because I do think there could be some hesitancy to bring it up in visits.

What key considerations should oncology nurse practitioners incorporate into long-term survivorship care plans to address both the physical recovery and the psychological well-being of male breast cancer survivors?

In addition to a lot of the things I just mentioned, talking about screening in the future. Male patients who have a history of breast cancer are also often offered contralateral screening mammograms, which is a little bit different [from] before their first diagnosis, where we don't have that recommendation. So I think that's important to note in survivorship.

I think it's also important to address any screening for lymphedema and educating on what the symptoms of that could be after surgery, so that you can promptly detect that and give the patient access to resources to manage that. Also, always [working] to improve the fatigue that could come after, whether it's surgery and radiation or just related to the endocrine therapy that they may have to take for 5 to 10 years, as well as the sexual health component.

Because, again, I think one thing that can be tricky is that in the breast cancer space, yes, after surgery, after radiation, we may say that you have no evidence of disease, but those treatment side effects with the endocrine therapy, or tamoxifen, as I keep mentioning—it really is something that they'd be living with for 5 to 10 years. [It's important to be] educating about that and ways to promote adherence and make it more tolerable, just to lead to better outcomes.

And then also, I think it's important to educate on any potential symptoms to bring to the attention of their team that could be suggestive of recurrence, and just really letting them know, even if it doesn't seem like a big deal, we would rather hear about it than not and talk through it together.

How can oncology nurses advocate for greater inclusion of male patients in breast cancer clinical trials in order to bridge some of these existing gaps in gender-specific evidence and guidelines?

I think that this is a challenge and something that's been ongoing. I'm fortunate in where I work that we do have a Program for Breast Cancer in Men here at Dana-Farber, and Dr. Jose Pablo Leone is the director of that, who I was fortunate enough to work with. And so with him being a big advocate in this space, and that being his clinical area of interest, and running a lot of clinical [trials], I think I'm in a space where this is something that we're doing every day.

But if you're not in a space where you have that access, I think it's really just advocating when you can. So if there is a clinical trial exclusion criterion that is only gender specific, is there room to advocate with the PI for an exception to that? [It's also important to be] involving any research nurses that you have early and often to look through the broader network at other cancer centers, and really educating our male patients to reduce the fear or any worries or misconceptions they have about going on a clinical trial—in particular when you're balancing the fact that they are also navigating a world that's predominantly directed toward females. So there's already some isolation there.

I think just the more education, the more talking about it, the more awareness, I think that can really go a long way.

Editor's note: This transcript has been lightly edited for clarity and length.

References

1. Key statistics for breast cancer in men. American Cancer Society. Updated January 13, 2026. Accessed October 20, 2026. https://www.cancer.org/cancer/types/breast-cancer-in-men/about/key-statistics.html

2. Male breast cancer: developing drugs for treatment. Guidance for industry. US Food and Drug Administration. August 2020. Accessed October 20, 2026. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/male-breast-cancer-developing-drugs-treatment

3. Program for Breast Cancer in Men. Dana-Farber Cancer Institute. Accessed October 20, 2026. https://www.dana-farber.org/cancer-care/treatment/breast-oncology/programs/breast-cancer-in-men

4. Rivera S. Nurses and practitioners inspire male breast cancer survivor. Oncology Nursing News. March 14, 2019. Accessed October 20, 2026. https://www.oncnursingnews.com/oncnurse-tv/nurses-and-practitioners-inspire-male-breast-cancer-survivor