Who Is Caring for Male Veterans with Breast Cancer? A National Analysis of Surgical Burden Within the Veterans Health Administration

Introduction The epidemiology of breast cancer among men is poorly characterized. As the Veterans Health Administration (VA) serves a disproportionally male population, a larger percentage of breast cancer cases diagnosed and treated in VA are among male patients. However, whether current breast oncology operational infrastructure is prepared to address this need is unclear. Materials and Methods The VA Breast and Gynecologic Oncology System of Excellence (BGSoE) established a tracking dashboard for all incident breast and gynecologic malignancies in VA in 2021. All breast surgery cases within the VA performed on male Veterans for an indication of cancer in 2023 were reviewed and mapped by the Veterans Integrated Service Network (VISN). Operative cases performed for gynecomastia were excluded. To determine the total affected population, incidence of male breast cancer was calculated using data from the Surveillance, Epidemiology, and End Results (SEER) database. Breast surgeries, reported as a fraction of incident cases, were plotted. The number of active surgeons performing breast surgery in 2023 was garnered from the staff surgeon identified in the BGSoE dashboard. Results Based upon SEER age-adjusted estimates of breast cancer in men nationally and current Veteran census data, there were estimated to be 188 incident cases of breast cancer among male Veterans in 2023. In comparison, 82 (44%) male Veterans underwent surgery for their breast cancers in VA in 2023. The median age of the cohort was 72 years (interquartile range 58-78). Geographic variability in surgical volume was noted, with the number of surgeries performed in each VISN ranging from 0 to 13 cases. VISNs performed between 0% and 112% of the expected number of cancer operations for male Veterans. All VISNs had at least 1 surgeon performing breast surgery among this population in 2023 (range: 1-15). Conclusions There is wide variation in incident cases of breast cancer among male Veterans treated in VA. Whether these geographic differences are reflective of differential incidence, discrepancies in access, or availability of breast oncology health services is unclear. Although most patients with breast cancer do present with resectable disease, the proportion of incident cases among male Veterans by our estimates with stage IV disease (not amenable to surgery) cannot be ascertained. Future work will be aimed at characterizing availability of multidisciplinary breast cancer care in VA.