Clinical and psychosocial differences between male and female breast cancer patients in India

Breast cancer (BC) is predominantly considered a female-specific disease; however, male BC, though rare, presents distinct clinical and psychosocial challenges. Evidence on differences in clinical features, psychological outcomes, and socio-demographic factors between male and female Indian BC patients remains limited. This study addresses this gap by examining these variations.

A total of 355 BC patients were interviewed in this cross-sectional study from two cancer hospitals in India. Data on age at diagnosis, cancer stage, symptom severity, depression scores, diagnostic delay, and socio-demographic characteristics were collected. Group comparisons were conducted using Mann-Whitney U tests, which were appropriate for skewed distributions and the small male subsample (n = 31). Multivariable regression analyses adjusted for current age, disease stage, and study site.

Females reported higher symptom severity than males (7.05 ± 3.26 vs. 4.06 ± 2.14; r = -0.255, small effect), whereas males had higher depressive symptoms (PHQ-9: 6.68 ± 3.35 vs. 4.52 ± 4.12; r = 0.173, small effect). Cancer stage at diagnosis was higher among males (2.88 ± 0.81 vs. 2.54 ± 0.93; r = 0.108, small effect). Male participants had higher BC risk-factor awareness scores than female participants (6.68 ± 2.34 vs. 5.69 ± 2.61; r = 0.119, small effect). In the unadjusted comparison, diagnostic delay did not differ significantly between male and female patients. However, after adjustment for current age, disease stage, and study site, female patients had a longer diagnostic delay than male patients (adjusted β = 0.60 months, 95% CI: 0.11 to 1.10). Adjusted differences also remained statistically significant for symptom severity (β = 3.07, 95% CI: 2.21 to 3.94), depressive symptoms (β = -1.98, 95% CI: -3.22 to -0.74), BC risk-factor awareness (β = -0.92, 95% CI: -1.70 to -0.14), and modifiable risk-factor exposure (β = -0.61, 95% CI: -0.88 to -0.33). No statistically significant adjusted differences were observed in BMI, current age, out-of-pocket expenditures or household size.

The study highlights differences between male and female BC patients in their clinical characteristics, psychological outcomes, and awareness of risk factors. Female patients show higher symptom burden and lower risk factor awareness, while males present with more advanced stages and elevated depression scores. BC care in India must move beyond a female-only focus. Screening, awareness initiatives, and psychosocial support should address the specific needs of male and female BC patients.