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Breast cancer in men: A Q&A

John Foulston male breast cancer

National Breast Cancer Awareness Month in October is a time to shine the spotlight on the importance of early detection of the disease. Most people are aware of breast cancer, but it’s important to have a plan to detect the disease in its early stages and encourage others to do the same.

I am often asked, “Can men get breast cancer?” The answer is yes, it can happen, but it is fairly rare. In the U.S., one man will get breast cancer for every 100 women who do. Nearly 2,000 men a year in the U.S. are diagnosed with breast cancer. The overall risk of a man developing breast cancer is one out of 1,000 — the risk for women is one in 10.

How does breast cancer occur in men?

Boys and girls are both born with a small amount of breast tissue. At puberty, a girl’s ovaries make female hormones which cause the breast ducts to grow and lobules to form at the end of ducts. Later, the lobules and ducts work together for breast feeding. Boys go through puberty and their testicles make hormones that restrict further growth of breast tissue, but men still have a small amount of non-functioning breast tissue. A man’s breast cells can undergo cancerous changes. Breast cancer in men is much less common than women, because their breast duct cells are less developed and because their breast cells are not constantly exposed to female hormones.

How is breast cancer identified in men?

Breast cancer in men is usually diagnosed by a physician’s exam or by a patient’s self-exam. The most common symptoms are a lump in the chest area, skin dimpling/puckering, or nipple changes. The mass is often irregular, firm or hard and fixed to the skin or muscle. The lump usually does not hurt. If breast cancer spreads to other parts of the body, then symptoms such as bone pain, malaise, weakness and weight loss may occur.

Men may not realize that they can develop breast cancer, and this can delay their diagnosis. Because men have less breast tissue than women, their cancer will be able to grow into the skin or chest muscles quicker than in women and this makes the surgery to remove the cancer more difficult. It is therefore much easier to treat male breast cancer surgically when it is caught early. The survival rates for breast cancer are the same for men and women and are based on how advanced the cancer is.

What are the types of male breast cancer?

The most common type of male breast cancer is also the most common type of female breast cancer. It is called infiltrating or invasive ductal carcinoma. The cancer cells originate in the breast ducts and then spread out into the surrounding tissues. The other type of breast cancer called lobular is rare in men because they do not normally have breast lobules (milk glands). Most male cancers (85 percent) have receptors on their cancer cells for estrogen. Estrogen binds to the cancer cells and stimulates cell growth and enlargement of the cancer. There are a number of hormone medications that can prevent this from occurring and are excellent breast cancer drugs.

What type of tests will be done to diagnose the breast cancer?

Your doctor will do a complete medical history and physical exam including a breast exam. Often a mammogram and sonogram will be completed. Mammograms can be done in men and have a high accuracy in separating cancer from the more common condition of gynecomastia, a benign condition where the male breast begins to enlarge similar to a female breast. You will most likely have a breast biopsy to determine if the lump is cancerous. This biopsy is often done with a needle either in the radiology department of your surgeon’s office.

Are there any conditions that increase the risk of breast cancer in men?

Yes:

  • If a man has a strong family history of breast cancer (male or female relatives) or if there is a genetic mutation in the family (BRCA2 mutation).
  • A genetic condition such as Klinefelter’s syndrome increases estrogen levels which can increase the risk.
  • Breast cancer in men, just like in women, is more common as they get older.
  • Other factors that increase risk include chronic liver disorders, alcoholism and obesity because they increase the amount of estrogen.
  • If a man or woman was exposed to ionizing radiation to their chest as a teenager or young adult, their risk is increased.

What is the treatment for breast cancer in men?

Treatments for breast cancer in men are the same as for women. A mastectomy is a surgical procedure to remove the breast with the cancerous growth and is generally recommended as the best choice for male breast cancer. Your lymph nodes will need to be checked at the time of surgery as well and may be done with a Sentinel Node biopsy or an Axillary Node dissection. After surgery, your stage will be determined (how advanced the cancer is). The need for chemotherapy, hormone therapies and radiation is determined by stage and the characteristics or biology of the tumor. Radiation is often given if lymph nodes are involved or the cancer was growing into the muscle.

What is the outcome for men with breast cancer?

It is very similar to the prognosis in women. The overall survival rate for each stage of breast cancer is similar in men and women.

The five-year survival rate for Stage 1 is 96 percent; Stage II is 84 percent; Stage III is 52 percent and Stage IV is 24 percent. Educating men about the possibility of breast cancer is important, so the cancer can be caught in the earliest stage. 

About Patty Tenofsky MD FACS

Patty Tenofsky, MD, FACS, is a breast care specialist with Ascension Medical Group at Founders' Circle in Wichita, Kansas.