What is Male Breast Cancer?
Although breast cancer is typically associated with women, it can also develop in men. This is due to the fact that men, though in small amounts, have breast tissue that can potentially turn cancerous, in the same manner as it does in women, albeit less frequently. Male breast cancer is relatively rare, making up just 1% of all breast cancer cases, but it does happen, and it’s important to be aware of its possibility.
In the United States, about 2,800 men are diagnosed with breast cancer every year. Sadly, breast cancer in men is often detected late which results in high mortality rates. However, when comparing the same stages of the disease, survival rates for both men and women are similar.
What Causes Male Breast Cancer?
When talking about the causes of breast cancer in men, we need to look into the possible genetic or environmental factors. It’s important to understand that a majority of men diagnosed with breast cancer don’t have clear risks except being older (the average age of diagnosis being 71).
Just like women, men’s risk of breast cancer increases if they have a close relative (a parent or a sibling) who has had breast cancer. Research has found that if a parent or a sibling, regardless of the gender, had breast cancer, it can increase the risk of breast cancer in siblings, be it males or females. The risk is similar whether the parent suffering from breast cancer is the father or the mother. However, in the case of siblings, the risk for sister increases more if the brother had breast cancer.
In addition to family history of breast cancer, men with certain genetic mutations, such as BRCA mutations, are also at a higher risk. Even though it’s rare for men to have BRCA mutations, those with a a mutation called BRCA2 have a 6% increased risk of getting breast cancer, while those with a mutation called BRCA1 have a 4% increased risk. Other genetic conditions, such as Klinefelter syndrome, Cowden syndrome, Li-Fraumeni syndrome, and Lynch syndrome, have also been linked with higher risks of breast cancer in men.
The imbalance of estrogen and androgen hormones is a significant factor in male breast cancer. Estrogen, a hormone that promotes the development of breast ducts, can potentially increase the risk of breast cancer in men, just like in women. Certain conditions and lifestyle choices, such as obesity, marijuana use, liver diseases, thyroid diseases, and medications containing estrogen, could raise estrogen levels and hence, the risks. Similarly, conditions that decrease androgen hormones, such as cryptorchidism, orchitis, and orchiectomy, might increase the ratio of estrogen, adding to the risk.
Environmental factors also have a role to play in increasing the risk of breast cancer in men. Like in women, prior radiation therapy has been identified as a potential risk factor. Patients who’ve had radiation therapy to treat gynecomastia (enlargement of breast tissues in men) were found to have a 7 times higher risk of breast cancer. Occupations involving exposure to certain environments or substances, such as steel and rolling mills or organic solvents like trichloroethylene, have been associated with an increased risk of breast cancer in men.
Risk Factors and Frequency for Male Breast Cancer
Male breast cancer is pretty rare compared to female breast cancer—it’s responsible for only 1% of all breast cancer cases and affects one man for every 100 women who get it. In terms of cancer in men, it accounts for just 0.5% of all diagnoses. However, there has been a bit of worry recently as the number of men getting breast cancer has been going up. Researchers think that diet may play a role, alongside other risk factors like obesity and alcohol, but there’s no firm evidence yet. What’s also intriguing is that many men who are diagnosed with breast cancer don’t seem to have any known risk factors.
Signs and Symptoms of Male Breast Cancer
When men come to see the doctor, they frequently describe a painless lump in one breast. Other possible signs can include inward-turning nipple, nipple discharge, sores, and pain. It’s often easier to notice these lumps in men than in women because men usually have smaller breasts. However, enlarged male breasts (a condition known as gynecomastia) could make noticing these symptoms more challenging. It’s also important to discuss any family history of breast cancer, the patient’s personal medical history, job, and if they’ve previously been exposed to estrogen or radiation.
Testing for Male Breast Cancer
The process of diagnosing Male Breast Cancer (MBC), like breast cancer in women, includes three steps: clinical assessment, mammography, ultrasonography, and a core biopsy. Mammography, a type of breast imaging that uses low-dose x-rays, is quite powerful at correctly identifying MBC, with a sensitivity (ability to correctly identify the disease) of 92% and a specificity (correctly identifying healthy individuals) of 90%. However, due to differences in male breast size and volume, the effectiveness of this technique may sometimes be limited.
Thus, an ultrasound-guided core biopsy, a procedure where a doctor uses a needle to remove a sample of breast tissue, typically provides the most definitive diagnosis of MBC. It is often preferred to fine-needle aspiration, a similar procedure that uses a thinner needle and removes less tissue.
It’s also important to note that most male breast cancers are hormone receptor-positive, meaning they depend on certain hormones to grow and spread. This information helps doctors determine the best course of treatment.
Treatment Options for Male Breast Cancer
The treatment process for male breast cancer is much the same as it is for women with breast cancer. It generally involves removing the tumor and then following up with additional treatments such as hormone therapy, chemotherapy, or radiation therapy.
Treatment is decided based on various factors that might influence the prognosis or the course of the disease.
For cancers that are in the early stages – specifically, stages T1 and T2 – a simple mastectomy is commonly recommended. This is a surgical procedure where the entire breast tissue is removed.
For more advanced cases of cancer – T3 or higher, or cases where cancer has been found at the surgical margins or in four or more lymph nodes – radiation therapy is usually offered. This treatment uses high-energy rays or particles to kill cancer cells.
The drug tamoxifen is often recommended as ‘adjuvant therapy’ (additional treatment given after the primary treatment) and is usually taken for at least 5 years.
A majority of male breast cancers are responsive to estrogen, a hormone, and for these cases, tamoxifen is often the preferred treatment option. The drug works by blocking estrogen receptors on cancer cells, slowing or stopping their growth.
What else can Male Breast Cancer be?
When looking out for male breast cancer, doctors also watch for certain other conditions that may show similar symptoms. These include:
- Gynecomastia (an increase in the amount of breast gland tissue)
- Abscess (a collection of pus that has built up within the tissue)
- Lipoma (a lump of fatty tissue)
- Metastatic disease (cancer that has spread from another part of the body)
- Sarcomas (a type of cancer that develops from certain tissues, like bone or muscle) – though these are very rare.
Surgical Treatment of Male Breast Cancer
In less advanced stages of male breast cancer (specifically when it’s categorized as T1-T2, N0-N1), operations like simple or modified radical mastectomies are usually the preferred treatment options. These surgeries involve removing the entire breast and often some of the lymph nodes under the arm, but not the chest muscles.
Studies have shown that these types of surgeries have been as effective as more aggressive surgeries in terms of preventing the cancer from returning or worsening. In other words, more drastic surgeries do not necessarily offer a higher chance of surviving the disease or preventing its recurrence.
During surgery, it’s also common for doctors to perform axillary or sentinel lymph node biopsies. This means that some lymph nodes (small glands that filter body fluids and capture bacteria and viruses) are removed and examined under a microscope to determine if cancer cells are present. This information can help doctors further assess the stage of cancer and determine the most effective treatment plan.
Lastly, because men typically have less breast tissue than women, less invasive options that aim to conserve as much breast tissue as possible are rarely considered.
What to expect with Male Breast Cancer
Male breast cancer is often diagnosed later than female breast cancer, which can affect the survival rates. The general 5-year survival rate for male breast cancer ranges between 40% to 65%. To explain further, the rates differ depending on how advanced the cancer is, known as ‘stages’. For early stage cancer (stage I), the survival rate is between 75% to 100%. For stage II, it’s between 50% to 80%. As the illness progresses to stage III, the rate drops to 30% to 60%, and for the most advanced stage (stage IV), the rate falls to 20% to 30%.
Despite the numbers, when other factors such as age, stage of the disease, and the severity (or grade) of the disease are taken into account, men’s chances of dying from breast cancer are not significantly higher than women’s.
Recovery from Male Breast Cancer
Continual monitoring is crucial since men are at a significant risk for developing another breast lesion on the same side or the other side of their chest.
Preventing Male Breast Cancer
Regular checks for breast cancer in men aren’t common because it’s rare for men to get this type of cancer. However, it’s important for men, particularly those over the age of 35, to learn about the potential risk factors. If they have a family history of breast cancer (in both men and women), or other types of cancer that can be caused by a BRCA gene, such as ovarian, pancreatic, testicular, or prostate cancers, they should consider getting genetic counseling.
