The day honoring fathers is celebrated in the United States on the third Sunday of June. The celebration of Father’s is essential; therefore, this June month, we acknowledge ALL men and educate them and others on male breast cancer.
Male Breast Cancer
Although breast cancer is much more common in women, men do have a small amount of breast tissue and can develop breast cancer. Doctors aren’t sure what causes breast cancer in men, but what they do know is that it usually occurs when the breast cells divide more rapidly than healthy cells. These cells then develop a tumor and metastasize to nearby tissue. In men, breast cancer can develop in a few different places. One of them is the milk ducts. This is usually where most men develop breast cancer. Another area where men can develop breast cancer is in the lobular carcinoma, also known as the milk-producing glands, though this is a rarer type of cancer for men.
Both men and women have breasts of fatty tissue, fibrous tissue called stroma, nipples, ducts (tubes that carry milk to the nipples), and lobules (milk-producing glands). During puberty, the hormones in girls’ bodies cause their breast tissue to grow. The hormones in boys’ bodies restrict the growth of their breasts, so their breast tissue stays smaller.
Under-treatment of male breast cancer seems to account for much of the difference in survival rates. Overall survival is how long a person lives and whether the cancer grows. Like breast cancer in women, breast cancer in men can be hormone-receptor-positive or hormone-receptor-negative, as well as HER2-positive or HER2-negative.
Because the number of cases of breast cancer in men is relatively small compared to the number of cases in women, treatment decisions for male breast cancer are usually based on studies in women.
Commonality in Male Breast Cancer
Fortunately, more clinical trials of breast cancer treatments are now including men. If you’re a man who has been diagnosed with breast cancer, it’s worth finding out if you can enroll in a clinical trial of a treatment that might be beneficial for you. Some men who’ve had breast cancer say they felt shocked and isolated by their diagnosis because everyone views breast cancer as a women’s disease. Many say they had never met other men who had breast cancer. It’s important to know that support is available through groups.
Symptoms
Physical changes in your breast tissue are often the first noticeable signs of breast cancer. Male Breast Cancer Symptoms Include:
- A firm, painless lump in your breast tissue behind your nipple or armpit.
- The skin on your chest looks dimpled or pitted, like the skin of an orange.
- Red, flaky, or scaly skin on your chest or near your nipple.
- Pain or tenderness in your chest or underarm.
- Clear or bloody nipple discharge or an inverted nipple (a nipple that’s sunken inward instead of sticking out).
What Causes Male Breast Cancer?
Uncontrolled cell growth in your breast tissue causes male breast cancer. Tumors form when healthy cells transform into cancer cells. Unlike healthy cells, cancer cells multiply rapidly and don’t die. Eventually, cells from the tumor may break off and travel to other parts of your body via your lymphatic system or bloodstream. Cancer that’s spread is called metastatic. Treatment for breast cancer that’s spread will differ in some ways from cancer that is contained in your breast and lymph nodes. Scientists continue to research what causes healthy cells to become cancer cells. In the meantime, they’ve identified several factors that may increase your risk of developing breast cancer.
Risk Factors
Factors that increase the risk of male breast cancer include:
- Older age. The risk of breast cancer increases as you age. Male breast cancer is most often diagnosed in men in their 60s. Male breast cancer diagnoses are more common in people who are Black.
- Exposure to estrogen. If you take estrogen-related drugs, such as those used for hormone therapy for prostate cancer, your risk of breast cancer increases. Other conditions that raise your estrogen include obesity and cirrhosis of the liver, which can reduce male hormones and increase female hormones, increasing your risk of breast cancer.
- Estrogen-containing medications: Taking estrogen-containing drugs can increase your cancer risk. These include hormone replacement, including medicines taken as part of feminizing hormone therapy. A recent study suggests that among people assigned male at birth, transgender women who receive hormone therapy are more likely to develop breast cancer than cisgender men.
- Family history of breast cancer. If you have a close family member with breast cancer, you have a greater chance of developing the disease.
- Klinefelter’s syndrome. This genetic syndrome occurs when boys are born with more than one copy of the X chromosome. It causes abnormal testicle development, and as a result, men with this syndrome produce lower levels of certain male hormones (androgens) and more female hormones (estrogens).
- Testicle disease or surgery. Your risk increases if you’ve had surgery to remove a testicle (orchiectomy), an injury, or a condition involving your testicles. These include having inflamed testicles (orchitis) or undescended testicles.
- Radiation therapy: You’re more likely to develop breast cancer if you’ve had prior radiation therapy directed at your chest or torso. Cancer treatment that alters hormone levels, such as androgen deprivation therapy for prostate cancer and orchiectomy for testicular cancer, is also associated with an increased risk of breast cancer in those assigned male at birth.
Other Risk Factors Include:
- Genes: Mutations (changes) in your genes increase your risk of developing breast cancer. These include changes in the BRCA.
- Smoking is one of the leading causes of breast cancer. Heavy alcohol use also is associated with breast cancer, possibly, in part, because alcohol can increase estrogen levels.
Breast Size and Your Risk
Gynecomastia, the enlargement of male breasts, is a common condition that affects approximately 70% of adolescents assigned male at birth. It resolves about 45% of the time in those cases. However, 25% have gynecomastia that lasts into adulthood. Medications, being overweight, and liver disease can cause gynecomastia in adults assigned to males at birth. Gynecomastia is not thought to increase the risk of breast cancer, but you should discuss it with a healthcare provider, as there may be a medical cause behind it.
Hormone Imbalance
Hormone imbalance, whether caused by disease or medication use, can increase the risk of breast cancer in those assigned male at birth. Often, hormonal therapy is necessary for the treatment of illness or to improve a person’s quality of life.
Keep in mind that transgender women and transfeminine people who use estrogen therapy have an increased risk of breast cancer compared to cisgender men. That risk is estimated to be about the same as those assigned to females at birth. If you are a transgender woman or a transfeminine person, be sure to discuss screening mammograms with a doctor.
Lifestyle Risk Factors
Excessive weight is another risk factor as well, as it alters hormone levels in the body, increasing the production of hormones that promote breast cancer initiation and growth.
Diagnosis
While those assigned female at birth who are over 40 are advised to get screening mammograms, people assigned male at birth are not generally advised to have this test because it is low yield for people who have a low risk of breast cancer. That said, if you have a strong family history of breast cancer, then you may need genetic testing and periodic screening tests to identify breast cancer.
The diagnosis of breast cancer in cisgender men is usually initiated after symptoms develop. In these cases, a mammogram may be used for diagnostic purposes. A healthcare provider may also order a breast magnetic resonance imaging (MRI) scan and a biopsy (removing a sample tissue for testing in a lab) to identify the tumor and determine its stage, grade, and type. You may also need to have imaging and/or a biopsy of nearby lymph nodes so your medical team can check whether the tumor has spread.
Follow-Up and Recurrence
The risk of recurrence of breast cancer, which can occur up to 15 years (and beyond) the initial diagnosis, persists for all breast cancer survivors. While late recurrences (recurrences five or more years after diagnosis) have not been studied in assigned males as they have been in assigned females, assigned females who have estrogen-receptor-positive tumors are more likely to have the cancer return after five years. Potential symptoms of recurrence in assigned males include new lumps, bone pain, shortness of breath, chest pain, abdominal pain, and persistent headaches.
Follow-up differs across sex in a few ways. Assigned males who undergo a lumpectomy should have an annual mammogram of the involved breast. This contrasts with breast MRIs recommended for assigned females.
Also, unlike assigned females, the risk that assigned males will develop breast cancer in their noninvolved breasts is low, and screening mammograms on the noninvolved breast is not recommended unless a hereditary mutation has been identified.
Male Breast Cancers Related to BRCA1 and BRCA2
Generally, breast cancers related to a BRCA1 or BRCA2 (BRCA1/2) inherited gene mutation are treated the same way as breast cancers not related to a BRCA1/2 gene mutation.
However, some drug therapies may be more effective in treating BRCA1/2-related breast cancers than other breast cancers.
Male Breast Cancer and Genetic Testing
The National Comprehensive Cancer Network (NCCN) recommends all men diagnosed with breast cancer have genetic testing for BRCA1 and BRCA2 (BRCA1/2) inherited gene mutations. If you have inherited a damaged gene, the risk of developing breast cancer or other cancers can be as high as 80%, depending on the specific gene and your family history. Whether you get tested for genes that put you at risk for cancer is a personal decision and should be considered carefully with the help of your doctor and family.
Regular monitoring and preventive surgery are options to discuss with your doctor if you are at risk for hereditary breast cancer. Deciding to undergo testing is a difficult decision. It is essential to consider the potential impact of test results on one’s well-being, career, family, and other aspects of life. Knowing the results could affect your health and other family members, including your siblings and children. For instance, someone with a genetic mutation has about a 50% chance of passing that trait to his or her children.
Your doctor might want to discuss gene testing with you if:
- Someone in your family has tested positive for carrying a mutated gene
- You are of Ashkenazi Jewish ancestry
- You were diagnosed with breast cancer before age 50
- A man in your family has been diagnosed with breast cancer
- You were diagnosed with ovarian cancer
- There are multiple breast cancers on one side of your family
- You or a relative has had cancer diagnosed in both breasts
Genetic testing may start with a family member who has already developed breast or ovarian cancer. If this person is positive for a mutation, other family members can be tested for the same mutation to determine who has inherited that risk factor. If no one in the family is known to carry a mutation, the test is considered “non-informative,” meaning it cannot identify family members at risk. If testing confirms you are at risk, your care provider can work with you on a plan to safeguard your health, which could include:
- High-Risk Evaluation and Monitoring
- Screening schedules, including digital mammography and clinical breast exams
- Hormonal therapy medications designed to prevent the development of breast cancer.
- Preventive (prophylactic) surgery, such as mastectomy with breast reconstruction, is necessary only for patients at very high risk for aggressive breast cancer.
Stages of Male Breast Cancer
The stage of cancer, sometimes called TNM (tumor, node, metastasis), determines the type of treatment a patient should receive. It is calculated based on several factors:
- the size of the tumor (T)
- whether or not the cancer has spread to the axillary (armpit) lymph nodes, and if so, to how many (N)
- if the cancer has spread to other lymph nodes of the neck or chest area or other parts of the body (M)
Tests that may be used to determine how far breast cancer has spread include a chest x-ray and blood tests. In some cases, a physician might also order a bone scan, a CT scan, a PET scan, or an MRI scan to assess the extent of the disease.
Breast cancer is also staged by number, based on the size of the tumor and how far it has spread.
Stage 0 Male Breast Cancer
Stage 0 is also called ductal carcinoma in situ (DCIS). In DCIS, cancer cells are still within a duct and have not invaded deeper into the surrounding fatty breast tissue. Paget disease (a very rare cancer of the nipple in men) is also stage 0 if there is no underlying tumor mass.
Stage I (1) Male Breast Cancer
Stage I describes a tumor that is 2 cm or less and has not spread to the lymph nodes, or — if it has spread there — the cancer in the lymph nodes is microscopic (less than 2 mm in size).
Stage II (2) Male Breast Cancer
Stage II describes a tumor that is between 2 and 5 cm or has spread to a few lymph nodes in the armpit.
Stage III (3) Male Breast Cancer
Stage III describes a tumor that has spread to a greater number of lymph nodes in the armpit or has spread to other lymph nodes, such as those above the collarbone. It may have also grown into the chest wall.
Stage IV (4) Male Breast Cancer
Stage IV cancer can be any size and may or may not have spread to nearby lymph nodes. It has spread to distant organs (the most common sites are the bones, liver, brain, or lungs) or to lymph nodes far from the breast.
Tumor Grade
Tumor grade is an evaluation of how abnormal or disorganized the cells from a tumor appear when examined under a microscope. In general, a lower grade implies a less aggressive tumor.
Lymph Vascular or Perineural Invasion
Sometimes, tumor cells can invade the blood vessels, lymph, or nerve channels within breast tissue.
Radiation Therapy for Male Breast Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. It may be used after surgery to destroy any cancer cells that remain in the breast, chest wall, or underarm area.
If a patient needs chemotherapy after surgery, he also may receive radiation treatment once chemotherapy is completed. The oncologist, breast surgeon, and radiation oncologist will work together to decide the best sequence of treatments.
How the radiation therapy is given depends on the stage of the cancer being treated and the results of the pathology tests after breast surgery.
The usual course of radiation therapy includes daily treatments five days a week for five to seven weeks. By giving smaller amounts of radiation each day, rather than all the radiation at once, the radiation oncologist ensures that most healthy cells have the time to repair radiation-induced damage between treatments while cancer cells become inactive.
Each radiation session generally lasts less than an hour. Radiation is routinely given after breast-conserving surgery and is sometimes used after mastectomy depending on the number of lymph nodes with cancer, the size of the cancer, and how far away the tumor is from the margin or edge of the breast tissue that was removed.
Breast Cancer in Men statistics:
- Localized cancer has not spread outside of the breast. The survival rate is 95%–98%
- Regional cancer spreads outside the breast to nearby structures or lymph nodes. The five-year survival rate is 83%
- Distant cancer has spread to distant parts of the body, such as the lungs or brain. The five-year survival rate ranges from 19%–26%
- About 47% of all cases are found and diagnosed at the localized stage
- Men diagnosed with male breast cancer at an early stage have a good chance of a cure. Treatment typically involves surgery to remove the breast tissue. Other treatments, such as chemotherapy and radiation therapy, may be recommended based on their situation
Summary
The overall five-year survival rate is 80%–84%; however, the 5-year survival rate for men with breast cancer differs substantially based on how far the cancer has spread. The following are 5-year survival rates based on where cancer has spread: American Society of Clinical Oncology.
If you are concerned that you or someone you know may be dealing with breast cancer, knowing what to look for will help you determine your next steps. Much like women, men should also be encouraged to check for lumps. Self-checks play an essential role in detecting breast cancer early. When looking for male breast cancer, one of the main signs will be a lump in the breast that feels like a hard pebble.
Other symptoms that show breast cancer may have developed are nipple pain, lump(s) under the nipple or in the armpit, nipple discharge and its turning inward, changes in the breast (puckered, redness, soreness, dimpling, etc.), change in the shape of the breast and more. These are the same signs that women look for if breast cancer is developing.
REFERENCES
BlackDoctor.ORG
BreastCancer.org
City of Hope
Cleveland Clinic
John Hopkins Medicine
Mayo Clinic
Memorial Sloan Kettering Cancer Center
Very Well Health
