Understanding Breast Cancer in Men

By: Dr Tanvi Sood

Breast cancer in men might sound like a term that many would think that we are making up. We are not. Breasts are often talked about and around women. Men with breasts are tabooed and looked down upon, even though they might be leading a healthy life.

There is a plethora of information trending on the prevention, early diagnosis and treatment of different types and stages of cancer. Of these, breast cancer, the number one cancer found in women, is covered exhaustively.

But have you ever wondered, can men get breast cancer? The answer is a resounding yes! In fact, 1% of all breast cancer cases reported in India are male breast cancer and most cases are diagnosed at an advanced stage, often due to a delay in seeking treatment because of a lack of awareness.

With our world becoming more open to terms that were never understood in the past, it  is now of high importance to understand that breast cancer in male is highly possible and men should not feel ashamed of their body. 

Breast cancer in men

While men don’t have breast tissue the same way women do, the amount can be compared to the amount of breast tissue seen in prepubescent girls. Breast cancer in men starts from these tissues, which are situated behind the nipple. 

What are the risk factors for developing breast cancer in men?

While having risk factors does not mean that a male will definitely get breast cancer, it is important to be aware of them for prevention and early intervention:

  • Age: The risk for breast cancer increases with age. Most male breast cancers are found after age 50 but can occasionally affect younger men.
  • Genetic mutations: Mutations in certain genes, such as BRCA1 and BRCA2, increase breast cancer risk.
  • Strong family history of breast cancer: Risk for breast cancer is higher in a man if a close family member (specially mother, father, sibling, child) has had breast cancer or ovarian cancer.
  • Radiation therapy treatment: Men who had radiation therapy to the chest have an increased risk of  getting breast cancer.
  • Hormone therapy treatment: Drugs containing oestrogen (a hormone that helps develop and maintain female sex characteristics) increase men’s breast cancer risk. This is associated with prostate cancer, which includes oestrogen in the treatment regimen.
  • Genetic conditions such as Klinefelter syndrome, where there is an additional chromosome (X) increase the risk of male breast cancer.
  • Cirrhosis of the liver may lower androgen levels, which in turn raise oestrogen levels in men, thus increasing the risk of breast cancer.
  • Older men who are overweight or are obese have an increased risk of getting breast cancer than those men who are within a healthy weight range.

How can you tell if a man has breast cancer?

Signs and symptoms of male breast cancer can include:

  • A lump or swelling in the breast: The lump is usually hard, painless and does not move around within the chest. It usually happens only in one breast.The lump tends to feel bumpy, rather than smooth and gets bigger over time.
  • Redness or flaky skin such as a rash or a sore around the nipple. 
  • Irritation or dimpling of breast skin.
  • Fluid oozing from the nipple (discharge) – this may sometimes contain blood.
  • Pulling in of the nipple or pain in the nipple area.
  • Small bumps in the armpits.

Is a lump in male breast always cancer?

While a lump in the male breast can be cancer, there are other conditions such as gynecomastia (enlarged breast tissue), lipoma (a fatty deposition that tends to move), or a cyst (fluid filled bump) which could also be the cause of the lump. However, if a man feels a lump in his breast, he must go to a specialist as soon as possible as diagnosis is usually missed or delayed because of reasons like lack of awareness. A lot of times many overweight men miss feeling the swelling under the nipples that is often painless.

What are the tests commonly done to evaluate a male breast lump

After taking a detailed history, including family history and a thorough physical examination, which includes the armpits, we may suggest the following tests and procedures:

  • Blood tests: Blood tests such as complete blood count (CBC), to check for overall health status and blood indicators that may suggest cancer.
  • Mammogram: An x-ray of the breast, known as a mammogram, is done to look for any lumps or unusual areas.
  • Biopsy: If a lump is found in the breast, a biopsy will be done to check if it’s cancer.
  • Ultrasound: An ultrasound may be done of the breast to see if it’s solid or fluid filled (a solid lump is more likely to be cancerous).

In addition, we may suggest genetic tests and counselling in case there is a strong family history of breast cancer.

Can breast cancer in men be treated?

Men diagnosed with male breast cancer at an early stage have a better chance for a cure. Similar to women, the treatment of breast cancer in men depends on the size of the tumour and how far it has spread. 

Treatment may involve one or more of the following procedures: 

  • Breast cancer surgery: Removal of the breast tissue (either through mastectomy – complete breast removal or breast conserving surgery) along with axillary lymph node sampling is a typical course of treatment.
  • Chemotherapy: Given orally or IV, chemotherapy involves using cancer medicine to stop the growth of cancer cells by either killing the cancer cells or stopping them from dividing.
  • Radiation therapy: It is a type of cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells or keep them from growing. 
  • Hormone therapy: It is a type of cancer treatment which removes hormones or blocks their actions to stop cancer cells from growing. 
  • Targeted therapy: It is a type of cancer treatment where drugs or/and other substances (such as monoclonal antibodies) are used to identify and attack specific cancer cells.

How can men reduce the risk of getting breast cancer?

Here are some ways men can reduce their risk of getting breast cancer: 

  • Maintaining a healthy weight: Being overweight and obese has been linked to several cancers, including breast cancer. Following a well balanced diet, along with routine physical activity, is the best way to reduce the risk of breast cancer.
  • Exercising regularly: Studies have shown that moderate to vigorous physical activity reduces the risk of breast cancer in women as well as many other types of cancer. In fact, the American Cancer Society recommends adults get 150 – 300 minutes of moderate intensity or 75 – 150 minutes of vigorous intensity physical activity, throughout the week. 
  • Limiting alcohol intake: Alcohol use is linked to increased risk of developing breast cancer in both men and women and is one of the most important preventable risk factors.

Can males survive breast cancer?

The best chances for survival with any cancer, including male breast cancer is, early intervention and prompt treatment. Unfortunately, due to a lack of awareness, men tend to not realise they may be at risk for breast cancer and do not notice lumps or only go to the doctor when they get too big.

Men should take the opportunity to ask their doctors about what to look out for, especially if they have a family history of breast cancer, cancer of the pancreas or/and any other significant family history. The earlier the diagnosis is made, the better the chances are of recovering completely. 

Conclusion

Breast cancer like any other cancer in a male body is nothing to be ashamed of. Men while doing their physical exam should also make sure to look for lumps even in and around their chest. Like any other cancer, breast cancer has high chances of treatment when the detection has been done during the early stages. As said, prevention has always been better than any cure.

About the Author

Dr Tanvi Sood is a Consultant Medical Oncologist, MD General Medicine, DrNB Medical Oncology (Manipal),MRCP (UK) Medical Oncology European Society of Medical Oncology. She has a six years cumulative experience as a specialist and has special interests in Breast cancer, Urological cancers, Gynaecological cancers, Lung cancers and Preventive oncology.

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