Breast cancer in men

ALSO KNOWN AS: Infiltrating or invasive ductal carcinoma, ductal carcinoma in situ, inflammatory breast cancer, Paget disease of the nipple

RELATED CONDITIONS:Gynecomastia, fibroadenomas, papillomas

DEFINITION: Breast cancer occurs in men when malignant (cancerous) cells develop in the breast tissue of the male breast. The cancer can then spread into other tissues.

Risk factors: Advanced age is a for men, just as it is for women. From 2017 to 2021, the mean age of diagnosis for male breast cancer was sixty-nine, according to the Susan G. Komen Foundation. Men who have a close female relative with breast cancer are at risk and may be evaluated for the presence of a mutation in the BRCA2 gene. The ACS reports that men with the mutation have about a 6 percent lifetime risk for breast cancer. Other risks include radiation exposure (which may be occupational but is more often a result of treatment of other cancers) and liver disease, such as cirrhosis, which causes an increase in estrogen and a decrease in androgen hormones. Obesity and smoking may also play a role as risk factors.

Many male breast cancers are estrogen-receptor-positive, which means that estrogen will increase the risk of development or accelerated growth of the cancer. Estrogen is given to some men to slow the growth of prostate cancer and is used by some men who are undergoing sex reassignment. One risk specific to men for the development of breast cancer is Klinefelter syndrome, a genetic mutation involving at least one extra X chromosome that affects one in five hundred to one thousand male babies born each year, as reported by the National Institute of Health in 2024. These men have higher levels of estrogen and lower levels of androgens and therefore are at particular increased risk.

Etiology and the disease process: There are a number of risk factors for male breast cancer, but none of the known causes can be eliminated. Most male breast cancers are invasive, infiltrating ductal carcinomas and are far more treatable in early localized stages. Therefore, efforts should be concentrated on early identification and treatment by increasing awareness of risk factors, heightening surveillance of those with nonmodifiable risks, and attempting to change those risks that can be modified.

Incidence: Both men and women have breast tissue, and breast cancer occurs in men but is much rarer in men than in women, comprising only 1 percent of all breast cancers. The ACS estimated in 2013 that in the United States in 2014 more than 2,300 cases of invasive male breast cancer would be diagnosed and about 430 deaths would occur. The ACS's 2018 estimates included a diagnosis of 2,550 new cases of invasive male breast cancer. They estimate that approximately 480 deaths occurred from the disease. In 2023, the ACS estimated about 2,790 new cases of invasive breast cancer were diagnosed in men and about 530 deaths would occur. They also estimated the risk of contracting breast cancer was about 1 in 726.

Symptoms: Symptoms of breast cancer in men include breast lumps as well as nipple and skin changes. The cancer is most often diagnosed when a man goes to his doctor after finding a mass below the nipple in one breast.

Nipple changes can include redness or patchy scaling of the skin, nipple retraction (pulling inward), and nipple discharge. Skin changes may include puckering and dimpling as well as redness and scaling; however, chest hair may obscure subtle skin changes, and men are not accustomed to examining their breasts in a way that would help them find early lumps. Even when men find early symptoms, they may be misinformed about male breast cancer or embarrassed and delay seeking medical care.

Screening and diagnosis: Providing information that male breast cancer does occur and describing early symptoms may be the best screening tools to offer. Screening for male breast cancer is not common among primary care providers, but if a lump is detected or brought to the provider’s attention by the patient, the first step is a mammography done with spot compression or magnification and possibly ultrasound, followed by a biopsy. A biopsy is the only definitive way to diagnose breast cancer.

Staging of cancer assesses the size, location, lymph node involvement, and degree of metastasis of the cancer, ranging from Stage 0, which is the earliest stage, to Stage IV, which is the most advanced.

Treatment and therapy: Treatment usually involves surgery to remove the breast tissue and often lymph nodes and some of the chest muscles as well. Sentinel lymph node biopsy can be used to attempt to avoid more radical removal of lymph nodes. Radiation therapy and may be employed.

If the cancer is determined to be estrogen-receptor-positive, the antiestrogen drug tamoxifen can be used to slow the growth and reproduction of cells that require estrogen. Another drug used in treatment is megestrol, an antiandrogen drug that blocks the effects of androgen in the breast.

Prognosis, prevention, and outcomes: Prognosis is similar for male and female breast cancer when cancers of the same stage are compared. However, male breast cancer is not often discovered as early as is female breast cancer. Early detection is especially important because men have less breast tissue than women, and therefore their cancers can more easily reach and invade the chest muscles. Age at diagnosis and general health influence outcomes. With advanced medical care, five-year survival rates as of 2024 varied from 95 percent for cancers caught in Stage 0 to 20 percent for cancers that had progressed to Stage IV, as reported by the ACS. Prevention efforts center on screening for risk factors that may heighten surveillance for disease and on patient education about early self-detection of changes in the male breast. Outcome also depends on prevention of recurrence, and increased screening as well as adjuvant chemotherapy may improve long term outcomes. As with advances in detecting and treating female breast cancer, the ACS reports that genetic testing for genes that contribute to breast cancer, such as the BRCA1 and BRCA2 mutations, continues.

Bibliography

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“How Many People Are Affected by or At Risk for Klinefelter Syndrome (KS)?” National Institute of Child Health and Human Development, 9 Jan. 2024, www.nichd.nih.gov/health/topics/klinefelter/conditioninfo/risk. Accessed 6 July 2024.

“Key Statistics for Breast Cancer in Men.” American Cancer Society, 19 Jan. 2024, www.cancer.org/cancer/types/breast-cancer-in-men/about/key-statistics.html. Accessed 6 July 2024.