Male Breast Cancer

William Charles, MD

 

Although male breast cancer affects approximately 2,000 men per year and is responsible for almost 400 deaths per year, it still remains a relatively unknown disease.  In fact,
many people are unaware that breast cancer can develop in men.  For reasons that are unclear, there has been a 25% increase in incidence of the disease. In this article, we will explore the risk factors, clinical features, and diagnosis of male breast cancer.

 

What are the risk factors?

In discussing risk factors, the most important issue is hormonal imbalance.  In cases of male breast cancer there is an increased amount of female hormones as compared to male hormones.  This imbalance can be seen in diseases such as liver cirrhosis, alcoholic liver disease, and testicular conditions such as orchitis and cryptorchitis (undescended testicles). 

Perhaps the most important risk for developing male breast cancer is a condition known as Kleinfelter’s Syndrome.  In Kleinfelter’s, men are born with an extra X chromosome.  These men have small testes and enlarged breast tissue (gynecomastia).  The male hormones are typically low and the female hormones are elevated in Kleinfelter’s, leading to breast tissue stimulation.  As a result, men with Kleinfelter’s have a 20-50 fold higher risk of developing breast cancer in comparison to men without the condition.  Several common medications are known to cause gynecomastia, therefore it is very important that men discuss their medications and possible associated risks with their doctor. Gynecomastia should always prompt a visit to the doctor when present.  

 

Can I get male breast cancer if a family member has it?

The question is frequently asked, “Doctor, my brother or sister has cancer.  Can I get it?” In most cases, the answer is “No”, as the majority of cancers are random and sporadic. That said, among all cancer, male breast cancer has one of the strongest familial components. The most well known and strongest familial association with male breast cancer involves the breast and ovarian cancer gene-BRCA. 

The BRCA gene is an inherited defect that occurs in the DNA of patients resulting in an
increased risk of developing breast cancer. When this gene is present in men, it increases the risk of developing breast cancer 100 fold over non-affected males.  Therefore, guidelines have been developed regarding screening for the gene.  It is suggested that all men with breast cancer and their children are tested for the BRCA gene.  Additionally, if there is a family member with both ovarian and breast cancer, it may suggest that the BRCA gene is present and testing is recommended.

 

What should one look for when examining their breast?

One of the biggest issues with men is their reluctance to go to the doctor for regular check-ups.  Men are also more likely to ignore the physical symptoms and signs of disease.  Added to that is the common belief that only women can get breast cancer.  Unfortunately,
this may delay the diagnosis of breast cancer in men. 

The clinical features of the disease, that all men should know, include a firm painless breast lump, nipple retraction, and the presence of breast ulceration and/or palpable lymph nodes under the arm.  Given the perception about male breast cancer, it is imperative that men with any of these symptoms be examined by their physician as it may mean the difference between curable and incurable disease.

 

If one suspects a breast lesion, what should he do?

Because of the lack of a self breast exam by most male patients, the presenting lesion will likely have been ignored for some time before being discovered by the physician.  Once confirmed however, the approach to the diagnosis is similar to those in women. The first step when one presents with a suspicious lesion involves getting a mammogram.  It can detect 80-90% of male breast cancer.  If a mass is confirmed, then a biopsy is performed to confirm the presence of cancer.  The biopsy is a procedure that involves surgical resection of a sample of the mass for evaluation.  It is the gold standard test. 

Once the diagnosis of breast cancer is confirmed, knowing whether the cancer has spread
is a nail biter for most patients.  This process is known as staging.  It involves performing a biopsy of lymph nodes located under the arm on the same side of the affected breast and CT scans of the body if necessary.  The CT scans are able to tell if cancerous nodules are located in other organs.  With that information in hand, your physician should be able to determine the prognosis and treatment plans, which is the most important discussion in the patient’s care.

Male breast cancer can be a deadly disease if left untreated.  The median age for diagnosis
is 65-67 years old. With proper preventive health and regular health maintenance exams, male breast cancer is a disease that can be detected before serious complications develop.  Men, please remember to keep your breast health in mind.