Oct 26, 2017

Can Men Get Breast Cancer, Too?

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When we think of October being breast cancer awareness month, we conjure up throngs of women clad in pink, many of them survivors of breast cancer, participating in various breast cancer awareness events.  Would we ever consider a man walking alongside them as a breast cancer survivor?

The fact is that breast cancer can and does show up in men, although it is a rarity.  About one man in 1,000 will test positive for breast cancer in his lifetime, compared to about 1 in 8 women.  Putting this into hard numbers, the American Cancer Society predicts that in the next year about 460 men will die of breast cancer compared to 40,000 women.  

But it is because of these low odds that too many male breast cancers remain undiagnosed until the cancer reaches a later, more deadly, stage.  Men are not accustomed to checking for a lump in the breast tissue or changes in the nipple, and when they do spot an abnormality most would never consider that it is breast cancer.  So, the lump or discharge is ignored.

How Does a Man Get Breast Cancer?
While it is true that most men do not have breasts like a woman’s, they do have a small amount of breast tissue.  Because men do not produce much estrogen, the chest remains fairly flat.  However, there are certain risk factors that can lead to an increase in breast tissue and/or estrogen in a man, or an increase of overall risk for developing breast cancer:

  • Obesity.  Fat cells in the body will convert the male hormones, androgens, into the female hormones, estrogens.
  • Estrogen treatment.  Some drugs that treat prostate cancer are estrogen-related.  Also, transgender or transsexual individuals take high levels of estrogen as part of gender reassignment.
  • Liver disease.  Due to the liver’s function in sex hormone metabolism, men with cirrhosis have low levels of androgens and higher estrogens.
  • Aging.  As in women, the risk of a man developing breast cancer increases with age.  The average age for a male breast cancer diagnosis is 68.
  • Family history.  Breast cancer in a man is increased if other family members have had breast cancer.  Those men who test positive for the BRCA2 gene mutation have a 6-8% (depending on the study) chance of developing breast cancer during their lifetime.
  • Radiation exposure.  Men who were treated with radiation to the chest for lymphoma has a higher risk of developing breast cancer.
  • Klinefelter syndrome.  A rare condition that affects about 1 in 1,000 men that involves multiple X chromosomes, versus the usual single X chromosome.

Symptoms a Man Should Not Ignore
The symptoms of male breast cancer are identical to female breast cancer.  Any persistent change in the breast should be examined as early as possible to allow for the best prognosis in the event it is breast cancer.  Men tend to ignore the symptoms, assuming it could not possibly be breast cancer.  In fact, a study found that the time span between first noticing the symptom and diagnosis is 19 months.  The sooner breast cancer is diagnosed the more promising the outcome.

The types of breast cancer among men differ from those of women.  For example, most male breast cancers are estrogen-receptor positive, versus 80% of women’s breast cancers.  Also, lobular breast cancers are fairly common in women but are rarely seen in male breast cancer.

The symptoms of male breast cancer include:

  • A lump felt in the breast tissue
  • An inverted nipple
  • Nipple pain
  • Nipple discharge
  • Sores on the nipple and areola
  • Swollen lymph nodes under the arm

When a man discovers any of the above symptoms it is time to put any machismo aside and recognize that they might have breast cancer.  

Male Breast Cancer Treatment
As research continues to provide more answers about male breast cancer, treatments, which to date are modeled on women’s breast cancer, can be better tailored for men.  In fact, a new clinical trial is planned that will use a new medication that will block the androgen receptor, a protein found in most male breast cancer.

For now, though, male breast cancer is treated in similar to women’s, however, because men have little breast tissue they will have a mastectomy versus lumpectomy.  There are male breast reconstruction options available post-surgery, including fat grafting, scar revision, nipple reconstruction, and small implants to replace the natural chest shape.

Men are treated with tamoxifen and chemotherapy for hormone receptor-positive cancer, and just chemo with hormone receptor-negative cancers.  However, most male breast cancer is hormone receptor-positive.  Radiation may also be included in the treatment protocol.  Men with HER2-positive breast cancers may be treated with Herceptin and chemotherapy.

The most important variable in influencing the prognosis is early detection.  So guys, be proactive if you see a change in your breast and get a jump-start on treatment.  It may just save your life.

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