Breast Cancer in Men – Causes, Signs and symptoms

Breast Cancer Men

Also called: Breast Cancer in Males

Summary

Breast cancer in men is rare, accounting for less than 1 percent of all breast cancer diagnoses.  Each year, an estimated 2,000 new cases of male breast cancer are reported, as well as 450 deaths from the disease, according to the American Cancer Society (ACS).

Risk factors that increase a man’s chances of developing breast cancer include:

  • Radiation exposure

  • Estrogen administration

  • Diseases associated with excess accumulation of female hormones, such as cirrhosis of the liver 

  • Family history of several female relatives with breast cancer

  • Genetic predisposition such as BRCA1 gene mutation

The progression of breast cancer in men is similar to that in women. Nearly all breast cancers are adenocarcinomas with the most common type being infiltrating ductal carcinoma.

Men and women have similar survival rates for the different stages of breast cancer, which depend on the size of the mass and whether or not it has spread to the lymph nodes or beyond. However, male breast cancer is less likely to be detected early because most men mistakenly believe that only women can develop this disease.

As with survival rates and prognosis, treatment options for breast cancer are the same for men and women. Various combinations of surgery, chemotherapy, radiation therapy and hormone therapy are options in the treatment of male breast cancer. A patient’s treatment plan depends on the type of cancer, size and location of the tumor and the overall health of the individual.

About breast cancer in men

Few people realize that men can develop breast cancer. Nearly 2,000 men are expected to be diagnosed in 2007, according to the American Cancer Society (ACS). This compares to the ACS‘s 2007 estimates of 178,000 new cases of breast cancer diagnosed in women.

In the United States, an estimated 41,000 women and 450 men will die from breast cancer in 2007. Male breast cancer accounts for less than 1 percent of all breast cancer diagnoses and less than 1 percent of cancers in men.

The incidence rate of breast cancer among men has been rising. Between 1975 and 2002, the rate increased by 1.1. percent annually. Researchers are unsure of the reasons for the increase, although it is not attributed to increased detection. In the past, breast cancer was not typically diagnosed in men until it reached the later stages. However, this trend appears to no longer be the case. Mortality rates for men with breast cancer have stayed essentially the same since 1975. When comparing survival rates, men and women with the same stage of breast cancer have a similar prognosis.

The body’s organs and glands (including breasts) are made up of tissues composed of cells. Normal cells grow, divide and die when they grow old, allowing for new cells to take their place. When old cells do not die and the body continues to create new cells it does not need, a mass of cells forms a growth or tumor.

Tumors do not always signal cancer, particularly in the male breast. They can be benign (noncancerous) or malignant (cancerous). The most common breast disorder in men is gynecomastia, a nontumorous growth of tissue caused by hormonal changes. This condition can be mistaken for a tumor. Papillomas and fibroadenomas are benign tumors that are common in women, but extremely rare in men.

During puberty, a girl’s ovaries produce hormones that cause the breasts to grow. When boys enter puberty, the testicles produce male hormones that prevent the breasts from growing. Men have breast tissue, which contain breast ducts but few or none of the milk-producing glands (lobules) found in women.

Breast cancer begins with an abnormal growth of cells within the breast. The type of breast cancer is diagnosed by determining if the cancer began in the ducts, lobules or other area, such as the connective tissue. In some uncommon cases, cancer can develop from the blood vessels. It is also important to determine if the cancer has been contained in the original site or spread to nearby tissues or lymph nodes.

The lymph nodes are bean-shaped structures that are part of the immune systemThey help the body fight off infections and diseases. When breast cancer starts to spread, the most common first location is the lymph nodes. If breast cancer has spread to the axillary lymph nodes (located in the underarm region), it can cause swelling of these nodes. 

After the cancer cells have spread to the lymph nodes, if it remains undetected, it is likely that the cancer will spread or metastasize to other areas as well, such as the lungs, bones or brain. It is important to determine if cancer has spread to the lymph nodes for treatment planning and to help determine a patient’s outlook for survival.

Types and differences of breast cancer in men

There are several different types of breast cancer, but nearly all are considered adenocarcinomas because most develop in either the ducts or lobules, both of which are glandular tissue. Some cancers are followed by the words in situ, meaning the cancer is contained to a single area. If the cancer breaks through to the surrounding lobules or ducts, it is called infiltrating or invasive carcinoma. From there, the cancer can spread to blood vessels, lymph nodes and other parts of the breast. If not detected early, it can spread to other parts of the body resulting in a poorer prognosis.The staging of cancer is identical for men and women with breast cancer.

The most common types of breast cancer include:

  • Ductal carcinomas. Affecting the milk passages (ducts) of the breast. These are the most common breast cancers in both men and women. The two main types are:
    • Infiltrating (or invasive) ductal carcinoma (IDC). This is by far the most common in men, accounting for 80 to 90 percent of all male breast cancers, according to the American Cancer Society (ACS). As the mass grows, it can lead to a dimpling of the breast or the nipple retracting inward.
    • Ductal carcinoma in situ (DCIS). Also known as intraductal carcinoma or noninvasive ductal carcinoma, DCIS is an uncommon type of breast adenocarcinoma in men. It accounts for about 10 percent of male breast cancers, according the ACS.
  • Lobular carcinomas. Affecting the milk-producing glands (lobules). These are rarely seen in men since men’s breast tissue has ducts, but few lobules.
  • Inflammatory breast cancer. This form of the disease that has been diagnosed in men is highly malignant. Inflammatory breast cancer spreads rapidly, producing symptoms of swelling, redness and skin that is warm to the touch in the area of tumor involvement.
  • Paget’s disease. This disease is slow-growing cancer of the areola and nipple. Paget’s disease eventually grows onto the nipple itself. It is sometimes mistaken for eczema as it can create itchiness or a crusty appearance around the nipple. According to the ACS, it accounts for about 1 percent of female breast cancers, but a higher percentage of male breast cancers. Because of the smaller size of the male breast, tumors are more likely to start relatively close to the nipple and/or spread to the nipple.

Risk factors and causes of breast cancer in men

Male breast cancer is the same disease as breast cancer in women and is closely related to an increased exposure to the female hormone estrogen. Any injury or imbalance in the estrogen-testosterone ratio can increase a man’s risk of developing breast cancer. Other risk factors for this disease include:

  • Family history (several female relatives diagnosed with breast cancer).

  • Testing positive for mutations of the BRCA1 or BRCA2  genes. Mutations in these genes can significantly increase the chances of a man or woman developing breast cancer. Other gene mutations, including mutations of the CHEK2 gene, may play a role in the development of breast cancer in men.

  • Klinefelter’s syndrome (a condition in which not enough testosterone is produced). This condition is present at birth (congenital) and occurs in about 1 out of 1,000 men.

  • A history of mumps orchitis (testicular inflammation after the mumps).

  • Undescended testicles (cryptorchidism).

  • Testicular injury.

  • Exposure to female hormones (e.g., through diet, medications, chemicals).

  • Hormone therapy for prostate cancer.

  • Cirrhosis of the liver.

  • Cowden disease (a congenital condition involving multiple benign tumors).

  • Radiation to the chest area. For those treated for Hodgkin’s lymphoma with radiation therapy to the chest before age 30, the chances of also developing breast cancer are higher than the general population.

Signs and symptoms of breast cancer in men

Breast cancer can cause several outward symptoms that can be detected by men. Breast lumps in men are never a cyst or fibroadenoma, as in women, because men cannot develop either one of these conditions.

Often, breast lumps in men are not cancer, but gynecomastia. Gynecomastia is an enlargement of one of the breasts and is more common in adolescent boys, but can happen at any time in a man’s life. It may be triggered by taking certain medications for heart conditions or high blood pressure, or by smoking marijuana.

Though most changes in a man’s breast are not serious, anyone (male or female) experiencing any of these signs and symptoms should seek advice from a qualified physician:

  • Rash on the skin of the breast, areola or nipple that makes it appear scaly, red or swollen
  • Ridges, pitting or dimpling of the breasts
  • Fluid from nipples (discharge)
  • A lump or thickening in the breast
  • A lump in the underarm area
  • Nipple tenderness
  • A change in the size or shape of the breast
  • A nipple turned inward (into the breast)

The signs and symptoms of breast cancer can often go undetected for years. However, depending on the type of tumor and how quickly the mass grows, symptoms become more quickly apparent.

In the majority of breast cancer diagnoses, there is no pain associated with the development of a tumor but anyone experiencing a persistent or unexplained painful area of the breast should consult a physician.

Diagnosis methods for breast cancer in men

According to the American Cancer Society, men tend to be diagnosed at an older age with breast cancer compared to women. For men, the average age at the time of diagnosis is 67 (vs. 62 for women).

Regular physical examinations and maintaining an accurate medical history are important for maintaining good health, especially when screening for cancer. In this way, physicians are more likely to detect the disease before symptoms are present. When breast cancer is caught in its earliest stages, the survival rates are dramatically increased and the adjuvant therapies are much more successful. Adjuvant therapies are non-surgical treatments (e.g., chemotherapy, radiation therapy, hormone therapy) aimed at reducing the risk of a recurrence.

If a man presents with a suspicious lump, the physician may order a mammogram. Mammograms are x-ray pictures of the breast that can show a tumor before it is large enough to feel. Mammograms can also pick up microcalcifications (minute deposits of calcium), which may be signs of cancer. Although mammograms are usually associated with a woman’s breast, mammography can be obtained of any breast tissue. 

If a mammogram proves to be inconclusive as to whether a lump is solid (tumor) or cystic (fluid-filled), a physician may order a breast ultrasound.The ultrasound test works by sending and receiving high-frequency sound waves to create images of internal organs or tissues.

Sound waves are reflected by the tissues of the area being examined. These sound waves are recorded and displayed on a computer screen or television-type monitor or printed out for a physician to review.

Ultrasound creates images of soft tissue organs. It is often used to screen for a wide array of conditions since it is fast, noninvasive and relatively inexpensive. However, ultrasound is less sensitive than CAT scan (computed tomography) or MRI (magnetic resonance imaging), either of which could be used in the detection and diagnosis of breast cancer in men.

If the mammogram or ultrasound shows an area of possible concern, a biopsy is usually the next step. The physician most likely will refer the patient to a surgeon who will perform the procedure at the hospital in an outpatient setting. In some cases, a needle biopsy may be performed at the time of the mammography.

A biopsy is the removal of a sample of cells or tissues of concern so that they can be viewed and analyzed under a microscope by a pathologist. The pathologist will determine whether or not the cells are malignant and possibly determine the type and grade of the cancer.

Many breast biopsies are benign (noncancerous). However, if the biopsy turns out to be malignant (cancerous), additional tests may be recommended to further determine the course of treatment and whether or not the cancer has spread beyond the breast. Some of the tests that may be done if the tumor is malignant include:

  • Chest x-ray. The purpose of the chest x-ray is to determine if the breast cancer has spread to the lungs. This is normally done before any breast cancer surgery occurs.
  • Bone scan. Breast cancer commonly spreads to the bone in its advanced stage. A bone scan is usually done with breast cancer patients to detect metastasis to the bones. The bone scan involves injecting a small amount of radioactive substance into the patient’s vein. The substance is attracted to areas of the bone that may be abnormal, which then appear on films.
  • Computed axial tomography (CAT scan or CT scan). If metastasis to other organs is suspected or needs to be ruled out for any reason, the physician may order a CAT scan. This is normally used for more advanced or later-stages of breast cancer. CAT scans create images of the patient’s internal organs by taking multiple x-rays from different vantage points. A contrast dye may be injected into the patient’s vein prior to the test for better viewing of tissues or organs.
  • Magnetic resonance imaging (MRI). MRIs are powerful magnets linked to a computer. The MRI creates detailed images of the breast tissue to determine the need to proceed in the diagnosis of a mass. MRIs are often used prior to surgery for a detailed image of location of the cancer.
  • Positron emission tomography (PET) scan. A radioactive sugar substance is injected into the patient prior to testing. Cancer cells, with their high rate of metabolism, quickly absorb the radioactive substance and appear as “hot” areas on the image. A PET scan is typically used to detect any metastasis of the cancer or to monitor any recurrence of the disease.
  • Blood tests. A complete blood count (CBC), as well as blood chemical and enzyme tests, are normally requested prior to any surgery to determine if the blood has the correct type and number of blood cells. Blood tests give a quick glimpse into the patient’s overall health. Circulating antigens called tumor markers also may be checked through specific blood tests.
  • Tumor tests. Testing the tumor is extremely important for breast cancer as it bears significant weight in determining the best treatment options for each individual patient. Two female hormones, estrogen and progesterone, are tested for within the cancer cells (even for male breast cancer). The result will give the estrogen-receptor status and the progesterone-receptor status. These results have impact on the type of treatment for the cancer.

    Cancers that are receptor-positive will benefit from certain hormone treatments that will not help negative receptor cancers. For those breast cancer patients with an invasive form of breast cancer, the tumor should also be tested for another receptor called HER2/neu. Cancer cells that overexpress the HER2/neu oncogene grow more rapidly but respond better to specific combinations of adjuvant therapy.

Treatment options for breast cancer in men

There are many treatments available for women and men diagnosed with breast cancer. The best treatment options for breast cancer come with an early diagnosis.

One of the most important elements of the treatment decision will depend on the stage of the breast cancer, which is an indication of whether or not the breast cancer has spread and, if so, how far and to what areas of the body. The treatment protocol will depend on other factors as well, including:

  • The size of the tumor
  • The type and stage of breast cancer
  • The estrogen-receptor progesterone-receptor status
  • The patient’s age and general health
  • Personal opinions and preferences of the patient

Other factors that are normally taken into consideration include whether or not the breast cancer is newly diagnosed or if it is a recurrence.

Most breast cancers are treated with a combination of therapies based on the stage and type of cancer. Options include:

  • Surgery. There are several options with breast cancer surgery, and much will depend on the size and type of tumor involved, as well as its location within the breast. Surgeries commonly used in the treatment of breast cancer include:

    • Lumpectomy or segmental (partial) mastectomy. Both procedures are considered breast conservation surgery, which spare much of the breast tissue. Following this type of surgery, most patients will receive radiation therapy to destroy any remaining cancer cells in the breast tissue.

    • Mastectomy. Involves removing most of the breast tissue and may be accompanied by removal of most of the lymph nodes under the arm.

    • Radical mastectomy. Removes chest muscles, the entire breast and all of the lymph nodes under the arm plus additional fat and skin. This was the standard treatment for many years but is rarely used now.

      In addition to surgery of the breast tissues, a physician may perform diagnostic procedures to determine if the cancer has spread to the lymph nodes. These tests often involve surgical removal of one or more lymph nodes. The most common procedures are:
  • Axillary lymph node dissection. Removal of some or all of the axillary (underarm) lymph nodes for inspection by the pathologist for evidence of cancer. Many surgeons will also perform an axillary node dissection at the same time as the breast cancer surgery.   

  • Sentinel node biopsy. A procedure in which a dye and/or radioactive tracer is injected at the site of the tumor. The dye is followed to determine into which lymph node it drains. Only the first lymph node that the dye or tracer reaches is removed for analysis because it is believed this node is the most likely area for the spread of breast cancer. The information on involvement of lymph nodes (whether or not they contain any cancer cells) is used for staging and treatment decisions for the patient.
  • Chemotherapy. Powerful drugs are used to treat the disease by destroying cancer cells but normal cells may also be involved. Chemotherapy may be accomplished using a single drug, but more often involves a combination of medications. The drugs may be given in several forms, such as intravenously or orally. Treatment with chemotherapy may be used before radiation therapy, surgery, biological therapy or bone marrow transplants. In other cases, chemotherapy may be used after or in conjunction with other treatments.
  • Radiation therapy. High-energy x-rays are concentrated on the site where the tumor was removed to kill any remaining cancer cells following surgery. Radiation may also be used to shrink a tumor prior to surgical removal. Radiation targets dividing cancer cells and disrupts or destroys their genetic material, preventing the cells from continuing to grow and spread throughout the body. Radiation therapy is sometimes used alone to treat cancer. In other instances, it is combined with other cancer treatments such as chemotherapy or surgery. Radiation therapy normally involves short treatments once or twice a day for six to seven weeks.
  • Hormone therapy. This type of therapy blocks the effect of estrogen on breast cancer cells. Hormone therapy is used with cancers that are estrogen or progesterone-receptor positive. It is commonly prescribed for men with metastatic breast cancer (breast cancer that has spread to other areas of the body). In men, more than 75 percent of breast cancer cases contain estrogen receptors. Anti-estrogens, such as tamoxifen, may be recommended for treatment and to prevent a recurrence. 
  • Another group of drugs known as aromatase inhibitors are also used in hormone therapy. These drugs have been show to be effective in treating breast cancer in women. However, additional studies are needed to determine their effectiveness in mne. Clinical trials are examining the uses of aromatase inhibitors with other drugs to lower androgens (male sex hormones) in men. Research has shown that decreasing androgen levels in men may shrink breast cancer metastases.
  • Biological therapy. A treatment designed to bolster or substitute for the body’s natural defenses against cancer. HER2/neu is an oncogene that is found to be abnormally expressed in some breast cancers (in addition to some stomach and lung cancers). It produces a protein that allows the entrance of growth factors into the cancer cell, monoclonal antibody or anti-HER2 antibody (Herceptin) that binds to the HER2 receptor on the surface of the tumor cells. Biological therapy is very different from chemotherapy, but they are often used togehter. The monoclonal antibody binds only to cells that over-express HER2/neu and not other cancer cells or normal cells. This type of therapy is now in regular clinical use.

Prevention methods for breast cancer in men

As with breast cancer in women, there are no known ways to prevent this disease. However, there are several risk factors that may impact a person’s risk of breast cancer. Though certain risk factors are outside an individual’s control, men can reduce the risk of breast cancer by avoiding the following risk factors:

  • Consumption of alcohol
  • Use of tobacco
  • High-fat diet
  • Sedentary lifestyle
  • Testicular injury (wear a protective cup during contact sports)
  • Female hormones. Men taking high levels of estrogens for a sex change have increased risk of breast cancer.

Hormone therapy for prostate cancer might slightly raise the risk of breast cancer in men, but the benefits of the treatment outweigh the small risk, according to the American Cancer Society.

Staging breast cancer in men

Physicians use a staging method to classify breast cancer diagnoses. This information allows them to choose the best treatment options based on the level and type of cancer. The stages are as follows:

  • Stage 0. Includes carcinoma in situ (noninvasive cancer), intraductal carcinoma and lobular carcinoma in situ.

  • Stage I. The tumor size is equal to or less than 0.8 inches across (2 centimeters [cm]) and has not spread.

  • Stage II. Like Stage I, Stage II is considered an early stage of breast cancer. Tumors can range from less than 1 inch across (2 cm) to 2 inches across (5 cm). They may or may not have spread to the axillary lymph nodes (under the arm).

  • Stage III. Locally advanced breast cancer. It has spread to the axillary lymph nodes or to tissues near the breast (such as the skin or chest wall). Tumors are larger than 2 centimeters.

  • Stage IV. Metastatic cancer that has spread to other organs of the body. Frequent metastases sites for breast cancer are the bones, lungs, liver or brain. This is also the classification given to inflammatory breast cancer or breast cancer that has spread to the lymph nodes in the neck near the collarbone.

Although breast cancer in men is often caught in later stages than it is in women, the overall five-year survival rate is relatively high when diagnosed and treated early. For the earliest stages (Stages 0 and I), the normal survival rate is 98 percent. As the disease progresses, the survival rates drop to 88 percent for Stage II, 67 percent for stage II and 14 percent for Stage IV, according to the American Cancer Society.

Breast Cancer 5 Year Survival Rates 

StageWomenMen
0100 percent100 percent
I100 percent96 percent
II81 to 92 percent84 percent
III54 to 67 percent52 percent
IV20 percent24 percent

Questions for your doctor about breast cancer

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about breast cancer in men:

  1. How does breast cancer in men differ from breast cancer in women?

  2. What signs and symptoms will I have if I develop breast cancer?

  3. Which tests will I have to diagnose my condition?

  4. What type of breast cancer do I have?

  5. What stage is my breast cancer?

  6. What are my treatment options?

  7. What are the risks associated with these treatments?

  8. What is the prognosis for my type and stage of cancer?

  9. What are the chances my cancer will return?

  10. Am I at a higher risk for the disease based on my medical or family history?

  11. Should I consider genetic testing? If so, what type?

  12. Will my children have a greater chance of developing breast cancer if I have breast cancer?

  13. Do I have a higher risk for other cancers if I have breast cancer?

  14. Can you recommend a breast cancer support group?
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