We commonly associate breast cancer with women. Is it possible to have such a type of cancer in males?
Contrary to popular belief, males do have breasts. They have mammary glands, but these are underdeveloped. That’s why male breast cancer is not as common as female breast cancer.
In this article, we’re covering the details you need to know about male breast cancer. You will get a complete list of symptoms you can use as a checklist. We will then go through causes, risk factors, and how it is diagnosed and treated.
What is male breast cancer?
As the name implies, male breast cancer is a malignant tumor that grows in a male’s breasts. It is a very rare form of cancer in males and usually appears in older men. However, young males are not immune to this type of cancer.
In US statistics, breast cancer in males accounts for 1% or less of breast cancer cases. The overall survival is similar to that of women. That is, even though it is usually diagnosed at a late stage of the disease. Breast cancer in males has a peak at 71 years old, and they usually have close family members with breast cancer.
It is usually not a fatal type of cancer. When discovered and treated at an early stage of the disease, it can be eradicated. The most common type of treatment features the complete removal of the breast tissue. As a part of the therapy, we can use radiotherapy and chemotherapy, as discussed below (1).
What are the symptoms?
The most important symptoms of breast cancer include (1, 2):
- A palpable lump: Similar to a woman’s breast cancer, one of the symptoms is a noticeable lump. It is sometimes felt as thickening of the mammary gland instead of a lump. Since males do not have so much mammary and fatty tissue, lumps are easy to be felt. Still, they are not usually diagnosed as early breast cancer. They are diagnosed very late. This is probably because there’s a lack of awareness about breast cancer in males.
- Skin changes: Breast cancer in males and females come with an alteration in the skin. Scaly skin or reddening in the area of cancer is common. Sometimes, we can also see dimpling or puckering on the skin that covers the tumor. This is because breast cancer triggers inflammatory changes and tissue formation that pulls on the skin from the inside.
- Nipple changes: These are usually similar to the skin changes described above. Scaling and redness are also typical. In some cases, the nipple turns inward. Indeed, this does not mean that every case of inward nipples is a sign of cancer.
- Nipple discharge: Breast cancer is associated with an inflammatory process and may cause pus. It may also lead to other secretions, which drains in the nipple. In many cases, patients may bleed from the nipple instead of having a whitish secretion.
- Skin ulceration: There are many skin manifestations of breast cancer, and they are sometimes ulcers. They are usually very near or above the palpable lump.
- Adenopathy: In some cases, we can also find enlarged lymph nodes or adenopathy. They are usually axillary lymph nodes and suggest a possible invasion of cancer cells.
Causes
Similar to other types of cancer, male breast cancer does not have a single cause. It is an interplay of events and risk factors that may trigger this condition. In general, we can say that male breast cancer is caused by mammary gland cells that divide rapidly.
These breast cancer cells replicate without control, faster than healthy cells. The tumor can spread, then, and may take nearby tissue as well. The lymph nodes can be taken, and if no treatment is followed, it may metastasize to distant organs.
Male breast cancer is multifactorial. In other words, many factors converge in causing cancer instead of only one. Genetics, for example, can increase breast cancer risk.
Men who inherit BRCA2 gene mutations are at a higher chance of male breast cancer. This gene is located in chromosome 13 and stands for “breast cancer 2”. This gene produces a protein that repair damaged DNA and prevents tumors. In a BRCA2 mutation, the body becomes unable to fight cancer. We can also have a mutation of the BRCA1 gene, but this gene is implicated in fewer cases.
CHEK2 is another gene that contributes to breast cancer in males. This particular gene encodes a protein that serves as a checkpoint for DNA repair. Without it, cancer cells are unable to tell they are actually becoming unhealthy (1).
Another important cause of male breast cancer has to do with exposure to estrogen. The estrogen receptor can promote rapid growth in the breast tissue. Similar to women, this is usually an estrogen-dependent tumor.
As noted above, males and females have breast tissue. The only difference is that a female’s breast tissue is highly developed. This tissue includes glands, which are arranged in lobules. They are meant to produce milk, carrying the liquid to the nipples through a series of ducts.
All of this structure is also found in males, at a smaller degree. And, since men do have breast tissue, they also can develop breast cancer. Depending on where cancer starts, it has a name and a prognosis (1, 2).
For example, ductal carcinoma begins in the breast ducts, where milk is meant to be delivered. After that, they may become invasive ductal carcinoma when they start invading nearby tissue.
Most types of breast cancer in males are ductal carcinomas. But sometimes we can have lobular carcinoma, which grows from the gland tissue. This type of cancer is uncommon because male breasts do not have lobular units at the ducts’ end. Thus, lobular cancer is rare, but not as unusual as inflammatory breast cancer and other types.
Risk factors
We don’t have exact causes for male breast cancer but do have risk factors. These are conditions, lifestyles, and other factors that increase the likelihood of having breast cancer as a male.
The most important risk factors in breast cancer are as follows (2):
- Age: As mentioned above, male breast cancer is more common in older males-the risk increases for every decade of life. The diagnosis is usually made after a man’s 60 years old. Indeed, this doesn’t mean it cannot appear in younger men.
- Race: According to certain studies, there is apparently a greater risk of breast cancer in black men.
- Estrogen exposure: Taking estrogen or being exposed to phytoestrogens may increase your risk of male breast cancer. This is the case in men who undergo androgen-deprivation therapy for prostate cancer. They may require hormone therapy (estrogen) to reduce the incidence of osteoporosis. But this increases their risk of male breast cancer.
- Radiation exposure: Similar to female breast cancer, it is associated with exposure to radioactivity. The incidence rate is higher in those whose job involves handling radiation.
- Breast cancer history: As noted above, there’s a breast cancer gene in chromosome 13. This gene can be transmitted from one generation to the other. Thus, if you have family members with cancer, your risk is higher for the same condition. This gene increases the likelihood of breast cancer in males and females.
- Klinefelter’s syndrome: Men with Klinefelter’s syndrome are at increased risk of breast cancer. This is a genetic syndrome in which men have underdevelopment of the testes. They also have higher levels of estrogens and gynecomastia.
- Liver diseases: When liver disease is severe, such as liver cirrhosis, it can be a risk factor for male breast cancer. This condition can increase the level of female hormones, which may trigger cancer.
- Obesity: This condition is associated with higher levels of estrogens. The fatty tissue contains an enzyme called aromatase. This enzyme converts testosterone into estrogen. Thus, obese individuals have a higher risk of male breast cancer.
- Testicular issues: A disease in the testicle, such as orchitis (inflamed testes), may increase the risk of breast cancer in males. The same goes if the testicles are surgically removed in orchiectomy.
How is male breast cancer diagnosed?
The diagnosis of male breast cancer is usually made after feeling a lump in the thorax. This is often a painless lump and may go unnoticed by obese individuals. But it is often felt as hard and fixed closed to the nipple.
In most cases (75%), the lump is found in the subareolar lesion. Nipple involvement (nipple inversion) is more common in males than female patients.
At the moment of diagnosis, the disease is often at a late stage. 40% of male breast cancer patients are at stage 3 or 4 when they are diagnosed. At this stage, cancer is starting to extend to nearby areas.
The diagnose usually requires a physical examination, imaging techniques, and fine-needle aspiration biopsy (1, 3).
- Physical examination: It is vital to examine the lump and differentiate the condition from gynecomastia. In males with gynecomastia, breast cancer is usually excluded. Also, having gynecomastia does not mean you need to have routine imaging tests. These are reserved for those who have an indeterminate lump or mass in their breast tissue.
- Imaging tests: We can evaluate a breast lump in males with ultrasound or mammography. In men younger than 25 years, an undetermined lump should be evaluated with an ultrasound. Older men need mammography, instead, or a digital breast tomosynthesis. However, if the doctor considers the mass very suspicious, mammography is recommended regardless of the male patient’s age. MRI is only recommended in invasive breast cancer found on the chest wall. In a mammogram, breast cancer looks like an eccentric mass, usually found behind the areola. It is irregular and usually has spiculated edges. Still, and even if you have such a lesion, doctors need to confirm the diagnosis.
- Fine-needle aspiration biopsy: This is only used to confirm the diagnosis of breast cancer. When the lesion is highly suspicious of breast cancer, a sample is taken with a fine needle. Then, it will be analyzed in the laboratory for histological signs of breast cancer.
Treatment options
Similar to other types of cancer, male breast cancer requires surgery and a combination of systemic therapy and radiation (4).
- Surgical resection of male breast cancer: The usual approach is similar to that of women. Whenever possible, simple mastectomy is the standard procedure. It is recommended for stage 1 and 2. In these cases, breast-conserving surgery and cosmetic outcomes are not as necessary as in women. However, they can be taken into consideration. As noted above, most cases are diagnosed in stage 3 or 4. In these cases, a simple mastectomy is not appropriate. They require a more advanced procedure. For example, doctors may need to extract axillary lymph nodes and nearby tissues.
- Radiation therapy: Radiation therapy in male breast cancer is similar to that of women. Given the anatomy of male breasts, radiation therapy is usually held at a lower threshold. However, there are no breast cancer clinical trials in males. It is generally recommended at stage 3 or a higher stage.
- Systemic therapy: These are also similar to the recommendations made for women. The most common drug in this group is tamoxifen, which is usually held for 5 years. In some cases, systemic therapy with tamoxifen is extended for 10 years. Aromatase inhibitors may also be used in males. However, when this is the case, they should also use endocrine therapy with the gonadotropin-releasing hormone. More recently, Palbociclib was approved by the FDA to treat males with breast cancer. It can be used in advanced cases with metastatic breast cancer, usually in combination with aromatase inhibitors. In these men, luteinizing hormone-releasing hormone agonists are also recommended.
- Follow-up and monitoring: In this type of cancer, there’s a chance of recurrence on the same or the opposite side. Thus, it is essential to continue with follow-ups and monitoring after treatment is concluded. The highest risk of recurrence is found in patients younger than 50 years at the time of diagnosis.
After treatment, the outcome or prognosis of breast cancer in males is similar to that of women. Overall survival is somewhat lower as compared to women, but this difference is easily explained.
Breast cancer in women is usually found earlier than male breast cancer, and before it spreads. Also, breast cancer in males is generally diagnosed at an older age, so they have a shorter life expectancy. By adjusting this fact into the statistics, the prognosis is similar or almost the same (1).
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Conclusion
Breast cancer is more common in females. However, males do have breast tissue and may also grow malignant tumors. These are usually grown in the ducts of the mammary tissue instead of the gland.
Similar to other types of cancer, male breast cancer is multifactorial. There is not a single cause. Instead, we have several risk factors that may play a role in developing this type of cancer. Genetics is one of them, through a BRCA mutation. Estrogen exposure is another, and anything that increases estrogen levels in males.
Treatment for breast cancer in males is similar to that of women. They need to undergo surgical resection of the breast mass. Radiotherapy and systemic therapy are also recommended. And follow-up is critical because there’s a high chance of recurrence.
