CancerQuest | Breast Cancer in Men

Although it is a rare form of cancer, breast cancer does occur in men. It is estimated that 1,970 new cases in males will develop in 2010, with 390 deaths. It tends to occur at a later age in men than in women, with the male peak age being 71 years old as opposed to peaks at 51 and 71 years old in women.⁽¹⁾⁽²⁾

Symptoms⁽¹⁾ ⁽²⁾

Painless lump in the breast (over 75% of cases)
Nipple retraction, discharge, or ulceration
Painful lump in the breast
Paget's Disease (only about 1% of cases): This is a rare type of cancer that can appear as a skin rash (dermatitis) around the nipple. Note that this is NOT related to Paget's disease of the bone.

Detection and Diagnosis

Diagnosis of breast cancer in men is generally delayed 6 - 10 months (the time from the onset of symptoms until the patient seeks treatment). This delay is partially due to a) the rarity of the disease and b) a lack of awareness of (suspicion of) the disease by patients and their doctors. Because of this delay, men present with the disease at a later stage than women:

Stage I - ~40%
Stage II - ~20%
Stage III/IV - Over 40%

When symptoms are present, doctors generally use the Triple Test (TT) method to determine stage and treatment plan. The TT is the use of clinical exam, mammography or ultrasound, and fine needle aspiration (FNA) or core needle biopsy (CNB). ⁽²⁾⁽¹⁾ Watch a video about mammography, ultrasound, and/or biopsy.

Mammography has been shown to have a sensitivity of 92% and a specificity of 90% in male breast cancer, but is not used as a screening tool. ⁽¹⁾ Watch a video about sensitivity and specificity of medical tests.

Pathology

Male breast tissue is mostly fat and the lobules needed to form milk are undeveloped. Over 90% of male breast tumors are invasive (infiltrating) ductal carcinoma and ER positive.⁽¹⁾ ⁽²⁾

Risk Factors⁽²⁾⁽¹⁾

Obesity
Alcohol consumption
Liver damage or dysfunction
Testicular abnormality or damage
Radiotherapy, especially to the chest
Family history of breast cancer (especially with a BRCA2 mutation)
Klinefelter's Syndrome

Treatment

Surgery
Simple or modified radical mastectomy and surgical assessment of the lymph nodes are used when cancer is found in its early stages. Assessment of the lymph nodes is accomplished using either axillary dissection or sentinel lymph node biopsy.⁽³⁾⁽¹⁾

Radiotherapy
Males are more likely to receive radiotherapy than females, probably due to the fact that males present with breast cancer at a later stage than females. Radiation dosages used to treat men are generally the standard amounts used to treat women. Radiotherapy has been shown effective in preventing local recurrence in men with breast cancer.⁽³⁾⁽⁴⁾

Systemic Therapy
Because about 90% of men with breast cancer are hormone receptor positive (HR+), treatment with tamoxifen is standard in HR+ men. Men treated with tamoxifen have shown higher overall survival rates. Men may also receive systemic chemotherapy.⁽³⁾ ⁽²⁾

Quality of Life
Men with breast cancer face a different environment than women coping with breast cancer. There is a large amount of information and public support for women. On the other hand there is a lack of information and added stressors for men. Men deal with issues of masculinity and stigmatism in addition to the other physical and emotional concerns that come along with having breast cancer.⁽⁵⁾⁽⁶⁾

Learn more about Quality of Life from CancerQuest

Resources for Men with Breast Cancer

The American Cancer Society
The National Cancer Institute
Breastcancer.org