Male Breast Cancer

Although breast cancer is most commonly thought of as a disease that affects women, breast cancer does occur in men. Male Breast Cancer is around 1% of the total Breast Cancer An analysis of National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program data from USA reveals that out of a total of 289,673 cases of breast cancer in the period 2005-2010 , 287,619 were women and only 2054 were men, accounting for 0.7% of all breast cancers. 1 The incidence of MBC is low. In “Cancer in five continents”, a meta-analysis study; published in 1987, the highest incidence was reported in Brazil (3.4 /100,000 man years) and lowest in Japan and Singapore (0.1/100,000 man years). 5 Indian data on incidence of MBC is available from Institution based studies, most reporting it as <1% of all breast cancers in their Institutes. it is usually a disease of elderly men and seen in 6th or 7th decade. The risk increases progressively with increasing age. it's important to understand the risk factors for male breast cancer — particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

Here is the list of risk factors

  • Growing older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The average age of men diagnosed with breast cancer is about 68. In India this age is younger as compared to west
  • High estrogen levels: Breast cell growth — both normal and abnormal — is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:
    • taking hormonal medicines
    • being overweight, which increases the production of estrogen
    • having been exposed to estrogens in the environment (such as estrogen and other hormones in meat, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body)
    • being heavy users of alcohol, which can limit the liver’s ability to regulate blood estrogen levels
    • having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
    • Certain conditions like Klinefelter syndrome; Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer\\ Men with Klinefelter syndrome have more than one X chromosome the female chromosone(sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).
  • A strong family history of breast cancer or genetic mutations: Family history can increase the risk of breast cancer in men — particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk of male breast cancer. There is a strong association between male breast cancer and an abnormal BRCA2 gene, the history demonstrate strong presence of male breast cancer and prostrate cancer in the males of the family
  • Radiation exposure: If a man has been treated with radiation to the chest for any condition such as for lymphoma, bone tumor, even hypertrophic scar or keloid has an increased risk of developing breast cancer.

Following are the signs which if present  a medical help should be immediately sorted:

  • a lump felt in the breast
  • nipple pain
  • an inverted nipple
  • nipple discharge (clear or bloody)
  • enlarged lymph nodes under the arm

It’s important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Breast enlargement can be idiopathic or due to certain medications, heavy alcohol use, weight gain. Gynecomastia itself does not cause cancer, the high estrogen state which causes cancer also acauses gynecomastia.

A small study about male breast cancer found that the average time between first symptom and diagnosis  is over a year and a half. This long time between the symptom and diagnosis is probably because people don’t expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. if more public awareness is created men will learn that just like women, they need to go to their doctor right away if they detect any persistent changes to their breasts.

Diagnosis is made by evaluation of the signs and symptoms by

  • Mammogram
  • Ultrasound of Breast
  • Cytology of Nipple discharge if present
  • Biopsy(core needle) of the Breast Lump
  • Imaging by PET CT/ MRI/ CT scan/ Bone scan. etc for evaluating distant spread.

Treatment

Male Breast cancer is generally hormone positive disease. If detected early it can be treated by surgery followed by hormonal therapy. Chemotherapy and radiation are needed if the disease presents in advanced stage.

In Males the loss of breast and body disfigurement is not as impactful as in a female. Although, the loss of nipple does have a psychological impact on males. Therefore, the need for early detection is as important in Male breast Cancer also:

  • To improve survival
  • De escalation of treatment
  • Minimising body disfigurement

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