Many people assume that only females can get breast cancer; however, this is not the case. Men can also develop male breast cancer (MBC). MBC accounts for less than 1% of all global breast cancer cases. MBC cases are not well-reported because, usually, male patients with MBC are diagnosed at late stages of the disease due to a lack of awareness about MBC, delayed symptoms of MBC, and the prevalent notion that men cannot get breast cancer.
While the biological factors that cause MBC are the same as those that cause female breast cancer (FBC), the hormones that are involved, risk factors associated with both types of cancers, and management of MBC versus FBC differ. The early diagnosis of MBC is crucial and will have a huge effect on the patient. Those patients diagnosed early have a great deal better prognosis than those diagnosed later.
The objectives of this article will be to present an accurate biological definition of MBC and provide an overview of MBC's epidemiology and risk factors, clinical symptoms of MBC, methods for diagnosing MBC, and the different management strategies available for MBC, prognosis, and continuing follow-up care for males diagnosed with MBC.
What Is Breast Cancer In Men?
Even though men do not have the same amount of breast tissue as women, they do possess some breast tissue that can become malignant and cancerous. However, it is less frequent than in females.
Male breast cancer (MBC) represents only 1% of all breast cancers. It's important to remember that there is an opportunity for both males and females to develop breast cancer.
Kinds of Male Breast Cancer
There are two main types of breast cancer found in males. Two types of breast cancer develop in men and are classified into two groups. All types of male breast cancer develop from cells in a mammary tissue called glandular (lobular) tissue.
Male breast cancers that originate from the ducts that transport milk to the nipple are known as ductal cancers. Approximately 80% of males diagnosed with breast cancer will be diagnosed with a ductal type of breast cancer.
Male breast cancers that originate in the mammary glands are referred to as lobular cancers. Some males with lobular breast cancer will also have ductal carcinoma, although this is a rare occurrence. Approximately 12% of males with breast cancer will be diagnosed with the lobular type of breast cancer.
Other types of male breast cancer can also occur. Examples of these include:
- Paget disease of the nipple, which occurs when there is a change in the nipple colour or when there is an unusual discharge from the nipple
- Inflammatory breast cancer (IBC), which presents with swelling and redness of the breast and/or skin changes, as well as difficulty raising the breast
Risk Factors of Breast Cancer in Men
Many risk factors can raise a man’s risk of developing breast cancer. The following are all potential risk factors for breast cancer in males.
Age
Generally speaking, the increasing age of a male is associated with an increased likelihood of developing breast cancer, ranked by age 50+.
Genetic Change
Mutated genes (such as BRCA1 and BRCA2) have been attributed as causative contributors to breast cancer in male patients.
Family History
Individuals with a family history related to some degree to breast cancer (i.e., mother or sister) are at an increased risk of developing breast cancer.
Radiation Therapy
Males who have received a radiation dose to their chest area are at an increased risk of developing breast cancer.
Hormone Treatment
Males who have previously received estrogen therapy as treatment for prostate cancer (i.e., hormone therapy) are at an increased risk of developing breast cancer.
Klinefelter Syndrome
Klinefelter Syndrome is a genetic disorder that occurs when there is an extra X chromosome present in a male chromosome. This may result in the person's body making an excessive amount of the female hormone (estrogen) as it produces less of the male hormone (testosterone) than it normally would if the additional X chromosome were absent.
Liver Disease
Due to liver disease, men with cirrhosis (scarring) will have lower testosterone and higher estrogen levels, leading to a higher chance of developing breast cancer.
Obesity
Obesity is an additional risk factor for the development of breast cancer because morbidly obese men have a higher risk of developing breast cancer than men with a normal BMI.
Conditions that Affect Testicles
Males who suffer from conditions associated with the testicle may also have an increased risk of developing breast cancer due to testicular abnormalities.
Symptoms of Breast Cancer in Men
It is common for patients to present with a non-tender breast lump as their significant complaint, and at times these patients can present with other symptoms such as retraction of the nipple, discharge from the nipple, ulceration, and tenderness (pain). Lumps in men generally are more visible than in women because of the smaller volume of breast parenchyma, although they can be obscured by the presence of gynecomastia. In addition to this, when presenting the history of the current condition, it is also important to include any relevant family history of breast cancer, the patient’s past medical history, occupation, and previous exposure to estrogen or radiation.
How to Diagnose Breast Cancer in Men?
Some of the tests and procedures that might be used to diagnose male breast cancer include:
Clinical Breast Exam
Through this method, a medical professional is going to physically examine the breasts and the areas around them to detect any lumps or irregularities. The test facilitates the health care professional in identifying the size, the kind of surface, and how close the lumps are to the skin and muscles.
Imaging Tests
Imaging tests can create images of your breast tissue that can be used to spot cancer. Such tests can be a breast X-ray, which is also known as a mammogram, an ultrasound, or an MRI scan.
Biopsy
Maybe a biopsy test will be necessary, where a cancer testable sample of cells is taken out. A biopsy is a procedure in which a doctor or nurse removes a small sample of tissue for testing to see if there is cancer. The sample is taken with a needle through the skin of your chest by a medical professional. The medical professional uses a mammogram or other imaging tests to locate the needle.
In the laboratory, the cells are looked at under a microscope to identify whether they are malignant. Other tests can show if your cancer cells have hormone receptors or if they have certain DNA changes. Your healthcare team uses the test results to make treatment decisions.
Male Breast Cancer Treatments
Early Stage
Early stage means that the breast cancer is still a relatively small tumour in the breast, and either the cancer has not spread to the nearby lymph nodes or there is only a small amount of cancer in the lymph nodes.
Surgery for Breast Cancer in Men
The primary treatment for early-stage breast cancer is to surgically remove the cancer. This is almost always done with a mastectomy.
Adjuvant Therapy
Hormonal therapy, chemotherapy, and/or targeted therapy may also be given as adjuvant therapy after surgery, depending on how much cancer was found during the surgery and the laboratory results from specific tests.
Locally Advanced Stage
Locally advanced breast cancer encompasses larger tumours in the breast, tumours that have invaded neighbouring areas (such as the skin or chest wall), tumours in nearby lymph nodes (such as inflammatory breast cancer), and the absence of metastasis outside of neighbouring areas to the breast. For locally advanced patients, chemotherapy is the initial treatment in most cases to shrink the tumour before surgery can be completed.
Metastatic Stage
Cancer that originates in the breast is most often spread elsewhere in the body through cancer cells leaving the breast through the lymph system or bloodstream and travelling elsewhere. When someone has metastasized (spread) breast cancer, the areas where it usually spreads are: bones, liver, lungs, and brain. However, when cancer cells spread to other parts of the body (i.e., organs), this can cause them to destroy tissue.
Medications are usually the primary treatment for metastatic breast cancer in men. The choice of medications and the order in which they are taken depend on a variety of factors.
Advanced Stage
Treatment for advanced breast cancer in men can help shrink or slow the growth of cancer, sometimes for a long time. However, eventually, it will no longer be effective. Whether additional treatment is needed at this point depends on a variety of factors.
Prognosis of Breast Cancer in Men
Assessment of an individual’s prognosis with a diagnosis of cancer is dependent on multiple factors associated with their tumor – including the size of the tumor; the histological grade of the tumor; the status of lymphatic involvement (whether there is lymph node involvement); and the status of hormone receptors (for example: ER- and HER2- positive vs. ER- and HER2-non-positive). Prognostically, the single largest indicator of outcome is whether or not there has been any lymph node involvement. Therefore, an individual who does not have evidence of any lymph node involvement (a "node negative" individual) will typically demonstrate a 90% survival rate (at five years post-diagnosis), whereas an individual with evidence of some or all lymph node involvement (a "node positive" individual) will only exhibit a 65% likelihood of being alive five years after their diagnosis. In addition to having a longer average age than the female individuals, patients diagnosed with metastatic breast cancer tend to have a greater incidence of comorbidities (other illnesses), which limits the overall prognosis for these patients.
Side Effects and Quality of Life
Men with breast cancer may experience physical and psychological side effects of therapy, such as fatigue, sexual dysfunction, hot flashes, and distress. Concerns about body image and social stigma may also impact mental health.
Supportive care, counseling, and survivorship planning are critical components of comprehensive care
Male breast cancer is extremely uncommon, but it is a highly dangerous and potentially fatal disease that needs a higher level of awareness not only from patients but also from healthcare professionals. Frequently, men are misled by the wrong idea that breast cancer only affects women; hence, medical consultation is sought late, diagnosis is made at a more advanced stage, and the clinical outcome is poorer.
If cancer in men is detected early, suitable diagnostic procedures are used for assessment, and personalized treatments are given, men with breast cancer can be expected to have good long-term survival. Raising the public's knowledge about the issue, getting people to check breast symptoms quickly, and making genetic counseling a normal part of the treatment package are the basic means of lowering death rates and improving the general quality of life of the patients.
Frequently Asked Questions
Can a man really develop breast cancer?
Yes, men do have breast tissue, and cancer can form in this tissue. Although it is very unusual, male breast cancer is a recognized medical condition.
What is the main symptom of breast cancer in men?
The most common first symptom is a painless lump under or near the nipple.
Is male breast cancer more aggressive?
The cancer itself is no more aggressive in nature; it is just that the diagnosis is often delayed, hence the disease is more advanced at presentation.
At what age are men most at risk?
The majority of cases are between 60 and 70 years old, but younger men can get the disease, especially if they have genetic risk factors.
References
Website, Nhs. “Causes of Breast Cancer in Men.” nhs.uk, 2 Apr. 2024, www.nhs.uk/conditions/breast-cancer-in-men/causes-of-breast-cancer-in-men
Male Breast Cancer - Diagnosis and Treatment - Mayo Clinic. www.mayoclinic.org/diseases-conditions/male-breast-cancer/diagnosis-treatment/drc-20374745
Fentiman I. Male breast cancer: a review. Ecancermedicalscience. 2009;3:140. doi: 10.3332/ecancer.2009.140. Epub 2009 Mar 20. PMID: 22276005; PMCID: PMC3223984
“Breast Cancer in Men | Causes, Symptoms and Treatments.” Cancer Council, www.cancer.org.au/cancer-information/types-of-cancer/breast-cancer-in-men
“Treating Breast Cancer in Men.” American Cancer Society, www.cancer.org/cancer/types/breast-cancer-in-men/treating.html
