Breast Cancer in Men

Breast Cancer in Men

Breast cancer in men is a rare but possible condition where malignant cells develop in the breast tissue of males. While breast cancer is much more common in women, men can also be affected by this disease.

The anatomy of male breasts is similar to that of females, albeit less developed. Men have a small amount of breast tissue located behind the nipples. Breast cancer in men usually originates in the ducts, which are the milk-carrying tubes, but it can also develop in the glandular tissue or other parts of the breast.

Types of Breast Cancer in Men

Although breast cancer in men is rare, similar to women, there are different types of breast cancer that can occur. The most common types of breast cancer in men include –

1. Invasive Ductal Carcinoma (IDC) – This is the most common type of breast cancer in men, as well as in women. It starts in the breast’s milk ducts and then invades the surrounding breast tissue.
2. Ductal Carcinoma in Situ (DCIS) – DCIS refers to the presence of abnormal cells in the milk ducts that have not yet invaded the surrounding tissue. It is considered a non-invasive form of breast cancer but has the potential to become invasive if left untreated.
3. Lobular Carcinoma in Situ (LCIS) – LCIS is the presence of abnormal cells in the breast lobules. It is not considered true cancer but is regarded as a risk factor for developing invasive breast cancer.

Breast Cancer in Men

4. Inflammatory Breast Cancer (IBC) – IBC is a rare and aggressive form of breast cancer that can occur in men and women. It typically presents with redness, swelling, and warmth of the breast. The skin of the breast may appear thickened or have a pitted appearance, similar to an orange peel.

5. Paget’s Disease of the Nipple – Paget’s disease is a rare form of breast cancer that starts in the ducts and spreads to the nipple and the areola (the darker area surrounding the nipple). It can cause itching, redness, scaling, and crusting of the nipple and areola.

These are the main types of breast cancer that can affect men. It’s important to note that the treatment and prognosis for each type may vary, so a proper diagnosis and consultation with a healthcare professional are crucial for determining the most appropriate treatment approach.

Causes

The actual causes of breast cancer in men are not fully understood, but several risk factors have been identified. These risk factors may increase the likelihood of developing breast cancer in men –

1. Age – The risk of breast cancer in men increases with age, and it is more commonly diagnosed in older men, usually between the ages of 60 and 70.
2. Family History – Having close relatives, particularly female relatives, with breast cancer can increase a man’s risk. Inherited gene mutations, such as BRCA2, BRCA1, and others, can be passed down through families and increase the likelihood of breast cancer in both men and women.
3. Genetic Mutations – Inherited gene mutations, as mentioned above, can increase the risk of breast cancer in men. Mutations in the BRCA2 gene, in particular, have been associated with an increased risk of male breast cancer.
4. Hormonal Factors – Hormonal imbalances or conditions that affect hormone levels can influence the risk of breast cancer in men. Conditions such as Klinefelter syndrome (a genetic disorder that affects the sex chromosomes) and liver disease can lead to higher estrogen levels, which can increase the risk.
5. Radiation Exposure – Previous exposure to radiation, particularly in the chest area, can increase the risk of developing breast cancer in men. This may occur due to radiation treatment for other cancers or occupational exposure.
6. Conditions that Affect the Testicles – Certain conditions or medical treatments that affect the testicles, such as undescended testicles or orchitis (inflammation of the testicles), may increase the risk of male breast cancer. These conditions can alter hormone levels and potentially contribute to the development of breast cancer.

Having one or more of these risk factors does not guarantee that an individual will develop breast cancer, nor does the absence of these risk factors rule out the possibility. Breast cancer in men is relatively rare, and the majority of cases occur without any known risk factors. Regular screenings and early detection can help in the timely diagnosis and treatment of breast cancer in men.

Symptoms

The symptoms of breast cancer in men can vary, but some common signs to watch out for include –

1. Lump or Thickening – The most common symptom of breast cancer in men is the presence of a painless lump or thickening in the breast tissue. It is typically located just behind the nipple but can also be found in other areas of the breast.
2. Nipple Changes – Changes in the nipple can occur, such as nipple retraction (pulling inward), scaling, redness, ulceration, or discharge. The discharge may be bloody or clear.
3. Breast Skin Changes – The skin over the breast may appear dimpled, puckered, or indented. It may also develop redness or a rash that does not go away.
4. Changes in Breast Size or Shape – One breast may become larger or more swollen compared to the other. The breast may also appear asymmetrical or have changes in contour.
5. Pain or Discomfort – While breast cancer in men is often painless, some individuals may experience pain, tenderness, or discomfort in the breast area.
6. Swollen Lymph Nodes – The presence of swollen lymph nodes under the arm or in the neck area can be an indication that breast cancer has spread to nearby lymph nodes.

These symptoms are not exclusive to breast cancer and can be caused by various other conditions. However, if you notice any of these changes or have concerns about your breast health, it is important to consult with a healthcare professional for a proper evaluation and diagnosis. Early detection and prompt medical attention are crucial for successful treatment outcomes.

Diagnosis and Tests

The diagnosis of breast cancer in men typically involves several steps and tests to confirm the presence of cancer and determine its characteristics. Here are the common diagnostic procedures and tests for breast cancer in men –

1. Clinical Examination – A healthcare professional will conduct a thorough physical examination of the breast and surrounding areas to assess any abnormalities, such as lumps, changes in the skin or nipples, or enlarged lymph nodes.

2. Imaging Tests

• Mammography – Mammograms are X-ray images of the breast tissue. While mammography is primarily used for breast cancer screening in women, it can also be used as an initial diagnostic tool for men with breast symptoms or abnormalities.
• Ultrasound – Ultrasound uses sound waves to create images of the breast tissue. It helps to differentiate between solid masses and fluid-filled cysts.
• Magnetic Resonance Imaging (MRI) – MRI uses powerful magnets and radio waves to produce detailed images of the breast. It may be recommended for further evaluation or if there are concerns about the extent of the disease.

3. Biopsy – A biopsy is a procedure where a small sample of breast tissue is removed and analyzed under a microscope to determine if cancer cells are present. Different types of biopsies may be performed, including –

• Fine-needle aspiration biopsy – A thin needle is used to extract a small sample of cells from the breast lump.
• Core needle biopsy – A larger needle is used to remove a larger sample of breast tissue.
• Surgical biopsy – A surgical procedure is performed to remove a part or all of the suspicious tissue for further examination.

4. Pathology Analysis – The tissue samples obtained from the biopsy are sent to a laboratory, where a pathologist examines them under a microscope. They determine if cancer is present, the type of cancer, its grade (how aggressive it is), and other characteristics that help guide treatment decisions.

5. Hormone Receptor Testing – In some cases, hormone receptor testing may be performed on the cancer cells. This test determines if the cancer is estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), or human epidermal growth factor receptor 2-positive (HER2+). These results help determine appropriate treatment options, such as hormone therapy or targeted therapies.

6. Additional Staging Tests – If breast cancer is diagnosed, additional tests may be performed to determine the stage and extent of the disease. These may include blood tests, imaging scans (such as a bone scan, CT scan, or PET scan), and possibly a biopsy of nearby lymph nodes.

The specific diagnostic procedures and tests may vary based on individual circumstances and the recommendations of the healthcare provider. It is important to discuss any concerns and questions with a healthcare professional who can guide you through the diagnostic process. 

Stages

After diagnosis, the staging of cancer is determined on the basis of cancer spread, type of cancer, and overall health of an individual patient. You may need imaging tests such as CT scan, PET scan, and MRI. Your healthcare provider may perform a sentinel node biopsy to determine as part of staging. During this procedure, one or more of the lymph nodes are removed and tested for cancer cells –

The stages of breast cancer in men are as follows –

Stage 0 – Cancer cells are present only in the ducts. It is also called ductal carcinoma in situ.

Stage I – the tumor is small in size and has yet not spread to the lymph nodes.

Stage II – One of the situations is involved –

• The tumor is smaller than 20mm and has spread to a few lymph nodes in the armpit (axillary lymph nodes).
• The tumor is in the range of 20mm to 50mm and hasn’t spread to axillary lymph nodes (stage II A) or the tumor is 20mm to 50mm and has spread to axillary lymph nodes. 
• The tumor is larger than 50mm and hasn’t spread to a few axillary lymph nodes.

Stage III – Cancer has spread to surrounding lymph nodes. Cancer cells may be present in your chest wall or skin.

Stage IV – Cancer cells have already spread to other parts of your body including lungs, bones, liver, or brain.

Treatment

The treatment of breast cancer in men typically involves a combination of therapies that are similar to those used in the treatment of breast cancer in women. The specific treatment plan will depend on various factors, including the stage of cancer, its characteristics, the overall health of the individual, and personal preferences. Here are the common treatment options for breast cancer in men –

1. Surgery

• Mastectomy – This surgical procedure involves the removal of the entire breast tissue. It can be either a simple mastectomy (removal of the breast tissue) or a modified radical mastectomy (removal of the breast tissue and nearby lymph nodes).
• Lumpectomy – Also known as breast-conserving surgery, a lumpectomy involves the removal of the tumor and a small amount of surrounding normal tissue while preserving the rest of the breast. 

2. Radiation Therapy – Radiation therapy uses high-energy beams to target and kill cancer cells. It may be recommended after surgery to destroy any remaining cancer cells in the breast or surrounding lymph nodes.

3. Chemotherapy – Chemotherapy involves the use of drugs to kill cancer cells or prevent their growth. It is typically recommended for men with advanced-stage breast cancer or when there is a high risk of cancer recurrence.

4. Hormone Therapy – Hormone therapy is used when breast cancer cells are hormone receptor-positive (ER+ or PR+). Medications such as tamoxifen or aromatase inhibitors are used to block or lower the levels of hormones (estrogen) in the body, which can help slow down the growth of cancer cells.

5. Targeted Therapy – In cases where breast cancer cells are HER2-positive (HER2+), targeted therapy drugs such as trastuzumab (Herceptin) or pertuzumab (Perjeta) may be used to specifically target and inhibit the HER2 protein, which is involved in cancer cell growth.

6. Clinical Trials – Participation in clinical trials may be an option, allowing access to novel therapies and treatment approaches that are being studied and evaluated for their effectiveness in breast cancer.

Treatment decisions should be made in consultation with a multidisciplinary team of healthcare professionals, including surgeons, medical oncologists, radiation oncologists, and other specialists. The treatment plan will be tailored to each individual’s specific needs and preferences, and ongoing monitoring and follow-up care will be necessary to assess treatment response and manage any side effects or potential complications.

It is necessary to consider that emotional support, counseling, and access to support groups can also be valuable components of the overall treatment and recovery process.

Outlook 

The outlook for breast cancer in men can vary depending on several factors, including the stage of cancer at diagnosis, the characteristics of the tumor, the response to treatment, and the overall health of the individual. Generally, early detection and timely treatment significantly improve the prognosis and increase the chances of successful outcomes.

When detected at an early stage – before cancer has spread beyond the breast then it may increase the chance of survival. Also based on research and studies, the five-year survival rate for men with breast cancer is quite similar to that of women, ranging from 90% to over 99%. However, because breast cancer in men is often diagnosed at a later stage compared to women, the overall survival rates for men tend to be slightly lower.

Regular follow-up care, ongoing monitoring, and adherence to recommended treatments and screenings are essential for the long-term management and surveillance of breast cancer in men. In addition to that, emotional support, counseling, and access to support groups can provide valuable assistance by improving the overall quality of life during and after treatment.