When you hear about breast cancer, it is most often related to a woman being diagnosed with the disease.  However, on rare occasions, ≤ 1%, a man will be diagnosed with breast cancer. Typically, it occurs in older men but can occur at any age.

Breast cancer affects men in the same location as a woman, in the breast tissue. This tissue is composed of ducts and lobules (glands) but since men have fewer female hormones then women, the breast tissue does not grow as much.  

It is not always clear why a man develops breast cancer, but doctors do know that at some point the normal breast cells start growing faster than normal cells and spread into the surrounding tissue. This can form a lump or a “tumor”. These fast-growing cells can then spread to nearby tissue and lymph nodes or other parts of your body if medical attention isn’t received in a timely manner.

Due to the stigma of male breast cancer, some men may choose to ignore the symptoms or avoid seeing a doctor all together. If diagnosed early, you will have a very good chance of a cure. 

Risk Factors:

There are some known factors that can increase the risk of male breast cancer: 

• Advanced age – Male breast cancer is most often diagnosed in men 60 or older.
• Family history of breast cancer – Men that have close family members with breast cancer are at an increased risk for breast cancer.
• Estrogen exposure – Some hormone therapies for prostate cancer have estrogen and may put you at an increased risk for breast cancer.
• Obesity – Fat cells have an increased number of female hormones, which put you at an increased risk for breast cancer.
• Other diseases such as testicular cancer or liver disease can reduce male hormones and increase female hormones, putting you at an increased risk for breast cancer. 
• Genetic diseases such as Klinefelter’s Syndrome can reduce male hormones and increase female hormones, putting you at an increased risk for breast cancer. 

Signs and Symptoms of Male Breast Cancer:

• A painless lump that won’t go away
• Swelling to the axillary (armpit) area
• Thickening of breast tissue or a dimpling appearance
• Changes to the nipple area
  • pulling inward
  • scaling
  • redness or changes in skin color
  • nipple discharge

Diagnosing Male Breast Cancer:

When you visit your physician, you can expect some combination of the following: 

• Physical exam
• Personal and family history review
• Imaging studies
  • Diagnostic mammogram and/or ultrasound
  • Bilateral breast MRI
  • PET/CT or CT/Bone Scan if signs of metastatic disease are present
• Genetic testing if you have a family history of breast cancer
  • Inherited mutations, such as BRCA 1 and 2, may put you at a higher risk for getting breast cancer
• Breast biopsy
  • A core needle biopsy is a test that has a wide hollow needle that removes small pieces of tissue from the suspicious area.  A pathologist will then analyze the tissue’s cells to determine the diagnosis. It can take several days to get the results of the biopsy.
  • Less frequently, a fine needle aspiration is done to determine the diagnosis. This test is typically done to examine cells near the lymph node(s) in the axillary area.  The test draws cells or fluid into a small hollow needle that is sent to a pathologist for analysis.  It can take several days to get the results of the biopsy.

Types of Male Breast Cancer:

The most common type of male breast cancer is called adenocarcinoma. This type of carcinoma starts in the breast ducts or lobules (glands). Less common types of carcinomas are called sarcomas, angiosarcomas, phyllodes or Paget’s Disease. These carcinomas start in the cells of fat, connective tissue or muscle.  In some cases, a combination of different types of cells are found.  

• Cancer that begins in the milk ducts is called ductal carcinoma. Nearly all male breast cancer is ductal carcinoma.
  • Ductal carcinoma in situ (DCIS) 
    • DCIS is considered a Stage 0, non-invasive breast cancer, meaning it has not spread beyond the walls of the ducts to the surrounding breast tissue. DCIS is very curable type of cancer because it has been caught in the early stages of development.
  • Invasive ductal carcinoma (IDC)
    • IDC is the most common type of male breast cancer, affecting 8 out of 10 men diagnosed with the disease.
    • IDC is an invasive breast cancer, meaning it has spread beyond the walls of the ducts into the surrounding breast tissue.   At this point, it has the potential to spread to other parts of the body if it is not treated in a timely manner.
• Cancer that begins in the glands is called lobular carcinoma. 
  • Lobular carcinoma in men is rare, approximately 2%, because men have fewer lobules in their breast tissue then woman. 
  • Invasive lobular carcinoma (ILC) is an invasive carcinoma, meaning it has spread outside of the lobules (glandular tissue) into the surrounding breast tissue. 
• Rarer types of male breast cancer include:
  • Paget's disease of the nipple. This accounts for approximately 5% of breast cancers in men.  It starts in the ducts and spreads to the nipple and sometimes the areola area (circular area around the nipple).  
  • Inflammatory breast cancer (IBC). An aggressive type of breast cancer causing the breast to become swollen, warm and red. It may be tender to touch and mistaken for an infection. 

Treatments for Male Breast Cancer:

Men with breast cancer are candidates for lumpectomy with radiation, mastectomy alone, or mastectomy with reconstruction (nipple alone or entire breast). Not as much is known about breast cancer in men, but treatment in men is similar to that for women. Indications for chemotherapy are similar.

A lumpectomy is not performed as frequently in men as in women because most men don't have much breast tissue and very little breast tissue is left behind once the tumor is removed. In men, the tumor is usually noticed as a palpable lump or hardness at the nipple-areola complex, which means it will be removed at surgery. 

A study published in the Annals of Surgical Oncology assessed outcomes in men with breast cancer based on the type of surgical therapy performed. While there were some limitations to the study, the authors found improved 10-year survival in patients who underwent breast conserving therapy (lumpectomy and radiation) compared to mastectomy, suggesting that radiation therapy may improve outcomes. Oncoplastic procedures are also sometimes possible and can allow men to undergo breast conservation without significant deformity. 

Many men choose mastectomy to decrease the potential need for radiation and make future monitoring easier. 

Lymph node staging for invasive carcinoma is performed by sentinel node biopsy, where a radioactive dye is injected into the areola prior to surgery and the nodes (typically from 1 to 3) that have taken up the dye are removed and examined for cancerous cells.

Most breast cancers in men are hormone-receptor-positive (either estrogen or progesterone). Breast cancer is a systemic disease, thus most men with ER positive tumors will require anti-hormone therapy, like tamoxifen or aromatase inhibitors. You may also need chemotherapy depending on how far your breast cancer has progressed. The choice of surgical procedure does not reduce the need for anti-hormone therapy or chemotherapy. 

Many men also need radiation therapy after healing from their surgery. In that case you will be referred to a radiation oncologist, a physician who specializes in the use of radiation therapy to treat the affected area(s) after surgery. Radiation therapy uses high energy x-rays to destroy any microscopic cells that may be left behind after your breast surgery and helps reduce your risk of recurrence of breast cancer.  

Radiation therapy may be recommended for the following reasons:

• If your tumor is ≥ 5 cm (approximately 2 inches)
• If you have positive surgical margins or the cancer is very close to the edge of the tissue that has been removed.
• If the tumor involved the skin or muscle
• Lymph node involvement
  • Usually if you have three or more positive nodes. However, patients with 1-2 positive lymph nodes may require radiation

Radiation is typically given in an out-patient setting after the surgical wound has healed, which is approximately 4 weeks after surgery. It is usually given daily and the full course can take up to 5-6 weeks. The daily treatments are typically very quick, 15 minutes or less.  

Men with BRCA mutations have up to a 10% lifetime risk of development of breast cancer, much lower than women with BRCA mutations. While some men choose to undergo prophylactic mastectomy, it is not routinely recommended for men. 

Chemoprevention (medication to lower the risk of future cancer) for male and female BRCA1 carriers does not seem to reduce cancer risk since tumors associated with BRCA1 are usually ER negative. BRCA2 carriers may benefit since many of these tumors are ER positive. Annual screening is advised for male BRCA carriers.

Following mastectomy, men can have the same chest wall deformities and concerns about their appearance as any other breast cancer patient. Like women, male breast cancer patients have several breast reconstruction options. Men can have nipple reconstruction in conjunction with total breast reconstruction, fat grafting, or nipple reconstruction alone. These are usually performed after completion of all other breast cancer treatment. 

Content provided by Dr. Patricia Clark | Ironwood Cancer and Research Center.