Breast cancer is a malignant tumor of breast tissue.
Because the breast is composed of identical tissues in males and females, breast cancer is sometimes found in men, but cases of breast cancer in men are rare – 1% of patients with breast cancer.
It is important to know the risk factors for breast cancer in men. Since this is a quite rare disease doctors believe that they don’t deal with breast cancer. This leads to the fact that men are diagnosed with the later stages of breast cancer.
The Risk Factors
This is one of crucial factors. Like the case for women, risk increases as age increases. The average age of men diagnosed with breast cancer is about 67.
High estrogen level
Growth of breast cells — both normal and abnormal — is stimulated by the presence of female hormone – estrogen. Men can have increased estrogen levels in the following cases:
- Intake of hormonal medications
- obesity, which increases the production of estrogen
- exposure to estrogens, for example, consumption of certain food
- abuse of alcohol, which can limit the liver’s ability to regulate blood estrogen levels
- liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen. This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
Men with Klinefelter syndrome have lower levels of androgens and higher levels of estrogen. Therefore, they have a higher risk of developing gynecomastia and breast cancer. Klinefelter syndrome is a genetic pathology that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (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 alterations
Family history can increase the risk of breast cancer in men — particularly if other family members (particularly men) 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 for male breast cancer. The lifetime risk of developing breast cancer by age 70 is approximately 1% with the BRCA1 gene and 6% with the BRCA2 gene. Because of this strong association between male breast cancer and an abnormal BRCA2 gene, first-degree relatives (siblings, parents, and children) of a man diagnosed with breast cancer may want to ask their doctors about genetic testing for abnormal breast cancer genes. Still, the majority of male breast cancers occur in men who have no family history of breast cancer and no inherited gene abnormality.
Having radiation therapy to the chest particularly during adolescence, may increase the risk of developing breast cancer. This has been seen in young people receiving radiation to treat Hodgkin’s disease. (This does NOT include radiation therapy to treat breast cancer.)
A study of breast cancer in men showed that the average time between the onset of symptoms and detection of cancer is 19 months. This is a very long period to detect cancer. This is due mainly to the fact that the doctor or the patient does not expect such diagnosis. Early diagnosis would play a huge role in reducing mortality from this disease.
According to one of the studies it has been shown that the frequency of developing breast cancer in men increased by 25% from 1973 to 1988. However, even despite this fact, this pathology is still rare.
Male Breast Cancer Symptoms
Signs and symptoms of male breast cancer can include:
- A painless lump or thickening in your breast tissue
- Changes to the skin covering your breast, such as dimpling, puckering, redness or scaling
- Changes to your nipple, such as redness or scaling, or a nipple that begins to turn inward
- Discharge from your nipple (clear or bloody)
- Pain in the nipple
- Heightened lymph nodes in the affected area of your armpit.
Diagnosing Breast Cancer in Men
After the doctor or the patient found some signs and symptoms of breast cancer, for further diagnosis certain tests are carried out.
Mammography is an X-ray method of examining the breast. Two X-ray images are taken of the breast – from the top and from the side. After that, a radiologist examines the images.
If there is something suspicious on the basis of the images, additional pictures of a particular area of the breast are required – so-called spot or magnification views.
Ultrasound is one of the cheapest, easiest and safest methods of examining patients. A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later
If any abnormal formation is shown on a mammogram or by physical exam, ultrasound is the best method to determine whether the tumor is solid (for example, cancer or fibroadenoma) or fluid-filled (cyst). Unfortunately, ultrasound can not determine benign or malignant nature of the tumor.
Nipple discharge examination. If you have nipple discharge, some of the fluid may be collected and examined under a microscope to see if any cancer cells are present.
Biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If cancer is present, the biopsy also helps your doctors determine the size, type, and kind of breast cancer. Biopsies are performed on any kind of abnormality.
Various techniques are used to biopsy tissue.
- Fine needle biopsy. A long, thin, hollow needle is placed in the abnormal area. Cells are extracted through the center of the needle. The tissue is then sent off to pathology for analysis. This biopsy technique has the highest risk of a “false negative” — a biopsy result that says “normal,” even though a cancer is present. The reason for this is probably that the needle doesn’t always pick up the cancer cells.
- Stereotactic needle biopsy removes multiple pieces of tissues. If the tumor can’t be felt, the needle is guided to the area of concern with the help of mammography or ultrasound.
- Incisional biopsy resembles surgery — it removes a bigger piece of tissue than a fine needle biopsy. Often, incisional biopsies are done when needle biopsies are inconclusive or if the lump is too extensive or too big to be removed easily. The purpose of this procedure is to make a diagnosis. Because it only takes out part (not all) of the cancer, it is not a treatment. In men, once a breast cancer diagnosis is made, mastectomy is usually done.
- Excisional biopsy is based on the complete removal of the affected area. This is the most precise method to make the diagnosis. Both incisional and excisional biopsies can be done in an outpatient center or hospital, using local anesthesia.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The results will help the surgeon prepare for the operation. In addition, magnetic resonance imaging can help to determine the condition of the other breast.
The purpose of these methods is to make a diagnosis. Even if the entire tumor was removed during a biopsy it does not mean that the patient is cured, since in any case a mastectomy is required.
Treatment of male breast cancer
Treatment options depend on factors such as the size of the tumor, its location, the stage of the cancer and laboratory findings.
While treating breast cancer in men and women the whole arsenal of modern oncology is used.
Methods of treatment
- Radiation therapy
- Hormone therapy