Male Breast Cancer

Male breast cancer is a rare form of cancer that develops in the breast tissue of men.

Even though breast cancer is thought to be a woman's disease, male breast cancer does occur, and is most common in older men, but it can occur at any age.

Male breast cancer diagnosed at an early stage has a good chance of getting cured completely. But, many men delay seeing their doctors even if they notice one of the unusual signs or symptoms, such as a breast lump. For this reason, most male breast cancers are diagnosed only when the disease has reached a more advanced stage.

Signs and symptoms of male breast cancer include:

• A painless lump or thickening felt in your breast.
• Changes to the skin covering your breast, such as dimpling, puckering, redness or scaling.
• Changes to your nipple, such as pain, redness or scaling, or an inverted nipple that begins to turn inward.
• Bloody or clear discharge from your nipple.
• Lymph node enlargement under the arm.

When to see a doctor?

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

The exact cause of male breast cancer is not clear. It is only known that male breast cancer occurs when some of the breast cells start dividing more rapidly than the healthy cells. The cancerous cells accumulate to form a tumor that may spread (metastasize) to the nearby tissues, lymph nodes or other parts of the body.

Where breast cancer originates in men?

Every person is born with a small amount of breast tissue. Breast tissue is made up of milk-producing glands (lobules), ducts that transport milk to the nipples, and fatty tissues.

During puberty, women start developing more breast tissue while men do not. As men also have a small amount of breast tissue, they can develop breast cancer.

Types of breast cancer diagnosed in men include:

• Cancer that begins in the milk ducts (ductal carcinoma): Almost all male breast cancer is ductal carcinoma.
• Cancer that begins in the milk-producing glands (lobular carcinoma): This occurs rarely in men because they have very few lobules in their breast tissue.
• Cancer that spreads to the nipple (Paget's disease of the nipple): Rarely, male breast cancer forms in the milk ducts and spreads to the nipple, causing crusty, scaly skin around the nipple.

Inherited genes that can increase your breast cancer risk

Some men inherit abnormal (mutated) genes from their parents that can increase their risk of developing breast cancer. Mutations in one of several genes, especially a gene called BRCA2, puts you at a greater risk of developing breast and prostate cancers.

These genes normally produce proteins that avoid abnormal growth of cells, which helps in preventing cancer. But if these genes are mutated genes, they become ineffective at providing protection from cancer.

Meet a genetic counselor and discuss about genetic testing that can be done to determine whether you are carrying gene mutations that increase your risk of breast cancer — and if you can pass this gene along to your children, both boys and girls. Talk about the benefits and risks of genetic testing with your doctor.

Making a diagnosis of male breast cancer is done by performing several tests.

You may start by seeing your family doctor or a general practitioner if you notice any unusual signs or symptoms that worry you. If your doctor thinks you may have breast cancer, you may be referred to a doctor who specializes in treating cancer (oncologist).

As appointments can be brief, it is a good idea to be well prepared. Here is some information to help you get ready for your doctor's appointment.

What you can do?

• Know your pre-appointment restrictions, such as avoiding intake of solid food for a certain period of time before your appointment.
• Write down your symptoms, including those that seem unrelated to the reason of your appointment.
• Write down your key medical information, including other co-existing conditions.
• Write down key personal information, including any recent life changes or major stresses.
• Make a list of all your medications, vitamins and supplements with their doses.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.
• Write down questions to ask your doctor. Preparing a list of questions in advance can help you save most of your time, and can avoid missing out important questions you want to ask your doctor.

For male breast cancer, some basic questions to ask your doctor include:

• • What type of breast cancer do I have?
  • At what stage is my cancer?
  • Has my cancer spread beyond the breast?
  • Is my cancer curable?
  • Do I need more tests?
  • What are my treatment options?
  • Are there any potential side effects of each option?
  • Which treatment option do you feel is best for me?
  • How long will my cancer treatment last?
  • Does cancer treatment affect my daily life?
  • How can I best manage my other health conditions with cancer?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor?

Your doctor may ask you a number of questions. Be ready to answer them so that you have time to discuss other points you want to ask.

You may be asked:

• What symptoms do you have?
• How severe are they?
• When did you experience these symptoms first?
• Do these symptoms occur continuously or are they occasional?
• Do any of your relatives have cancer?
• If yes, what type of cancer and at what age were these family members diagnosed?

Diagnosing male breast cancer

Your doctor may perform a number of diagnostic tests and procedures, such as:

• Clinical breast exam: The doctor uses his or her fingertips to examine your breasts and surrounding areas for lumps or other changes. Your doctor will assess the size of the lumps, their texture, and their proximity to your skin and muscles.
• Imaging tests: Mammogram and ultrasound can detect abnormal masses in your breast tissue. 
• Biopsy: A long, thin needle is inserted into the breast to aspirate tissue for analysis in the laboratory. Test results can reveal whether you have breast cancer and if so, the type of breast cancer you have.
• Nipple discharge examination: If you have nipple discharge, a little amount of the fluid is collected and examined under a microscope to check whether there are any cancer cells present.

If a diagnosis of cancer is made, your doctor might recommend some more tests. For example, MRI scan can reveal the extent of cancer in the affected breast as compared to the normal tissues right under and next to the breast cancer. This gives the surgeon, an idea to plan the extent of surgery.

Other tests, such as blood tests, chest X-ray, and bone scan, might be done to check whether the cancer has spread to other parts of the body.

Determination of the extent of the cancer

Determining the extent (stage) of your cancer guides your doctor through evaluation of treatment options. Biopsy, blood tests, and imaging tests can be used to stage male breast cancer.

The stages of male breast cancer are:

• Stage I: The tumor does not exceed 2 centimeters (cm) in diameter (about 3/4 inch) and has not spread to the lymph nodes.
• Stage II: The tumor may measure 5 cm (about 2 inches) in diameter and has spread to the nearby lymph nodes or the tumor may be larger than 5 cm but no cancer cells are may be found in the lymph nodes. 
• Stage III: The tumor may be more than 5 cm (about 2 inches) in diameter, and may involve several nearby lymph nodes including lymph nodes situated above the collarbone.
• Stage IV: The cancer has spread beyond the breast to involve distant areas, such as the bone, brain, liver or lungs.

Your doctor will develop a treatment plan for male breast cancer based on your cancer's stage, your overall health, and your preferences. Male breast cancer treatment often involves surgery and may also include other treatments.

Surgery

The objective of surgery is to remove the tumor and the surrounding breast tissues. The procedures include:

• Removal of breast tissue and surrounding lymph nodes (modified radical mastectomy): Your surgeon will remove the entire breast tissue, including the nipple and areola, and some lymph nodes under your arm.
• Removal of one lymph node for testing (sentinel lymph node biopsy): Your doctor will identify the lymph node to which your cancer cells would spread first. That lymph node is removed and examined. If no cancer cells are detected, there is a good chance that your breast cancer is still localized, and has not spread beyond your breast tissue.

Radiation therapy

Radiation therapy makes use of high-energy beams to destroy cancer cells. In male breast cancer, radiation therapy may be used after surgery to kill any remaining cancer cells in the breast, chest muscles or armpit. During radiation therapy, beams come from a large machine that moves around your body to direct the energy beams to more precise points on your chest.

Chemotherapy

Chemotherapy makes use of certain drugs to kill the cancerous cells. These medications are administered into a vein in your arm (intravenously), in the form of a pill or by both methods. Your doctor might advise chemotherapy after surgery to destroy cancer cells that might have spread outside your breast. Chemotherapy is also an option for men with advanced stage breast cancer.

Hormone therapy

Your doctor may recommend hormone therapy if your cancer is hormone-sensitive. Most men with male breast cancer develop tumors that depend on hormones to grow (hormone-sensitive). Hormone therapy for male breast cancer usually involves the medication tamoxifen, which is also used for women.

Other hormone therapy medications used in women with breast cancer have not been as effective enough for men.

Lifestyle modifications are necessary in order to cope with male breast cancer.

A diagnosis of cancer can be both shocking and upsetting at once. But, as time passes, you can find ways to cope with the stress and challenges that follow cancer and cancer treatment.

Until then, you may consider the following measures:

• Find someone you can talk to: You may feel comfortable after discussing your feelings with a friend or family member, or you may prefer meeting a formal support group. Support groups created for the families of cancer survivors also are available.
• Prayer or meditation: You can pray or meditate on your own or receive guidance from a spiritual advisor or an instructor. 
• Exercise: Performing mild exercises can boost your mood and make you feel better. Ask your doctor to advise appropriate exercise for you. 
• Creative activities: Engage yourself in entertaining activities, such as art, dance and music. This may help you feel less distressed. Some cancer centers have specially trained professionals who can guide you through these activities. 
• Relaxation exercises: Relaxation exercises can refocus your mind and help you relax. Relaxation exercises include guided imagery and progressive muscle relaxation. You can do relaxation exercises on your own, with an instructor or by listening to a recording that guides you through the exercises.

There are a number of factors that can increase a man's risk of getting breast cancer, which include:

• Advancing age: Your risk of male breast cancer increases as you grow older. The average age at which breast cancer is diagnosed in men is between 68 and 71 years.
• Exposure to high estrogen levels: Abnormal growth of breast cells in men is stimulated by high estrogen levels, which occur as a result of taking hormonal medicines or estrogen-related drugs, such as those used as part of a sex-change procedure. Heavy use of alcohol leads to higher levels of estrogen in men. 
• Family history of breast cancer or genetic factors: If you have had a close family member with breast cancer, you have a greater chance of developing the disease. Men who inherit abnormal BRCA1 or BRCA2 genes have an increased risk for male breast cancer. 
• Klinefelter's syndrome: This genetic syndrome occurs when a boy is born with more than one copy of the X chromosome, sometimes as many as four. It is characterized by abnormal development of the testicles. As a result, men with this syndrome have lower levels of male hormones (androgens) and higher levels of female hormones (estrogens). For this reason, they are at a higher risk of developing breast cancer.
• Liver diseases: Cirrhosis of the liver causes reduction in the level of male hormones and increases female hormones to increase your risk of breast cancer. 
• Obesity: Being overweight also increases estrogen production. Fat cells can convert androgens into estrogen. A higher number of fat cells in your body may result in increased estrogen and higher risk of breast cancer. 
• Radiation exposure: If you have received radiation therapy to your chest, during adolescence or before the age of 30, to treat cancers in the chest, you are more likely to develop breast cancer later in life. 
• Testicle disease or surgery: Inflammation of testicles (orchitis) or surgery done to remove a testicle (orchiectomy) can increase your risk of male breast cancer.