Breast cancer is rare in men. Only about 350 men are diagnosed each year in the UK compared to around 55,000 cases in women.This accounts for about 1% of breast cancer cases in the UK.
Breast cancer develops in the small amount of breast tissue men have behind their nipples. The most common type of breast cancer in both women and men is called 'invasive ductal carcinoma - no special type'.
The prognosis for breast cancer in men depends on how far it has spread by the time it is diagnosed.
Are Male And Female Breast Cancers Different?
Although there are some similarities between male and female breast cancer there are also important differences.
Men can develop rare types of breast cancer such as inflammatory breast cancer. They might also develop uncommon conditions related to the breast, including:
- Ductal carcinoma in situ (DCIS)
- Invasive lobular cancer
- Paget's disease of the breast
What Causes Breast Cancer In Men?
The exact cause of breast cancer in men is not known. There are, however, a number of risk factors have been identified, including:
Most breast cancers are diagnosed in men between the ages of 60 and 70 years of age.
All men produce small amounts of the female hormone called oestrogen. High oestrogen levels in men have been linked to a higher breast cancer risk. Conditions that can increase the level of oestrogen in men include:
- Chronic liver conditions, such as cirrhosis
- Genetic conditions such as Klinefelter syndrome
Men with Klinefelter's Syndrome have an increased risk of developing breast cancer. Klinefelter's syndrome is a rare genetic condition where a man is born with an extra female chromosome. This leads to a hormone imbalance where the body makes less testosterone.
Exposure To Radiation
Men who have had previous radiotherapy to the chest area are at an increased risk of developing breast cancer.
Genes And Family History
Inheriting faulty genes increases your risk of developing breast cancer. Doctors think that around 5 to 10% of breast cancers diagnosed in men are due to inherited faulty genes. In men with breast cancer, changes in the BRCA1 or BRCA2 faulty gene have been linked to breast cancer.
Having a family member with breast cancer also increases your risk of developing breast cancer. This is particularly true in men who have a close female relative (mother or sisters) with breast cancer.
Symptoms Of Breast Cancer In Men
If you have any of these symptoms it is important to seek medical advice. Detecting and treating cancer early gives the best chance of successful treatment. The symptoms of breast cancer in men include:
- A lump in the breast that is usually hard but painless
- A nipple retraction (the nipple turning inwards)
- Nipple discharge (oozing from the nipple) that may be blood stained
- An ulcer (sore) or rash around the nipple that does not go away
- Swelling of the breast (gynecomastia)
Diagnosing Breast Cancer In Men
If your doctor suspects that you may have breast cancer, you will usually be referred for an ultrasound which is a scan of the breast and the lymph nodes under your arm. You might also have a mammogram.
If the ultrasound shows an area of concern that could be cancerous. A sample of breast tissue (biopsy) will be sent to the laboratory for analysis. If the biopsy shows that you have breast cancer, you might have other tests to see whether the cancer has spread. These tests include:
- An MRI scan
- A bone scan
- A CT scan
- A liver scan
How Is Breast Cancer Treated In Men?
The same treatments are used for breast cancer in both men and women. The treatment for breast cancer in men depends on several factors, including:
- the extent to which the cancer has spread (the stage)
- the type of breast cancer
- the size of the cancer
- how abnormal the cells look (the grade)
- whether the cancer cells have receptors for particular hormones
- whether the cells have receptors for targeted cancer drug therapy
Based on the nature and extent of your breast cancer, you might have one or more of the following treatments:
- hormone therapy
- targeted cancer drug therapy
The most common operation is a mastectomy. During this procedure the affected breast tissue, nipple and some of the lymph nodes in the armpit are removed. Any removed lymph nodes are sent to the laboratory to see if they contain cancer cells. The surgeon might also check the lymph nodes closest to the breast using a procedure called a sentinel node biopsy.
Once treatment has finished, and the wound has fully healed, your surgeon can create a new nipple if desired. This is achieved by either doing a skin graft or tattooing a new nipple.
Your specialist will probably suggest radiotherapy after surgery. This treatment, which uses high doses of radiation to target cancer cells, lowers the risk of the cancer cells growing back in the breast area in the future.
Your doctor might recommend chemotherapy after surgery to reduce the chance of the cancer coming back or spreading. Chemotherapy is also sometimes used before surgery to shrink a large tumour. Your doctor will usually recommend chemotherapy if you have any of the following:
- cancer cells in the lymph nodes under the arm
- a tumour bigger than 20mm
- you are young
- the cancer is high grade
Men only have small amounts of oestrogen or progesterone in their bodies, but these hormones can stimulate some breast cancers. More than 95% of men have hormone receptor positive breast cancer which means that their cancer cells have the receptors for these hormones.
If a receptor test shows that you have these hormone receptors, your doctor might prescribe hormone therapy for you. The most common hormone therapy for male breast cancer is tamoxifen. It stops breast cancer from growing.
Targeted Cancer Drug Therapy
Occasionally cancer cells contain proteins called HER2 receptors. If a lot of cancer cells with these receptors are found, your doctor may prescribe a targeted drug treatment called trastuzumab.
Treatment For Advanced Breast Cancer
When cancer has spread beyond the breast it is called secondary breast cancer, advanced breast cancer, or metastatic breast cancer. Treatment options for advanced breast cancer in men include:
- hormone therapy
- targeted cancer drug therapy
- a combination of these treatments
Outlook For Men With Breast Cancer
The outlook for men with breast cancer varies depending on how far it has spread at the time of diagnosis.
If found early, breast cancer can be cured. However, a cure is much less likely if the cancer is found once it has already spread beyond the breast.