Male Breast Cancer

Many people are unaware that breast cancer can occur in men. 

While rare, approximately 20 men in NZ are diagnosed with breast cancer each year or 1% of all cases1.  Breast cancer in men is the same disease which affects women 1,2 but most of the available information is directed at women.  
However much of the information that men need is the same,  as the diagnosis and treatment for both genders is very similar.

Breast cancer is more common in men over the age of 60 but all men need to know what to look for and report any breast changes to their GP.
Some men may be embarrassed about getting a change in their breast or chest area checked out, and put off seeing a doctor.  This may result in a delay in diagnosis. Survival is highest when breast cancer is found early. The prognosis for men with breast cancer is similar to that for women at the same age and stage of the cancer. In NZ, the 5 year survival rate is 86%. 4 

Signs and symptoms of breast cancer in men

  • A lump or area of thickened tissue .  This is most commonly painless and situated close to the nipple.
  • Skin changes such as puckering or dimpling, redness or ulceration.
  • Nipple changes e.g. a  newly indrawn nipple, or itchy ,scaly skin on the nipple.
  • Fluid discharge from the nipple. This might be clear or bloodstained.
  • Unusual breast pain or tenderness.
  • Painless lump in the axilla ( armpit)

These symptoms may also be signs of a benign (non-cancer) breast condition but it pays to get any breast changes checked out. 

Risk factors

  • Getting older as most cases are diagnosed in men between 60 – 70 years3,5
  • Having a strong family history of breast and/or ovarian cancer. 3  Men who have several family members with breast cancer have an increased risk of developing the disease.
  • BRCA gene mutation.  10 – 20% of male breast cancers are associated with an inherited fault in the BRCA genes which normally function as cell growth suppressors. Men who carry an inherited BRCA1 or BRCA2 gene mutation, or who have a strong family history of breast cancer have an increased risk of developing breast cancer.  
  • Repeated exposure to radiation, especially to the chest.  e.g. treatment for Hodgkins Lymphoma especially when young.
  • High oestrogen levels.  This may be due to obesity which is associated with elevated oestrogen levels (fat cells help to produce oestrogen) and breast enlargement. Chronic liver conditions such as cirrhosis can damage the liver. When the liver is damaged it is unable to regulate hormone levels efficiently.
  • Klinefelter’s Syndrome – a congenital ( present at birth) chromosomal disorder. Affected males are born with an extra X (female) chromosome  ( XXY rather than XY) resulting in lower testosterone production. This makes their breast cancer risk the same as for the average woman.
  • Gynaecomastia  - a benign enlargement of breast tissue in the male breast.

The tests used to investigate breast changes in men are the same as those used for women. 
The 'triple test'  is used to find the cause of a suspicious breast change. This consists of a breast examination by a breast specialist, breast imaging with mammogram and ultrasound and a biopsy of the lesion.

Treatment of male breast cancer

The same treatments are generally used for men as for women. Because men have much smaller breasts, the surgical treatment for men is usually mastectomy to remove the tumour, whereas many women may be able to have partial mastectomy. Mastectomy usually involves removing all of the breast tissue, plus the nipple and areola and some surrounding skin.

Reconstructive procedures can be used to improve the appearance of the chest wall if needed. 5,6. Implant reconstruction is not an option as currently available implants are all designed to replicate women’s breasts rather than men’s. Nipple reconstruction may be an option or 3D tattooing can give the appearance of a nipple .

One or more lymph nodes will usually be removed from your armpit when the mastectomy is performed to check whether the cancer has spread to this area. This allows the disease to be staged and aids treatment decisions.
Adjuvant treatment (after surgery) is the same as for women and may include hormone-blocking therapy, radiation therapy, chemotherapy or other targeted therapy5. This will depend on the characteristics such as size and stage of the tumour and whether the cancer cells have receptors for oestrogen, progesterone and HER2.  

Most male breast cancers are hormone receptor positive so Tamoxifen is a common treatment option to reduce the risk of recurrence in the future. This blocks the action of oestrogen which can stimulate the growth of breast cancer cells. Aromatase Inhibitors are another class of hormone-blocking drugs and are often used for post-menopausal women with breast cancer. These are not generally used in male breast cancer as research on their effectiveness in men is limited.

Herceptin, a targeted biological therapy can be given for men with HER2 positive disease .

Support
Some men may feel embarrassed and isolated after diagnosis of a disease they didn't know they could get.3 The psychological and social aspects of men having what is generally thought of as a woman's cancer are increasingly recognised internationally.
You might find it helpful to talk with others about your diagnosis and its impact on you. This may include your GP, Breastcare nurse, psychologist/counsellor or other men who have had the same experience.
The NZ Breast Cancer Foundation provides three free sessions of counselling for anyone who has been diagnosed with breast cancer. Find out more

If you have any  questions or concerns, phone  the Foundation's confidential advice line 0800BCNURSE (0800 2268 773) - available Tuesday - Thursday, or leave a message. Or email our breastnurse with your questions.  
 
The Cancer Society provides a great book on male breast cancer here  
Cancer Australia provides further resources for men with breast cancer
Download a copy of the 'Male Breast Cancer in New Zealand' fact sheet

1. Ministry of Health/NZHIS (April 2010). www.moh.govt.nz
2. Auckland Breast Cancer Study Group (2010, July). The Auckland Breast Cancer Patient Register/Poster: 1 June 2000 - 31 May 2008. 
3. National Breast and Ovarian Cancer Centre (2009). Breast cancer in men. 
www.nbocc.org.nz
4. Ministry of Health: Wellington (unpublished data) and OECD's ‘Health at a Glance 2007' Report. www.oecd.org
5. Agrawal, A., Ayantunde, A.A., Rampaul, R., Robertson, J.F.R. (2007). Male breast cancer: A review of clinical management. Breast Cancer Res Treat 103:11-21 and www.breastcancer.org
6. American Cancer Society (2010). Treating Breast Cancer in Men/Surgery 
www.cancer.org
7. Heisler, J. (2010, 7 August). Male breast cancer and surgery 
http://surgery.about.com
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