Breast Cancer in Men | Dr. Deepak Jha

Although it is uncommon for males to develop Breast Cancer there have been instances of development of breast cancer in men too. It arises less frequently than in females.

The common symptoms that occur in both male and female breast cancer are:

1. The appearance of a lump/bulge

2. The difference in the sizes of both breasts, where one appears larger than the other

3. Secretion from the nipple that may or may not be blood-tinged.

4. Presence of lumps in the armpits or axilla

The risk factors for male Breast Cancer are not as widely known. Hormonal imbalance can be one of the causes. Aging increases the risk of cancer as in females. Alcoholism and exposure to chest wall radiation are other possible causes. Undeveloped testis, undescended testis, surgical removal of testis for any reason can also contribute to hormonal imbalances. The use of synthetic estrogen and chronic liver diseases are a couple of other risk factors. Estrogen is metabolized by the liver and its metabolism is seriously affected by liver diseases which lead to increased levels of estrogen. The activation of breast tissue is done by estrogen and over time, it can cause breast cancer. Similar to this, a background of consuming synthetic estrogen can also lead to this problem. A few of the genetic factors cause increased chances of breast cancer in males like BRCA syndrome. This usually happens when many male and female members of the family are affected by Breast Cancer or when females are affected by ovarian cancer. Males suffering from a relatively rare chromosomal disorder called Klinefelter syndrome are almost 30 times more likely to develop breast cancer than the rest of the population.

It is always advised to visit a doctor whenever any signs of the presence of a lump or other significant features start to appear. A detailed evaluation will be performed by your physician and accordingly, other investigations will be recommended. These investigations might include mammograms or ultrasounds to image breasts. Thereafter, a lesion sample will be collected, which is known as a biopsy. Once the type of breast cancer is detected, it is further examined to see the extent of the lesion and also the metastasis to other body parts. The technique used for this is PET-CT/CECT.

The treatment plan is usually decided once the full degree of the condition has been assessed. The treatment remains the same for both females as well as males. Surgery is performed to remove the lump and if there is no metastasis of the breast cancer. Once the cancer is removed, it is then decided by some characteristic features whether the patient requires chemotherapy, radiation therapy, or hormonal therapy thereafter.

However, if the disease has progressed to other parts of the body such as the liver, and lungs then systemic therapy (chemotherapy or hormonal therapy) is given to patients. Surgical removal of the lump seems to be less useful as it won’t cure the disease in these patients.

After the completion of the treatment, check-ups are arranged once every 3 – 6 months to check for cancer recurrence.

Let us look at some very obvious questions that arise when the topic of Breast Cancer in men arises:

How are the cases of breast cancer amongst males different from breast cancer amongst females?

Breast cancer is rare in males as compared to females. Male breast cancer comprises less than 1% of all breast cancer cases. Breast cancer usually presents at a more advanced stage in males, generally is hormone receptor-positive and carries a worse prognosis as compared to female breast cancer, and is often associated with genetic breast cancer.

Are the cases of breast cancer amongst males underreported? If so, why?

Breast cancer is thought to be an exclusive disease of females and hence patients often ignore male breast cancer. It can also be confused with gynecomastia leading to delay in diagnosis and present. These factors along with the general under-reporting of cancer in India lead to a gross underestimation of male breast cancer load in our country.

How can we encourage men to go for breast cancer check-ups?

Breast cancer awareness efforts have come a long way in our country and have been a story of success. We now need to include men in these campaigns and make them sensitive to the fact that they are also susceptible to this disease. They also need to be made aware of the genetic component of breast cancer. Promotion of simple habits like “self-breast examination” will go a long way in catching the suspicious lumps in the early stages leading to better cure rates.

Why people aren't aware of breast cancer amongst men?

Breast cancer is thought to be exclusive to women, even though the male breasts also contain the tissues that can develop cancer. A breast lump in a man is often ignored with the assumption that it is either gynecomastia or that it would go away with age,  and hence it gives cancer time to grow and spread. The ignored lump grows with time and involves the surrounding skin and starts discharging fluid and blood. A visit to the doctor then reveals the diagnosis and a small lump has by now developed into an advanced-stage disease

Why the cases of breast cancer among men suddenly emerged? What causes it?

The awareness campaigns surrounding breast cancer coupled with better access to healthcare facilities have led to more people coming forward with their symptoms and hence we have seen an increase in reporting. Understanding about genetic breast cancer and better testing facilities, sensitization of health care professionals to male breast cancer, and strengthening of cancer registries have all combined to better reporting and hence an increased incidence of male breast cancer.

What are the myths associated with breast cancer in males?

There are quite a few myths associated with male breast cancer.

1. The first and foremost is that “Men don’t have to worry about getting breast cancer”.

2. Another myth is that “male breast cancer occurs only if there is breast cancer in the family” whereas the truth is it can occur even without a family history.

3. Another myth is about undergoing annual screening mammograms for males. There is at present no role in screening mammograms for male breast cancer due to the rarity of the disease.

4. There are many myths regarding the type and treatment of breast cancer in males. The truth is that treatment follows the same course and patients often may require chemotherapy and radiation along with surgery if the disease is not caught in the early stages.

5. “Men don’t need hormone therapy” is also a statement heard from patients. In fact, male breast cancer is often hormone receptor-positive and will need hormone therapy as part of treatment. Non-compliance with hormone therapy due to its side effects is an important factor contributing to poor cure rates in male breast cancer patients.

What are the signs of breast cancer in males?

Male Breast Cancer is seen more often in the age group of 50-70 years. It often starts with a painless lump that can be detected by regular self-examination. Other signs can be changes in the skin of the breast (redness, dimpling) and in the nipple (scaling, inward turn). Nipple discharge, especially a bloody discharge, is another warning sign. There can be many subtypes of male breast cancer, however, ‘Invasive ductal carcinoma is the most common type, just as in females