Male Breast Cancer

What is it?

All males are born with breast tissue, and that tissue can develop cancer. Both boys and girls have a small amount of breast tissue located under the nipple and the area around the nipple. At puberty, female hormones cause the breast tissue to grow. On the other hand, male hormones prevent further growth of the breast tissue.

Statistics

Breast cancer accounts for about 0.22% of cancer deaths in men. In 2004, about 470 men will die from breast cancer in the United States. Unlike breast cancer in females, the number of new cases developing each year has remained constant over the past 40 years. Although breast cancer in men has been reported in males as young as 5 years old and as old as 93 years of age, the median age at diagnosis is 68 years (compared to 63 years of age in women). In the United States, men account for approximately one percent of all cases of breast cancer.

What are the risk factors?

Many of the risk factors for male breast cancer involve hormonal abnormalities (particularly androgen and estrogen imbalance). These include undescended testes, congenital inguinal hernia, surgical removel of the testes, inflammation or infection of the testes, testicular injury, infertility, obesity, cirrhosis of the liver, and Klinefelter's symdrome. Klinefelter's symdrome is present at birth and affects about 1 out of 1000 men. Normally, males have one X and one Y chromosome and women have two X chromosomes. Men with Klinefelter's symdrome have an extra X chromosome, resulting in a total of one Y and two X chromosomes.

Other risk factors include a family history of breast cancer in first-degree relatives, benign breast conditions (such as nipple discharge, breast cysts, or a history of breast trauma), radiation exposure to the chest, increasing age, Jewish ancestry, and a genetic mutation in the BRCA2 gene. Gynecomastia (an increase in the amount of a man's breast tissue) is not a risk factor for breast cancer.

How is it diagnosed?

Any changes in the breast should prompt a man to see a health care provider as soon as possible for evaluation. Common signs include:

• a lump or swelling

• skin dimpling or puckering

• nipple retraction (the nipple turning inward)

• redness or scaling of the nipple or the skin around the nipple

• discharge from the nipple

Diagnostic procedures could include a complete medical history, a clinical breast examination (including an examination of the lymph nodes and liver), mammography, ultrasound, and biopsy (tissue sample).

How is it treated?

Due to its rarity, there have been no clinical trials on the treatment of male breast cancer. Information from treatment comes from studies with women. Therefore, treatment generally parallels that seen with women. The treatment is different depending upon the stage of the cancer. To read more about staging, click here.

What is the prognosis?

Researchers argue over whether the prognosis is worse for men than women. However, stage-for-stage, the survival rates are equal. Some argue, howver, that breast cancer in men is often diagnosed at more advanced stages. The percentage of men still living five years after diagnosis depends on the stage. The lower the stage, the better the survival rate.

• stages 0 and I: 97-98% 5-year survival

• stage II: 88% 5-year survival

• stage III: 67% 5-year survival

• stage IV: 14% 5-year survival (To read more about staging, click here).

How is it prevented?

Breast cancer in men is best prevented through early detection. The American Cnacer Society recommends yearly cancer-related health check-ups for all men age 40 and older. Since most men are not aware that they can indeed get breast cancer, many men ignore breast lumps or attribute them to other causes. This often causes a delay in diagnosis and a higher stage at diagnosis. Mammography may be a useful screening tool in men with a strong family history of breast cancer and BRCA2 mutations found by genetic screening.

Useful Links:

Medline Plus: Male Breast Cancer

American Cancer Society: Male Breast Cancer

breastcancer.org: Current Research on Male Breast Cancer

American College of Physicians: Breast Cancer in Men

National Alliance of Breast Cancer Organizations: Male Breast Cancer Resources (includes support groups)