Male Breast Cancer
Because male breast cancer is rare and has no formal screening guidelines, it is often not recognized until it reaches a more advanced stage. Feeling a lump in his breast is what leads a man to seek medical care. Not all lumps that occur in the male breast, however, are cancerous. All lumps need a thorough evaluation before one can be assured that he is cancer free. Awareness of the possibility of male breast cancer and associated risk factors can be life saving.
WHO IS AT RISK?
- Men with a family history of breast cancer in a male or female relative.
- Men with increased levels of circulating estrogen such as occurs with:
- Increasing age
- Obesity
Treatment for prostate cancer
- Liver disease such as cirrhosis
Men with an inherited genetic predisposition such as occurs in those with:
- Ashkenazi Jewish ancestors
- Klinefelters syndrome
A history of testicular dysfunction which can occur after:
- Childhood mumps
- An undescended testicle at birth
- History of radiation exposure
PREVENTION
While there are no specific guidelines for the prevention of male breast cancer, a diet low in fat, alcohol in moderation, regular exercise, self-examination, and regular visits to the doctor are advised.
EARLY DETECTION
Paying attention to your body coupled with knowledge of the physical signs associated with male breast cancer can lead to early detection. These physical signs are:
Dimpling or thickening of the skin, especially at the nipple area
Drainage or discharge from the nipple
Feeling a lump, especially just behind the nipple
Gynecomastia, a benign condition that causes enlargement of the breast in males and females alike, can also present as a lump behind the nipple and occurs in:
Male infants due to circulating maternal hormones
Adolescent males due to hormonal changes
Adult males on certain types of medication
If you are taking a medication that can cause this condition, it is unwise to assume that your lump is benign. Consult with your doctor.
There are many tests that assist in evaluation and diagnosis of male breast lumps. These tests include specialized imaging such as a mammogram, ultrasound, and MRI, all of which provide a picture of the mass from which decisions can be made regarding further evaluation. If the lump appears suspicious, a biopsy will be performed to prove whether the mass represents a benign or malignant condition. If the biopsy reveals cancer, treatment is next.
TREATMENT
Treatments available for male breast cancer are similar to therapies used for women and include:
Surgery-The standard operation is a mastectomy, which is removal of the breast including the nipple. On the affected side, some lymph nodes from under the arm may be removed to check for spread of the cancer.
Radiation-Administered to the chest wall after surgery to kill any remaining tumor cells.
Chemotherapy-Medication that is given if cancer is found in the lymph nodes that drain the breast, or if there is concern that tumor cells may be floating around in the body such as can happen with large tumors.
Hormone Therapy-Given as a pill for patients who have tumors that express the estrogen receptor.
Tamoxifen is the standard medication for men with hormone positive breast cancer.
Investigation into other medications for use in men, such as aromatase inhibitors, is currently ongoing.
Herceptin-A medication that is used to treat patients whose tumor expresses the HER2-neu receptor. Herceptin is an antibody that binds with the Her2-neu receptor and prevents the cancerous cells from growing.
Lack of awareness that breast cancer occurs in men is largely due to its very low occurrence. If you or your loved one is at risk, or has a physical finding concerning for breast cancer , see your doctor.
Deborah K. Cunningham, MD/FACS
Fellow-Diseases of the Breast
John Wayne Cancer Institute
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