Male breast cancer

Although breast cancer is predominantly seen in women, rarely it is also known to occur in men. Less than 1% of all breast cancers occur in men. This is because men too have breast tissue which is underdeveloped unlike women due to lack of exposure to estrogen. At puberty, girl’s ovaries start producing estrogen which stimulate growth breast tissue and boy’s testes start producing testosterone or androgens which are necessary for the normal male development.

Risk factors for male breast cancer include

Age – increasing age is associated with increased risk of breast cancer just like in women.

Increased exposure to estrogen –

• Taking hormones as treatment or through some processed foods
• Obesity
• Increased intake of alcohol leading to compromised liver function
• Chronic liver disease
• Strong genetic / family history – Mutations or abnormalities in BRCA1 and BRCA 2 genes can increase risk of breast cancer in men.
• Cryptorchidism (undescended testis), Orchietis (inflammation of testis) or Orchiectomy (removal of testis) – These conditions lead to lower androgen levels leading to increased breast cancer risk.
• Radiation exposure – Radiation to chest wall increases the risk of breast cancer in men as well as women.
• Klinefelter’s syndrome – Klinefelter’s syndrome occurs in men with more than one X chromosome. Due to low androgen and higher estrogen levels, the risk of breast cancer is increased in them.

Symptoms of breast cancer in males are similar to those in females. Most common symptom being presence of a lump which is usually painless. Additional symptoms include inverted nipple, nipple discharge, sores or skin changes on the nipple and areola and/or enlarged lymph nodes in the armpit.

Some men may have benign breast development or tissue leading to feeling of lumps called as gynaecomastia which needs to be distinguished from cancer. Gynaecomastia lumps are usually bilateral and central and more likely to be painful. The nipple and areola are usually normal and there is no swelling in the armpit.

Diagnostic tests done for male breast cancer are again same as that for women which include mammography and biopsy. Treatment is also along similar lines as that of women depending upon the stage and co-morbidities of patient. This may include surgery, radiation therapy, chemotherapy, hormone and targeted therapy. Male breast cancers are however more likely to be hormone receptor positive (estrogen and progesterone) and thus may be more amenable to hormone treatment. As this is a rare disease, most treatment strategies have been extrapolated for studies done in women with lack of detailed studies in men.