Male Breast Cancer - Symptoms, Risk Factors, Diagnosis, and Treatment

What Is Male Breast Cancer?

At birth, both men and women will have breast tissue in a smaller portion. During puberty, females develop more breast tissue due to hormonal changes, while males typically do not. Breast cancer is more common in females, but men may also develop breast cancer, influenced by genetic, hormonal, or environmental factors.

A rare cancer that develops in the breast tissue of men is referred to as male breast cancer. People known as male at birth (AMAB) do not develop milk-producing breasts, but will have a smaller proportion of fatty tissue, ducts, and breast cells that become cancerous. When these cells grow unusually, they form a tumor. While male breast cancer is uncommon compared to breast cancer in women, the ways of diagnosis and treatment are the same between the sexes.

Male breast cancer treatment involves surgical removal of affected breast tissue followed by chemotherapy, radiation therapy, or hormone therapy, depending on cancer stage and type.

How Common Is Male Breast Cancer?

Male breast cancer is relatively rare. In the United States, it is estimated that about 2,800 individuals assigned male at birth (AMAB) are diagnosed with breast cancer each year. This accounts for less than one percent of all breast cancer cases. Although uncommon, awareness is important because early detection and treatment improve outcomes.

What Causes Male Breast Cancer?

Male breast cancer happens with a variety of factors, like hormones, genetics, and environmental factors that influence breast cell growth and hormone balance.

1. Genetic factors involve gene mutations that increase the risk of male breast cancer. These genes are:

• The BRCA1 (breast cancer gene) mutation carries about a one percent lifetime risk, compared to 0.1 percent in the general male population.

• The BRCA2 mutation raises the lifetime risk to seven to eight percent.

• Other gene mutations, including ATM (ataxia-telangiectasia mutated), CHECK2 (Checkpoint kinase 2), and PALB2 (Partner and localizer of BRCA2), have also been associated with a higher risk, though more is needed.

2. Hormonal imbalances, both in men and women, have estrogen and testosterone, but men normally have lower estrogen levels. High levels of estrogen raise the risk of breast cancer in men. Estrogen levels get high due to the following:

• Hormone therapy for prostate cancer.

• Feminizing hormone therapy (for transgender women).

• Obesity.

• Alcohol abuse.

• Liver diseases such as cirrhosis.

• Testicular disorders.

• Surgical removal of testicles.

3. Environmental factors include radiation exposure, especially in the chest area. Men who have undergone radiation therapy for another cancer type may develop breast cancer later in life.

What Are the Risk Factors of Male Breast Cancer?

It is understood that men do not often get male breast cancer. However, there are various factors involved as risks for males to get breast cancer, such as:

• Advancing age. Most men get cancer in their 60s or older.

• Use of estrogen-containing medication or hormone therapy treatments for prostate cancer raises the risk.

• Having a close relative or a family history of breast cancer.

• Inherited gene mutation such as BRCA1 and BRCA2 increases the risk of breast cancer.

• A genetic condition called Klinefelter syndrome, in which men have an extra X chromosome, leads to hormonal imbalance and increased estrogen levels.

• Conditions like cirrhosis or other liver diseases disrupt hormone metabolism and increase estrogen levels.

• Obesity or excess weight.

• Testicular disorders or surgeries can reduce testosterone and disturb hormone balance, raising breast cancer risk.

What Are the Symptoms?

The symptoms of male breast cancer are no different and are similar to women with breast cancer. The common symptoms are:

• A lump or swelling in the breast.

• Inverted nipple.

• Nipple pain.

• Nipple discharge may be clear, bloody, or milky.

• Changes in breast skin, such as redness, scaling, dimpling, or puckering.

• Underarm lymph nodes swelling or swollen lymph nodes near the neck.

• Redness, sores, or ulceration on the nipple or areola.

How Is Male Breast Cancer Diagnosed?

Diagnosis of male breast cancer involves the assessment of symptoms, family history, risk factors, physical examination, and further tests. Male breast cancer diagnosis involves:

• Clinical breast examination by the doctor to look for lumps, skin changes, and abnormalities.

• Imaging tests like mammograms and ultrasound to check the breast tissue, mass, and fluid-filled cysts to diagnose male breast cancer.

• A biopsy is done by taking a sample from an area suspected of cancer and is examined under a microscope to look for cancer cells. A biopsy confirms whether the cells are malignant and helps determine the cancer type.

Once the cancer is diagnosed, a few more tests will be added by your doctor to identify specific receptors on cancer cells, like estrogen receptor (ER), progesterone receptor (PR), and HER2/neu (human epidermal growth factor 2) receptor. Only then will he/she be able to plan a proper treatment.

What Are the Stages of Male Breast Cancer?

After a breast cancer diagnosis, staging is done to understand how advanced the disease is. Staging helps plan treatment and predict outcomes. A sentinel lymph node biopsy is done as a part of the staging process. During this procedure, one or more nearby lymph nodes are removed and tested to see if cancer has spread.

The stages of male breast cancer are:

• Stage 0: In this stage, the cancer cells are limited to the ducts only and have not spread to the surrounding tissue.

• Stage 1: The tumor size is small and has not spread to nearby lymph nodes.

• Stage 2: The tumor is less than 20 mm (millimeters) but has spread to a small number of axillary (underarm) lymph nodes. Or the tumor measures 20 to 50 mm and may or may not have spread to axillary lymph nodes. The tumor is more than 50 mm but has not spread to distant sites.

• Stage 3: Cancer has proliferated to several lymph nodes and may have invaded nearby tissues such as the chest wall or skin.

• Stage 4: Cancer cells have metastasized or spread to distant organs like lungs, bones, liver, or brain.

What Are the Treatments for Male Breast Cancer?

Male breast cancer treatment depends on the type, stage, and receptor status of the cancer. Male breast cancer is treated in the following steps:

1. The main treatment is usually a mastectomy (removal of the entire breast) due to the limited amount of male breast tissue. Underarm lymph nodes are removed to check cancer spread. If the breast is removed, male breast cancer reconstruction surgery may also be recommended.

2. Radiation therapy is used as a supportive therapy after surgery (especially after a lumpectomy). Radiation therapy uses targeted beams to destroy any remaining cancer cells.

3. Chemotherapy involves anti-cancer drug administration to kill cancer cells, shrink tumors, and prevent recurrence. Chemotherapy may also be given before surgery (neoadjuvant) or after surgery (adjuvant).

4. Hormone therapy is used when cancer cells have hormone receptors (ER-positive or PR-positive). These therapies block or lower estrogen levels that fuel cancer growth. Tamoxifen is a commonly used medication.

5. Targeted therapy specifically targets abnormal features of cancer cells, such as HER2 overexpression or BRCA1 or 2 gene mutations, helping to minimize harm to normal cells.

Can Men With a History of Breast Cancer Develop Another Primary Cancer?

Yes, research shows that men who have had breast cancer are at a 16 percent higher chance of getting second primary breast cancer when compared to men in the general population.

A second primary breast cancer refers to a new, unrelated cancer that develops at least six months after the initial diagnosis and is not caused by metastasis of the original cancer.

Genetic mutations, environmental exposures, lifestyle factors, and treatments received for the first cancer will all contribute to the second primary cancer. A few common second primary cancers seen in male breast cancer survivors are those of the mouth (oral cavity), liver, lungs, esophagus, colorectal region, larynx, and blood (hematological cancers).

Men may have a higher risk than women due to the greater prevalence of lifestyle-related diseases, such as liver cirrhosis, chronic obstructive pulmonary disease (COPD), and diabetes mellitus.

Certain genetic predispositions lead to both early-onset breast cancer and a higher chance of developing additional malignancies. Treatments like radiation therapy, chemotherapy, and hormone therapy also increase the long-term risk of other cancers, including those of the thyroid, stomach, lung, and skin.

Furthermore, men with liver cirrhosis are more prone to secondary cancers of the esophagus, lung, and pancreas. Undiagnosed or untreated metastatic breast cancer also resembles the symptoms of a second cancer in some cases.

Conclusion:

Though rare, male breast cancer is a serious condition that goes unnoticed in most men at early stages. So, men must know about its symptoms, causes, risks, and genetic association, which help in early detection and effective treatment. Treating male breast cancer with targeted and hormone-based therapies improves survival rates. You need to understand that breast cancer is not just a woman’s disease; it affects men, too.

Key Takeaway From iCliniq:

• Male breast cancer is rare but occurs in anyone with abnormal breast tissue.

• Early detection improved treatment outcomes.

• Genetic factors, especially BRCA1 and BRCA2 mutations, increase the risk.

• If you have a family history or are experiencing changes in your breasts or develop any symptoms, consult a specialist online at iCliniq.