Risk of Second Primary Cancer In Male Breast Cancer Survivors

Introduction:

Both males and females are born with very little breast tissue. During puberty, females develop more breast tissue, but men do not. Female breast cancers are common, and various studies are conducted to diagnose and treat them. Due to genetic, environmental, or hormonal factors, males are also prone to get breast cancer.

What Is Male Breast Cancer?

Male breast cancer is cancer involving the breast tissues of men. Treatment includes surgical removal of the cancerous breast tissues. The common kind of breast cancer in men are invasive ductal carcinoma (cancer starts in the ducts and then grow outside of the ducts, and spread to other parts of the body), invasive lobular carcinoma (cancer starts at the lobules of the breast and then grow outside of the lobules and spread to a different part of the body) and ductal carcinoma in situ (cancer only on the lining of the ducts, it does not spread to other parts of the body). The causes of male breast cancer can be due to an inherited gene mutation.

What Are the Symptoms of Male Breast Cancer?

A male breast cancer patient can have the following signs and symptoms:

• Thickening or a lump in the breast tissue region, usually painless.

• Redness or puckering can be seen on the skin covering your breast.

• The nipple will begin to turn inward.

• Breast discharge.

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• Changes in shape and size of the breast.

What Are the Risk Factors for Breast Cancer in Men?

The risk factors which can cause breast cancer in males include:

• As age increases, there is a greater chance of getting breast cancer. Men above the age of 60 years are usually diagnosed with breast cancer.

• Men who take estrogen-related drugs for prostate cancer.

• Family history of breast cancer.

• In Klinefelter’s syndrome, an extra copy of the X chromosome increases estrogen production (female hormone).

• Men having liver diseases.

• In obese people.

How Is Breast Cancer in Men Diagnosed?

The tests and procedures used to diagnose breast cancer include:

• Physical Examination - General signs and symptoms are considered, like changes in the breast’s size, shape, and skin color. Also, past medical history and family history will be recorded.

• Clinical Examination - The breast and underarms are examined clinically and felt for lumps.

• Mammogram - By using low-energy x-rays, abnormal growths in the breast tissue are diagnosed.

• Ultrasound - High-energy sound waves produce images of the breast tissues by forming echoes when sound waves hit the internal organs.

• Magnetic Resonance Imaging (MRI) - MRI uses a strong magnetic field, radio waves, and computer technology to produce a detailed image of the breast.

• Biopsy - Removal of tissue and examining it under the microscope for abnormal growth. A biopsy can be of four types - excisional biopsy (removing entire lump of breast tissue), incisional biopsy (removing a small amount of tissue for sample), core biopsy (tissue removal with a wide needle) and fine needle aspiration biopsy (removing tissue or fluid by using a thin needle).

What Are the Treatments for Male Breast Cancer?

The treatment of breast cancer in males depends on how much the tumor has progressed and the spread of the tumor.

• Surgical Therapy - There are different methods of surgical approach for treating breast cancers in males. A modified radical mastectomy removes the whole breast affected by cancer, including the nipple, skin around the nipple, and skin over the breast and lymph nodes. In breast-conserving surgery, only the cancerous tissues are removed. A lumpectomy removes the tumor and a small amount of normal tissue.

• Chemotherapy - Chemotherapy uses drugs to kill cancerous cells and prevent the cells from dividing. It can be given orally or by injecting it into a muscle or vein, which enters the bloodstream and is called systemic chemotherapy.

• Radiation Therapy - High-energy x-rays are used to kill cancer cells. It can be done by external radiation therapy (by an outside source of radiation, usually from a machine) and internal radiation (by using seeds inserted inside the body, which produces radiation).

• Hormone Therapy - Hormone therapy uses hormones to stop the growth of cancerous cells. Tamoxifen is given to patients with estrogen and progesterone receptor breast cancers and metastatic breast cancers.

• Targeted Therapy - Drugs targeted at specific cancer cells are given, killing the cancer cells and reducing the cancerous cell growth. This therapy causes less harm to the normal tissues.

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

• Various studies show that men who had breast cancer and were treated for the same can develop a second primary cancer with -16% more chance than men in the general population. Men who survive breast cancer may develop second primary cancer.

• The new primary cancer can be due to common etiological risk factors like genetics, environmental causes, lifestyle choices, and diagnosing and treating breast cancer at a late stage.

• Second primary cancer can occur six months after the first cancer.

• There is an elevated risk of second primary cancers like oral, esophagus, colorectal, liver, lung, laryngeal, and hematological malignancies.

• The risk of getting second primary cancer in males is higher than in females because males have more lifestyle diseases like liver cirrhosis, chronic obstructive pulmonary diseases, and diabetes mellitus.

• Certain genetic factors are responsible for early development of breast cancer and higher risk of second primary cancer. Cancers of thyroid, stomach, lung, and skin can be caused due to the treatment during initial breast cancer, such as radiation therapy, chemotherapy, and hormonal therapy with Tamoxifen.

• Second primary cancer involving the esophagus, lung, and pancreas is seen in men with a history of liver cirrhosis. Some cancers are caused by metastasized breast cancer left undiagnosed and untreated.

Conclusion:

Male breast cancers are rare and are commonly seen in older people. Early diagnosis of breast cancer can result in a good prognosis for the treatment. Still, men with a history of breast cancer are at a higher risk of developing second cancer on the same or different side of the breast, primary colorectal, thyroid, or pancreatic cancers. So males with a history of breast cancer should be monitored carefully for second primary cancers.