How to Spot Male Breast Cancer
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Male breast cancer is incredibly rare and is usually not noticed until it has progressed. Symptoms include a painless mass, skin changes, or bloody or milky discharge from the nipple. It is usually a ductal carcinoma and treated via surgical removal of cancerous tissue.
What is male breast cancer?
Male breast cancer is rare and accounts for less than one percent of all cancers in the worldwide. The overwhelming majority of male breast cancers are a ductal carcinoma.
Breast cancer is often noticed by healthcare professionals or individuals when a painless breast mass appears, changes in the skin of the breast take place, or bloody or milky discharge is expressed from the nipple.
Breast cancer in men is often found at more advanced stages (Stage 3 or 4) and must be treated early and aggressively because it can involve the underlying muscle. Curative surgery or radiation therapy is more difficult (though not impossible) if the underlying muscles are affected. The main treatment modality is surgical removal of the cancerous tissue. The average age of presentation of breast cancer in men is 65.
Diagnosing breast cancer requires a physician's clinical exam, a mammogram, and tissue biopsy. Its treatment involves surgically removing the cancer followed by hormone treatments, chemotherapy, and/or radiation therapy. A doctor's visit is needed in the next few days!
Male breast cancer symptoms
The most common symptom of breast cancer in men is a solid mass beneath the areola of the breast. The areola is the darkened and pigmented ring around the nipple. It is distinct from the nipple and smaller in men than women.
- Mobile masses: The mass may be freely mobile, meaning that it moves when it is rubbed, without a feeling as though it is "tethered" to the chest "beneath" the lump.
- Fixed masses: The mass may also be fixed; although, if it is truly fixed to the chest behind the lump, this is a bad sign for the progression of the disease.
Gynecomastia, or enlargement of breast tissue, is commonly associated with breast cancer in anywhere from four to 40 percent of cases. Gynecomastia is distinct from "pseudogynecomastia" or enlargement of breast cancer because of a large amount of body fat. Gynecomastia is due to the growth of the underlying glands and connective tissue of the breast, which in turn, is due to an increased amount of estrogen exposure over time.
Paget's disease of the breast is a manifestation of underlying breast cancer. It manifests as skin changes beginning on the nipple and spreading outward. It is important to seek medical attention immediately if you notice symptoms similar to those below.
- Often mistaken for a skin condition: However, Paget's involves flaking or scaling of the skin overlying the nipple, crusty, oozing, and hardened skin.
- The skin is often red
- The nipple may be inverted, flattened or misformed
- Skin can also appear similar to eczema on the nipple or the areola
- Affected individuals may have itching, burning, or tingling of the breast
Male breast cancer causes
While men experience less breast cancer than women because they have less breast tissue, the causes of breast cancer in men are similar to the causes of breast cancer in women.
Increased Exposure to Estrogen
Estrogen has been found to greatly increase the risk of development of breast cancer. There are three pathways within the body through which estrogen can increase the risk of breast cancer: via receptors, increased rates of mutation, and interruption of proper cell division.
- Estrogen receptor-mediated breast cancer (ER-positive breast cancer): This is cancer in which estrogen attaches to estrogen receptors in the cancerous tissue, causing the cancer to grow and proliferate, advancing the stage. The presence and amount of receptors are genetic, and the larger the number of receptors, the higher the risk of developing breast cancer.
- Cancers without estrogen receptors: These cancers are actually more difficult to treat, develop earlier, grow faster, and are also associated with lifetime estrogen exposure (albeit less strongly associated). Accordingly, anything that increases the amount of estrogen in the body over time, may increase the risk of development of breast cancer.
The liver is an important organ that detoxifies and removes toxins in the body. However, the liver also converts estrogen (female hormone) in the bloodstream to androgens (male hormone). When the liver is excessively damaged over a long period of time, it may stop effectively eliminating estrogen from the body. This can lead to accumulation of estrogen. Prolonged exposure to estrogen as stated in the earlier description can and does increase the risk of developing cancer. The two primary ways in which the liver accumulates damage, particularly in men, are:
- Alcohol use
- Infection with hepatitis coupled with chronic alcoholism
Both of these, over time, can disrupt liver function and lead to increased amounts of estrogen, in turn, increasing the risk of development of breast cancer.
Exposure to Radiation
Exposure to radiation is a risk factor for many types of cancer. Exposure to large amounts of radiation through treatment of other types of cancer (e.g. Hodgkin's Lymphoma) can cause mutations in a cell that allow it to grow without regard to surrounding cells. The accumulation of these mutations of multiple exposures to radiation can lead to the development of a single cell that is able to escape either detection from the immune system or its own anti-cancer programming. Notably, radiation does not specifically increase the risk of just breast cancer, it can cause many types of cancer in the field or area that was exposed to radiation.
Development of Female Breast Tissue
Excess breast tissue or maturation of breast tissue (e.g. gynecomastia) is a notable risk factor for the development of breast cancer in men because the causes of gynecomastia also increase the risk of breast cancer, and as breast tissue increases during the development of gynecomastia, more cells are present. Because there are more cells, there is a higher chance that a single cell will undergo a cancerous change and develop a malignancy. Gynecomastia may be caused by the use of steroids, obesity, or a hormone imbalance.
Klinefelter's syndrome is a genetic disorder characterized by an extra X chromosome. Individuals with Klinefelter's syndrome have a genotype of XXY and tend to have reduced testosterone and excess estrogen. This leads to a classic series of symptoms including dysgenesis, gynecomastia, and an increase in sex hormones with the exception of testosterone. For individuals with Klinefelter's syndrome, the risk of disease is 20 to 50 times higher than the general population.
Treatment options and prevention for male breast cancer
The presence of a breast mass or any symptoms of breast cancer necessitate a consult from a physician. Treatment options include the following, and your care team will determine the best course of action for you.
Removal of the breast tissue is often complicated by spread to underlying structures. The degree of spread and the type of cancer determine the surgical approach. It is uncommon to treat breast cancer in men without a surgery as it is often found at an advanced stage. Surgery often involves either:
- A simple mastectomy: The breast tissue, nipple, areola and a series of lymph nodes — but not all of the lymph nodes — are removed at the discretion of the surgeon.
- A radical mastectomy: This involves the removal of the pectoralis muscles to eliminate cancer that has invaded the muscle of the chest.
Radiation therapy (adjunctive)
Radiation therapy is common among treatment modalities.
- Before surgery: Radiation is not a curative treatment but is often used prior to surgery (if the surgery is potentially curative) to reduce tumor burden and increase the chance of having no tumor within the margins of the surgery.
- After surgery: It can also be used after the surgery to reduce any tumor that was unable to be excised, or removed, by the surgery.
- With surgery: It is always used in conjunction with surgery if the goal is a cure.
- Radiation alone: It can be used solitarily to increase comfort and decrease the amount of pain if palliative care is necessary.
When to seek further consultation for male breast cancer
Breast cancer among men is a serious diagnosis because it progresses quickly and is often found late in its progression. The risk of mortality increases significantly if cancer progresses beyond the breast tissue. Look out for:
- Breast masses
- Nipple discharge of blood, clear fluid, or milky fluid
- Skin changes over the nipple, areola, or breast
These symptoms should be taken seriously and evaluated by a medical professional as soon as possible after detection.
It should also be noted that breast cancer in men is rare. The average man — without prolonged estrogen syndrome or Klinefelter's syndrome — has a relatively low risk of developing breast cancer. Breast masses in this setting are likely to be benign, but because of the danger of breast cancer, they should be evaluated to ensure that they are not cancerous.
Questions your doctor may ask to determine male breast cancer
- Is your bump still getting bigger?
- Have you ever been diagnosed with diabetes?
- Is your chest bump constant or come-and-go?
- How long have you had the bump?
- What is your race?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Ezekiel Richardson is a fourth-year medical student at UPenn, currently applying into Emergency Medicine. He completed an undergraduate degree with a concentration in health disparities at Stanford University. After graduation, he spent a year working in the Maryland Department of Health as a John Gardner Public Service Fellow. Between his third and fourth year of medical school, he completed multiple publications on public health and health accessibility through the Center for Emergency Care and Policy Research Fellowship. He has participated as a teaching assistant in anatomy, histology, and doctoring ethics courses at UPenn. Outside of medical school, he enjoys cooking, volunteering, and traveling in support of his partner’s work on girls’ education in Africa.
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