Until recently many people were shocked if asked, “Do men get breast cancer?” Men do get breast cancer and the percentage is on the rise. For men the lifetime risk of getting breast cancer is now 1 in 1,000 compared to 1 in 8 for women. The American Cancer Society estimates in 2012, 2,190 new cases will be diagnosed and 410 men will die from the disease.
An overview
Cancer is defined as an uncontrollable and abnormal proliferation of cells. Like all cells of the body, a man’s breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed, not having been constantly exposed to growth-promoting hormones.
As most of us learned in ninth grade health class, the breast is made up mainly of lobules (milk-producing glands in women), milk ducts and stroma (fatty tissue, connective tissue surrounding the ducts lobules, blood vessels, and lymphatic vessels).
Pre-adolescent boys and girls have a small amount of breast tissue consisting of a few ducts located under the nipple and areola. During puberty, female ovaries produce estrogen and progesterone causing the breast ducts to grow, lobules to form at the ends of ducts, and the amount of stroma to increase. In boys, testicular hormones inhibit breast tissue growth minimizing lobules at the end of the ducts.
Risk factors
Radiation exposure, alcoholism and liver disease, estrogen treatments, obesity, occupational conditions and genetic factors including a family history are all risk factors for male breast cancer.
- Radiation. While the incidence levels are still being researched, chest wall exposure to radiation may increase a man’s risk.
- Medication. Recent research has established a link between certain medications and increased risk of breast cancer. Propecia, used to treat enlarged prostate and male pattern baldness, has been directly linked to male breast cancer.
- Alcohol. The link between heavy use of alcoholic beverages and cancer continues to be researched, but there is a measurable risk for breast cancer in men because the liver plays an important role in sex hormone metabolism. Men with severe cirrhosis (liver disease) have relatively low levels of androgens and higher estrogen levels, increasing their risk of developing breast cancer.
- Estrogen. Remember estrogen differentiates anatomy during puberty. Estrogen-related drugs are sometimes used in hormonal therapy for prostate cancer. Men taking high doses of estrogens as part of a sex change procedure may also have a higher breast cancer risk.
- Obesity. Recent studies have shown that adulthood obesity increases a women’s breast cancer risk. Obesity is a risk factor for male breast cancer as well. Fat cells convert androgens into estrogens. This means that obese men have higher levels of estrogens in their body.
- Family history. The increase of breast cancer risk for women who have members of the family (blood relatives) with breast cancer is well documented. But what is less known are the genetic links for men with family members (blood relatives) who have had breast cancer. About 1 of 5 men with breast cancer have close male or female relatives with the disease.
- The most researched breast cancer genes are BRCA1 and BRCA2. Mutations in the BRCA2 gene, responsible for some breast cancers in women, account for about 1 in 10 breast cancers in men. BRCA1 mutations can also cause breast cancer in men. According to the American Cancer Society, one large ongoing study of causes of male breast cancer has recently identified several genetic variations associated with breast cancer risk. It reveals that the effect of these genetic variations on risk is different for men and women, suggesting differences in the biology of breast cancer in men and women. Other genetic mutations that may be responsible for some breast cancers in men include those in genes CHEK2 and PTEN, genes that help in tumor suppression.
- Klinefelter syndrome, a congenital condition that affects about 1 in 1,000 men. Characterized by cells with a Y chromosome plus at least two X chromosomes, men with Klinefelter’s syndrome exhibit androgen-estrogen imbalance. Some studies have found that men with Klinefelter syndrome are more likely to develop gynecomastia.
- Gynecomastia is the most common male breast disorder. It is not a tumor but rather an increase in the amount of a man’s breast tissue. Gynecomastia is common in both teenage boys and older men due to changes in their hormone balance. Medications such as those used to treat ulcers and heartburn, high blood pressure and heart failure.
Breast cancer types
Detected through mammograms, monthly self exams, MRI and sonograms, breast cancer types do not exhibit gender bias. The most common cancers for women report a lower incidence for men.
Benign breast conditions, such as invasive ductal carcinomas (most common), invasive lobular carcinoma and inflammatory breast cancer and ductal carcinoma in situ (DCIS), which is relatively rare in men, comprise 0.5% to 1% of those diagnosed, compared with women.
A rare breast cancer, Paget’s disease of the nipple, is characterized by a scaly skin rash that begins in the milk ducts and spreads to the skin of the nipple.
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Treatment
Surgical treatment for male breast cancer are similar to that for women; mastectomy and adjuvant therapies. Although a small percentage of women may not need a mastectomy, in almost 100% of male breast cancer cases, a mastectomy is performed. Lumpectomy or breast conserving surgery is rarely used because of the small size of the male breast. Additional treatments used to eradicate the breast cancer include radiation therapy, hormone therapy, chemotherapy and targeted therapy.
Additional concerns post-mastectomy
Although not well known, post-mastectomy pain syndrome (PMPS) is a recognized syndrome for breast cancer patients. First described in women who had total mastectomies, it occurs after breast conserving therapy as well. Some patients have problems with neuropathic pain in the chest wall, armpit and arm after surgery that doesn’t go away over time. Studies have shown that between 20% and 30% of women develop symptoms of PMPS after surgery and although men have reported the syndrome, it is unclear at this time as to the percentage.
Thought to be linked to damage done to the nerves in the armpit and chest during surgery, PMPS is characterized by pain and tingling in the chest wall, shoulder, surgical scar armpit, and arm. Patients diagnosed with PMPS report numbness, shooting or pricking pain or unbearable itching.
Options post-mastectomy
Because of the minimal amount of breast tissue, a mastectomy can be a disfiguring surgery. Men currently do not have pre-manufactured gender and anatomically appropriate replacement options post mastectomy. The only anatomical replacement option for men is custom breast prostheses.
Immediate or delayed reconstruction are options for men post-mastectomy. Additional surgeries, expanders and implants are unnecessary. Unlike female breast conserving surgeries, a male mastectomy leaves little or no residual tissue.
Research is ongoing into the incidences, demographic distribution and risk for male breast cancer. Ongoing studies have been found to support the theory that high stress and environmentally challenging occupations such as those in the military, steel workers and chemical workers may have an increased risk for male breast cancer.
