Breast Cancer in Men

Breast Cancer and Benign Breast Conditions in Men

Breast cancer in men is rare, the lifetime risk is only about 1 in 833, but it is often more advanced when diagnosed because men are not routinely screened for the disease and don't think to look for symptoms.

The Patricia Lynch Cancer Center at Holy Name has oncologists specially trained in diagnosing and treating breast cancer and benign breast conditions in men. Working with a team of experts, they will devise a personal treatment plan for each patient to ensure the best possible outcome based on each individual's needs and type and stage of the disease.

Both males and females are born with breast tissue, which contains fat, milk-producing glands (lobules) and ducts that carry milk to the nipple. Breast cancer in men typically develops in the milk ducts, known as ductal carcinoma. Less often, it may occur in the lobules, called lobular carcinoma.

About 2,650 men in the U.S. are diagnosed with breast cancer each year, only .5 to 1 percent of all breast cancer cases.

Symptoms

Men should be aware and contact their physician if they notice any changes to the breast, including the following symptoms:

• Lump or thickening in the breast
• Changes to the skin covering the breast, including dimpling, puckering, redness or scaling
• Nipple pain
• Inverted nipple
• Nipple discharge (clear or bloody)
• Enlarged lymph nodes under the arm

Enlargement of both breasts usually indicates a condition that is not cancerous, called gynecomastia

Risk Factors

• Age - as with women, a man's risk for developing breast cancer increases with age.
• High estrogen levels - estrogen stimulates cell growth, both normal and abnormal.
• Klinefelter syndrome - a condition that causes men to have more than one X chromosome, which produces longer legs, higher voice, thinner beard, smaller testicles and being infertile.
• Strong family history of breast cancer or genetic mutations proven to increase the risk of breast cancer such as BRCA1 or BRCA2.
• Radiation therapy to the chest before age 30, especially during adolescence, to treat certain illnesses such as Hodgkin's disease.
• Obesity - fat cells lead to the production of more estrogen, which increases the risk for breast cancer.

Treatments

Surgery

Different types of surgery may be done to remove the tumor and surrounding breast tissue. They include:

• Bilateral mastectomy: removal of both breasts and surrounding lymph nodes.
• Modified radical mastectomy: removal of breast tissue on one side of the chest, including the nipple and areola, and some nearby lymph nodes.
• Sentinel lymph node biopsy: the sentinel lymph node is the first one that would be affected by tumor cells that have broken away from the tumor and spread through the lymphatic system. If this node, or group of nodes is found to have cancer, the remaining lymph nodes are removed in a procedure called axillary lymph node dissection.

Hormone Therapy

Most male breast cancers rely on hormones to grow, meaning they are hormone-sensitive. As a result, hormone therapy is often prescribed for men with breast cancer. The most common medication for hormone therapy is tamoxifen, which is also used for female breast cancer.

Radiation Therapy

Frequently, radiation therapy is used in men after breast cancer surgery to eliminate any remaining cancer cells in the chest or armpit. It is a painless procedure, often given daily for several weeks.

Chemotherapy

Chemotherapy is prescribed based on a number of factors, including whether the cancer has spread and the genetic make-up of the tumor. It is often used when the disease is advanced. Chemotherapy can be given by infusion or through oral medications, depending on what type is needed.

Different Types of Breast Cancer in Men

The most common types of breast cancer in men include ductal carcinoma situ, invasive ductal carcinoma and invasive lobular carcinoma. Carcinomas start in the milk ducts or lobules of the breast.

Ductal carcinoma in situ (DCIS) is considered non-invasive, or pre-invasive breast cancer. The cells in the ducts have changed and look like cancer cells but they have not spread through the walls of the ducts or outside the breast. DCIS is considered a pre-cancer because it can develop into invasive cancer and currently there are no methods to determine which will go on to become cancer. It is treated with surgery, and in some cases, radiation also.

Invasive ductal carcinoma (IDC) starts in the milk duct and spreads to the fatty tissue in the breast. It may also spread through the lymphatic system and bloodstream to other parts of the body. The majority of male breast cancers are IDCs.

Invasive lobular carcinoma (ILC) starts in the breast lobules (group of cells that in women, produce breast milk) and grows into the fatty tissue of the breast. ILC is very rare in men because men do not have much lobular tissue.

Inflammatory breast cancer makes the breast swollen, red, warm and tender but doesn't form a lump. It is aggressive but very rare in men.