Male Breast CancerBreast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

The Risk Factors for Male Breast CancerIt's important to understand the risk factors for male breast cancer—particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

A number of factors can increase a man's risk of getting breast cancer:

Growing older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The median age of men diagnosed with breast cancer is about 67. This means that half the men who are diagnosed are over 67, and half are under.

High estrogen levels: Breast cell growth—both normal and abnormal—is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:

o Taking hormonal medicines.

o Being overweight, which increases the production of estrogen.

o Having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body).

o Being heavy users of alcohol, which can limit the liver's ability to regulate blood estrogen levels.

o Having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.

Klinefelter syndrome: Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer. Klinefelter syndrome is a condition present at birth that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).

A strong family history of breast cancer or genetic alterations: Family history can increase the risk of breast cancer in men—particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer. This risk of developing breast cancer by age 70 is approximately 1% with the BRCA1 gene and 6% with the BRCA2 gene. Overall, that's about 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. Still, the majority of male breast cancers happen in men who have no family history of breast cancer and no inherited gene abnormality.

Radiation exposure: Having radiation therapy to the chest before age 30, and particularly during adolescence, may increase the risk of developing breast cancer. This has been seen in young people receiving

radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)

One study found that male breast cancer is on the rise, with a 25% increase over the 25 years from 1973 to 1988. But it's still rare. It's unclear whether the reported rise means the disease is slowly becoming more common, or whether men better understand the symptoms and report their symptoms, leading to diagnoses that might have been missed in the past.

If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:

a lump felt in the breast nipple pain

an inverted nipple

nipple discharge (clear or bloody)

sores on the nipple and areola (the small ring of color around the center of the nipple)

enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Sometimes the breasts can become quite large. Non-cancer-related enlargement of the breasts can be caused by medications, heavy alcohol use, weight gain, or marijuana use.

A small study about male breast cancer found that the average time between first symptom and diagnosis was 19 months, or over a year and a half. That's a very long time! This is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that—just like women—they need to go to their doctor right away if they detect any persistent changes to their breasts.

Diagnosis of Male Breast Cancer

After an abnormality of the breast is found, tests are performed to see if the problem is cancer. One or all of these tests might be done:

Mammogram: A mammogram is an X-ray picture of the breast. Two pictures are taken of the breast after it is compressed between two glass plates. One image is shot from the top and the second picture is taken from the side. A radiologist will look at the pictures and determine if anything looks abnormal. He or she may then decide to get other pictures of a certain area. These are called spot or magnification views.

Ultrasound: Ultrasound sends high-frequency sound waves through your breast and converts them into images on a viewing screen. Ultrasound complements other tests. If an abnormality is seen on mammography or felt by physical exam, ultrasound is the best way to find out if the abnormality is solid (such as a benign fibroadenoma, or cancer) or fluid-filled (such as a benign cyst). Ultrasound cannot determine whether a solid lump is cancerous.

Nipple discharge examination: If you have nipple discharge, some of the fluid may be collected and examined under a microscope to see if any cancer cells are present.

Biopsy: A biopsy is necessary to distinguish normal tissue from cancer tissue. If cancer is present, the biopsy also helps your doctors zero in on the size, type, and kind of breast cancer. Biopsies are performed on any kind of abnormality that your doctor can feel or that looks suspicious. (Because most breast cancers in men are discovered by feeling something abnormal, it's highly unusual to find an abnormality only by mammography or another imaging modality.) Various techniques are used to biopsy tissue, and it's likely that your surgeon will try to use the least invasive procedure possible while making sure that enough tissue is removed to make a clear diagnosis.

Needle biopsy of palpable lesions (lesions that can be felt) is least invasive. It can be done in the doctor's office. Results are often available in 24 hours. A long, thin, hollow needle is placed in the palpable abnormality. The tissue is then sent off to pathology for analysis. If the lesion is only seen by mammography or another test, then your doctor may need the help of this test to guide the needle to the right place. Cells are extracted through the center of the needle. A collapsible hook at the end of the needle keeps the needle in place until the surgery is done. X-rays verify that the abnormal area seen on the original X-rays is the same area into which the surgeon inserts the needle. This biopsy

technique has the highest risk of a "false negative"—a biopsy result that says "normal," even though a cancer is present. The reason for this is probably that the needle doesn't always pick up the cancer cells.

Stereotactic needle biopsy: (core biopsy) removes multiple pieces of a lesion. If the lesion can't be felt, the needle is guided to the area of concern with the help of mammography or ultrasound. If a cancer is only found by MRI (magnetic resonance imaging), then needle biopsy may be guided by that technique. A small metal clip may be inserted into the breast to mark the site of biopsy in case the biopsy proves cancerous and additional surgery is required. But since most men diagnosed with breast cancer have mastectomy, a clip is usually unnecessary since the whole breast is removed.

Incisional biopsy: is more like regular surgery— it removes a bigger piece of tissue than a fine needle biopsy or a core biopsy. Often, incisional biopsies are done when needle biopsies are inconclusive or if the lump is too extensive or too big to be removed easily. The purpose of this procedure is to make a diagnosis. Because it only takes out part (not all) of the cancer, it is not a treatment. In men, once a breast cancer diagnosis is made, mastectomy is usually done.

Excisional biopsy: is the most involved kind of biopsy. It attempts to remove the entire suspicious lump of tissue from the breast. This is the surest way to establish the diagnosis without missing the cancer tissue (winding up with a false negative). Removing the entire lump may also provides you some peace of mind until the final treatment plan is put in place. Both incisional and excisional biopsies can be done in an outpatient center or hospital, using local anesthesia. The purpose of this procedure is to make a diagnosis. Even if the lumpectomy takes out all of the cancer in the breast with clear margins, if breast cancer is diagnosed, mastectomy is usually done.

If a cancer diagnosis is made, your doctor might recommend more tests. For example, an MRI can show how much cancer is in the affected breast relative to the normal tissue right under and next to the breast cancer. This information may help the surgeon plan the extent of surgery. Plus, an MRI can help evaluate the other breast to see if it's OK. Other tests, such as blood work, chest X-ray, and bone scan, might be done to see if the cancer has spread to other parts of the body.

Research News on Male Breast Cancer

Men less likely to survive early breast cancer

Last Updated: 2007-05-09 16:39:58 -0400 (Reuters Health)

NEW YORK (Reuters Health) - While breast cancer is far more common in women than in men, men may be more likely to die from early-stage breast tumors, a new study suggests.

Male breast cancer is rare, accounting for less than 1 percent of all breast cancers. But unlike the case with breast cancer in women, there have been no improvements in survival the past 30 years in men with this disease.

The rarity of breast cancer in men has prevented clinical trials, and treatment is based on what's known about female breast cancer.

But the new findings, published in the journal Cancer, suggest that there may be biological differences in male and female breast cancers that affect survival. Specifically, men with relatively small tumors or tumors that had not yet spread to the lymph nodes had a shorter survival time than their female counterparts.

Among men whose breast cancer had not spread to the lymph nodes, the typical survival time was 6 years, compared with nearly 15 years among women.

The difference suggests a need for better understanding of male breast cancer, and improved treatments, according to Dr. Zeina A. Nahleh and her colleagues at the University of Cincinnati.

The researchers based their findings on a large cancer registry maintained by Veterans' Affairs. They reviewed the records of 612 men treated for breast cancer and compared them with 2,413 women treated for the disease.

While Nahleh's team found no difference in survival times of men and women with more-advanced breast cancer, they did find one among patients with earlier-stage tumors.

When it came to treatment, men had lower rates of both chemotherapy and radiation than women did, but they were as likely as women to receive hormone therapy.

Hormonal therapies for breast cancer, such as the drug tamoxifen, block the ability of estrogen to fuel tumor growth. As in women, men's breast tumor cells often have receptors for estrogen, which means hormone therapy can be helpful.

However, Nahleh and her colleagues write, it's possible that men's breast tumors do not respond well to standard therapy with tamoxifen.

"A better understanding of this disease is needed," they conclude, "so that new opportunities for therapeutic intervention may be developed."

What breastcancer.org says about this article

Breast cancer is rare in men, but it does happen. According to the study reviewed here, men diagnosed with early-stage breast cancer are more likely to die from the cancer than women diagnosed with early-stage disease. Men with early-stage disease survived about 6 years, while women survived about 15 years. (For people with advanced breast cancer at diagnosis, men and women had the same survival times.)

There are a number of possible reasons for the difference in survival, including:

Genetic or biological differences between the breast cancers in men and the breast cancers in women. This means that male breast cancers may develop, grow, and spread differently than female breast cancer. Breast cancer in men also may respond differently to treatment than breast cancer in women.

Differences in when breast cancer is diagnosed. Diagnosing early breast cancer in men may take longer compared to diagnosis in women.

Treatment needs. Because breast cancer is rare in men, it's hard to study the best way to treat it. Most male breast cancer treatments are modeled on treatments for women. A different approach may be needed.

Men with breast cancer risk second cancer, too

Last Updated: 2007-01-25 15:05:49 -0400 (Reuters Health)

WASHINGTON (Reuters) - Men who have survived breast cancer have a higher risk of a second cancer than most other men, U.S. researchers reported on Thursday.

They said men who have had breast cancer need to be closely watched for new cancers, particularly of the breast, stomach and skin.

Breast cancer will be diagnosed in 2,030 men in the United States alone this year and kill 450 of them, according to the American Cancer Society.

Sacha Satram-Hoang and colleagues at the University of California at Irvine looked at California cancer statistics from 1988 to 2003. Of the 1,926 diagnosed with breast cancer for the first time, 221 or 11.5 percent were diagnosed with a second new cancer -- not a spread of the original tumor -- after their breast cancer diagnosis.

They were especially prone to breast, colorectal, bladder and stomach cancers and melanoma, Satram-Hoang and colleagues wrote in the journal Breast Cancer Research.

"Our study shows that men diagnosed with a first primary breast cancer have a 16 percent increased risk of developing a new primary cancer in comparison with men in the general population," the researchers wrote.

The earlier the men developed cancer, the higher their risk of a second cancer.

The researchers said it is not clear why.

The men could have a genetic mutation that puts them at risk, such as BRCA1 and BRCA2 mutations. "Male tumors related to BRCA1 and BRCA2 include breast, melanoma, stomach, prostate, colon and pancreatic cancer," they wrote.

The men could also be exposed to some environmental or occupational cause of cancer, or there could be other differences, such as obesity, which is linked with some cancers.

What breastcancer.org says about this article:

Breast cancer is a rare disease in men, but it does happen. The study reviewed here found that men diagnosed with breast cancer were 16% more likely than men without breast cancer to develop another, new cancer. For some men, the second cancer was a new breast cancer (not spread from the first breast cancer). Other men in the study developed another type of cancer, including colon, bladder, stomach, and skin cancer. The study couldn't say why men who had breast cancer had a higher risk of a second cancer.

There are factors that increase the risk of breast cancer in men. These include a family history of breast cancer, genetic mutations, obesity, alcohol, and using

hormonal medicines. It's likely that these and other unknown factors increase a man's risk of cancer, including breast cancer. The challenge to doctors is to identify these unknown risk factors for cancer. When the risk factors are known and understood, men AND women will have the hope that they can more effectively lower their risk of all forms of cancer, including breast cancer.

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