Around the world, the month of October is dedicated to increasing awareness for early detection and treatment of breast cancer, because the earlier the disease is diagnosed the greater the chances of recovery. Visibility and early diagnosis of the disease is unfortunately lacking when it comes to breast cancer in men, which means at the point of diagnosis the cancer is often at an already advanced stage.
The percentage of men with breast cancer is extremely rare, compared to the prevalence among women. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,0001, representing 0.4-1.2% of all male cancers. In 2018, about 2,550 men are expected to be diagnosed with the disease, compared with 2 million news cases for women in 20182. However, while the numbers are low, the risk remains real and should not be ignored. The "breasts" of an adult man are similar to the breasts of a girl before puberty. In men, the tissue doesn't grow, but because it is still breast tissue, men can get breast cancer.
In Western countries, the age of onset in men is approximately 60-65 years3, about 8 to 10 years later than in women, and that risk increases with age.
Late diagnosis decreases the odds of recovery
Screening procedures for women are well established, with recommendations for regular mammograms, fundraising and awareness events to finance research and publicize the importance of early diagnosis. None of these events are aimed at men and this lack of readily available information means that most men are unaware that it could happen to them. Men are also less likely to be suspicious of something abnormal in that area. In addition, the small amount of breast tissue in men makes it harder to feel and so more difficult to spot a problem early.
Symptoms of breast cancer in men are, however, similar to those in women and most male breast cancers are diagnosed when a man discovers a lump. But unlike women, men tend to delay going to the doctor until they have more severe symptoms, like bleeding from the nipple. At that point, the cancer may have already spread to another part of the body. Men also find it embarrassing to talk to a doctor about their breasts.
Risk factors for men
In 20-25% of men who develop breast cancer there may be a genetic abnormality, a mutation of the gene Brca2. In other cases, certain risk factors may be identified. If a close relative (male or female) has had breast cancer, the risk is higher and this risk increases if several close relatives are affected; if one of the affected parents was under 40; or if the cancer has spread to both breasts. Children whose fathers have breast cancer are also more likely to have the disease.
In addition, the risk is higher if the level of estrogen (female sex hormone) is significant, if the level of androgens (male hormone) is low as is the case for rare genetic diseases such as Klinefelter syndrome (a genetic disorder that affects men and is characterized by abnormalities in the genital tract).
Other risk factors are related to obesity, which increases the risk of breast cancer in women and could also increase the risk in men. Fat cells turn androgens into estrogen, so men who have more fat cells have higher estrogen levels. A man who has had mumps in adulthood and has had inflammation of a testicle may also be at higher risk for this type of cancer.
The symptoms, diagnosis and management of breast cancer in men are largely identical to that in women.
In principle, men cannot undergo surgery that just removes the lump, because there is little tissue in the breast and the cancer is usually near the nipple. Treatment options depend on the progress of the cancer once it has been diagnosed. In general, treatment involves a mastectomy, an operation that involves removing the entire breast. Lymph nodes located nearby (e.g. under the arm) are also removed in case the cancer has spread, followed by radiotherapy, chemotherapy or hormonal therapy.
Although the medical procedures are similar to those for women, the aftercare for men is very different. There is no discussion of breast reconstruction or any consideration of the emotional fallout post cancer. Yet the psychosocial impact on men is considerable. Support during and after treatment is crucial and much remains to be done in this area.