Male Breast Cancer

Male breast cancer is one of the rarest forms of cancer, but about 1,600 new cases are diagnosed each year, and about 400 men will die of this disease. The average age at diagnosis is 65, but men of any age can be affected.


Risk factors

The cause (or causes) of breast cancer in men, as in women, is not known, but certain risk factors have been associated with a higher incidence of disease. These include:

Symptoms

The most common symptom is a breast mass or lump which is usually firm, not tender, and beneath the areola (the area around the nipple). Since the tumor is usually near the nipple, nipple retraction, ulceration or destruction of the nipple often occurs. Nipple discharge, either clear or bloody, may be present and needs to be investigated immediately.

Gynecomastia ("female breast") is a condition in which the male breast enlarges and becomes tender. This is not the same as the large breasts of an obese man. Gynecomastia can be stimulated by hormones, such as estrogen, or non-hormonal drugs, such as digitalis (for heart problems), reserpine or spironolactone (for high blood pressure), ergotamine (for migraines) and phenytoin (for seizures). It can also occur with cancer of the testes or the adrenal glands, cirrhosis of the liver, chronic renal dialysis or Klinefelter's syndrome. This condition often occurs in older men and must be differentiated from breast cancer.

Diagnosis

Since there is usually an obvious mass present, fine needle aspiration (a very thin needle is inserted into the mass and some cells are drawn out and then looked at under a microscope) is very useful for diagnosis. Nipple discharge should also be examined microscopically. A biopsy is often needed for conclusive diagnosis, however.

Infiltrating ductal cancer is the most common type of breast cancer in men, probably because the location of the tumor below the areola allows the tumor cells to access the lymph channels in this area. Intraductal cancer, inflammatory cancer, and Paget's disease (looks like a rash around the nipple) have also been observed in men, but lobular cancer has not (mainly because lobules are not usually found in a male breast). Breast cancer is staged the same way in men as in women.

Often, men are first diagnosed with more advanced disease than women. This is probably due to a number of factors:

Treatment

The treatment of male breast cancer, as with female breast cancer, depends on the stage of the disease. Surgery is usually the treatment of choice, especially for stage I and II disease. A modified radical mastectomy, which removes the nipple and areola, the entire breast tissue, and regional lymph nodes, but not the pectoral muscles, is preferred. This method maintains the contour of the chest wall and function of the arm. A radical mastectomy may be needed for more advanced disease. Reconstructive surgery can be performed to repair any deformity.

Since the rate of estrogen-receptor positive lymph nodes is much higher in men than in women, hormonal therapy, such as tamoxifen, is often used to increase survival. Radiation therapy or chemotherapy may also be used after surgery to increase survival.

Locally recurrent disease (disease that comes back, but only in a limited area), is usually treated with surgery, radiation therapy, and chemotherapy.

The National Cancer Institute recommends hormonal therapy, chemotherapy or a combination for disease that has spread beyond the original site (distant metastases).

Hormonal therapy may include

Generally, men respond to therapy the same as women with breast cancer.

Psychological aspects

Conclusion

Although male breast cancer is rare, it is usually diagnosed when the disease is more advanced, leading to a reduced survival rate. Increasing awareness of this disease would lead to earlier diagnosis, allowing more tolerable treatments and better prognosis. Male breast exams should become a part of all regular checkups, especially in patients at high risk.

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