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Male breast cancerBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/male-breast-cancer/DS00661
Male breast cancer is cancer that forms in the breast tissue of men. Though breast cancer is most commonly thought of as a woman's disease, male breast cancer does occur.
Male breast cancer is most common in older men, though male breast cancer can occur at any age.
Men diagnosed with male breast cancer at an early stage have a good chance for a cure. Still, many men delay seeing their doctors if they notice unusual signs or symptoms, such as a breast lump. For this reason, many male breast cancers are diagnosed when the disease is more advanced.
Signs and symptoms of male breast cancer can include:
- A painless lump or thickening in your breast tissue
- Changes to the skin covering your breast, such as dimpling, puckering, redness or scaling
- Changes to your nipple, such as redness or scaling, or a nipple that begins to turn inward
- Discharge from your nipple
When to see a doctor
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.
It's not clear what causes male breast cancer. Doctors know that male breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do. The accumulating cells form a tumor that may spread (metastasize) to nearby tissue, to the lymph nodes or to other parts of the body.
Where breast cancer begins in men
Everyone is born with a small amount of breast tissue. Breast tissue is made up of milk-producing glands (lobules), ducts that carry milk to the nipples and fat. Women begin developing more breast tissue during puberty and men do not. Because men are born with a small amount of breast tissue, they can develop breast cancer.
Types of breast cancer diagnosed in men include:
- Cancer that begins in the milk ducts. Ductal carcinoma is the most common type of male breast cancer. Nearly all male breast cancers begin in the milk ducts.
- Cancer that begins in the milk-producing glands. Lobular carcinoma is rare in men because men have few lobules in their breast tissue.
- Cancer that spreads to the nipple. In some cases, breast cancer can form in the milk ducts and spread to the nipple, causing crusty, scaly skin around the nipple. This is called Paget's disease of the nipple.
Inherited genes that increase breast cancer risk
Some men inherit mutated genes from their parents that increase the risk of breast cancer. Mutations in one of several genes, especially a gene called BRCA2, put you at greater risk of developing breast and prostate cancers. The normal function of these genes is to help prevent cancer by making proteins that keep cells from growing abnormally. But if they have a mutation, the genes aren't as effective at protecting you from cancer.
Meeting with a genetic counselor and undergoing genetic testing can determine whether you carry gene mutations that increase your risk of breast cancer. Discuss the benefits and risks of genetic testing with your doctor.
Factors that increase the risk of male breast cancer include:
- Older age. Breast cancer is most common in men ages 60 to 70.
- Exposure to estrogen. If you take estrogen-related drugs, such as those used as part of a sex-change procedure, your risk of breast cancer is increased. Estrogen drugs may also be used in hormone therapy for prostate cancer.
- Family history of breast cancer. If you have a close family member with breast cancer, you have a greater chance of developing the disease.
- Klinefelter's syndrome. This genetic syndrome occurs when a boy is born with more than one copy of the X chromosome. Klinefelter's syndrome causes abnormal development of the testicles. As a result, men with this syndrome produce lower levels of certain male hormones (androgens) and more female hormones (estrogens).
- Liver disease. If you have liver disease, such as cirrhosis of the liver, your male hormones may be reduced and your female hormones may be increased. This can increase your risk of breast cancer.
- Obesity. Obesity may be a risk factor for breast cancer in men because it increases the number of fat cells in the body. Fat cells convert androgens into estrogen, which may increase the amount of estrogen in your body and, therefore, your risk of breast cancer.
- Radiation exposure. If you've received radiation treatments to your chest, such as those used to treat cancers in the chest, you're more likely to develop breast cancer later in life.
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you notice any unusual signs or symptoms that worry you. If your doctor thinks you may have breast cancer, you may be referred to a doctor who specializes in treating cancer (oncologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For male breast cancer, some basic questions to ask your doctor include:
- What type of breast cancer do I have?
- What is the stage of my cancer?
- Has my cancer spread beyond the breast?
- Can my cancer be cured?
- Will I need more tests?
- What are my treatment options?
- What are the potential side effects of each option?
- Is there a treatment option you feel is best for me?
- How long will cancer treatment last?
- How will cancer treatment affect my daily life?
- I have these other health conditions. How can I best manage them together?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions that occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have any of your relatives been diagnosed with cancer? If so, what type of cancer and at what age were family members diagnosed?
Tests and diagnosis
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Diagnosing male breast cancer
If breast cancer is suspected, your doctor may conduct a number of diagnostic tests and procedures such as:
- Clinical breast exam. During this exam, your doctor uses his or her fingertips to examine your breasts and the areas around your armpits and your collarbone for lumps or other changes. Your doctor assesses how large the lumps are, how they feel, and how close they are to your skin and muscles.
- Mammogram. A mammogram is an X-ray of your breast tissue. To assess your breast tissue, your breast will be pressed flat as much as possible. During a mammogram, you stand in front of a machine with your shirt off. Two flat plastic plates come together to compress your breast tissue. A radiology technician takes the X-rays. The compression of the mammogram can be uncomfortable. Ask the technician what to expect and speak up if you're feeling pain.
- Ultrasound. Ultrasound uses sound waves to create pictures of a suspicious breast mass. Your doctor may recommend an ultrasound in certain situations.
- Using a needle to remove cells for testing. A biopsy procedure involves removing a sample of suspicious tissue for laboratory testing. A breast biopsy is commonly done by inserting a needle into the breast lump and drawing cells or tissue from the area. When analyzed in a laboratory, your tissue sample reveals whether you have breast cancer and, if so, what type of breast cancer you have.
Determining the extent of the cancer
If you've been diagnosed with breast cancer, your doctor will work to determine the extent (stage) of your cancer. Your cancer's stage helps your doctor determine treatment options. Staging tests include blood tests and imaging tests, such as X-ray and computerized tomography (CT).
The stages of male breast cancer are:
- Stage I. The tumor is no more than 2 centimeters (cm) in diameter (3/4 inch) and hasn't spread to the lymph nodes.
- Stage II. The tumor may be up to 5 cm (about 2 inches) in diameter and may have spread to nearby lymph nodes. Or the tumor may be larger than 5 cm and no cancer cells are found in the lymph nodes.
- Stage III. The tumor may be larger than 5 cm (about 2 inches) in diameter and may involve several nearby lymph nodes. Lymph nodes above the collarbone may also contain cancer cells.
- Stage IV. Cancer at this stage has spread beyond the breast to distant areas, such as the bone, brain, liver or lungs.
Treatments and drugs
To determine your male breast cancer treatment options, your doctor considers your cancer's stage, your overall health and your preferences. Male breast cancer treatment often involves surgery and may also include other treatments.
The goal of surgery is to remove the tumor and surrounding breast tissue. Surgical procedures used to treat male breast cancer include:
- Surgery to remove breast tissue and surrounding lymph nodes. Most men with breast cancer undergo a modified radical mastectomy. In this procedure, a surgeon removes all of your breast tissue, including the nipple and areola, and some underarm (axillary) lymph nodes. Your lymph nodes are tested to see if they contain cancer cells. Removing your lymph nodes increases your risk of serious arm swelling (lymphedema).
- Surgery to remove one lymph node for testing. During a sentinel lymph node biopsy, your doctor identifies the lymph node most likely to be the first place your cancer cells would spread. That lymph node is removed and tested for cancer cells. If no cancer cells are found in that lymph node, there is a good chance that your breast cancer hasn't spread beyond your breast tissue.
Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. During radiation therapy for male breast cancer, radiation comes from a large machine that moves around your body, directing the energy beams to precise points on your chest.
In male breast cancer, radiation therapy may be used to eliminate any remaining cancer cells in the breast, chest muscles or armpit after surgery.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment often involves receiving two or more drugs in different combinations. These may be administered through a vein in your arm (intravenously), in pill form or by both methods.
Your doctor may recommend chemotherapy after surgery to kill any cancer cells that may have spread outside your breast. Chemotherapy may also be an option for men with advanced breast cancer that has spread beyond the breast.
Some breast cancers rely on hormones for fuel. If your doctor determines that your cancer uses hormones to help it grow, you may be offered hormone therapy. Most men with male breast cancer have hormone-sensitive tumors. Hormone therapy for male breast cancer often involves the medication tamoxifen, which is also used in women. Other hormone therapy medications used in women with breast cancer haven't been shown to be effective in men.
No alternative treatments for male breast cancer are proved to cure the disease. But some alternative treatments are thought to be helpful when coping with the side effects of cancer and cancer treatment.
Alternative medicine treatments may help you cope with feelings of anxiety and distress, which many people diagnosed with cancer experience. You may experience anxiety and distress from the shock of your diagnosis and from worrying about your future. If you have anxiety and distress, you may have difficulty concentrating and sleeping.
To help you cope, you might consider alternative medicine treatments, such as:
- Creative activities. Creative activities such as art, dance and music may help you feel less distressed. Some cancer centers have specially trained professionals who can guide you through these activities.
- Exercise. Gentle exercise may help boost your mood and make you feel better. If you haven't been exercising regularly, ask your doctor if it's OK. Start slow and work your way up to more exercise on more days of the week.
- Meditation. Meditation is a quiet activity that helps you clear your mind of distracting thoughts. You can meditate on your own or receive guidance from an instructor.
- Prayer. Many people find strength from a power greater than themselves. You can pray on your own or you can meet with a chaplain or other religious person who can pray with you.
- Relaxation exercises. Relaxation exercises help refocus your mind and help you relax. Relaxation exercises include guided imagery and progressive muscle relaxation. You can do relaxation exercises on your own, with an instructor or by listening to a recording that guides you through the exercises.
Coping and support
Receiving a cancer diagnosis can be shocking and upsetting. With time you'll find ways to cope with the stress and challenges of cancer and cancer treatment. Until then, you might find it helpful to:
- Learn enough about your cancer to feel comfortable making treatment decisions. Ask your doctor for the specifics of your cancer, such as the type of cancer and its stage. Also ask about good sources for reliable information. You can also do your own research. Start with the National Cancer Institute and the American Cancer Society. Learning about your cancer and your treatment options may make you feel more confident as you make decisions about your future.
- Find someone to talk with. Find a close friend or family member you can talk with. Talking about your fears and hopes as you make important choices about your treatment might help you feel less stressed. Sometimes, though, you may feel like friends and family can't understand your situation if they've never had cancer. In these situations, you may find the concern and understanding of other men with cancer especially helpful. Your doctor or a medical social worker may be able to put you in touch with a support group. Or contact an organization that can connect you with another man with breast cancer, such as the Y-Me National Breast Cancer Organization.
- Take care of yourself. Take care of yourself during your cancer treatment. Get enough sleep so that you wake feeling rested. Choose a diet full of fruits and vegetables. Try to exercise most days of the week. Find relaxing activities that help reduce your stress level, such as listening to music or meditating.
To reduce your risk of male breast cancer you can:
- Drink alcohol in moderation, if at all. Limit yourself to a drink or two a day, if you choose to drink alcohol.
- Maintain a healthy weight. If your weight is healthy, work to maintain it by exercising most days of the week. If you're overweight or obese, work to lose weight slowly. Ask your doctor about strategies to lose weight. Combine a healthy diet full of fruits and vegetables with increased exercise.
- Male breast cancer treatment (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/patient. Accessed Jan. 18, 2012.
- Johansen Taber KA, et al. Male breast cancer: Risk factors, diagnosis and management. Oncology Reports. 2010;24:1115.
- Gomez-Raposo C, et al. Male breast cancer. Cancer Treatment Reviews. 2010;36:451.
- Brain K, et al. Psychological distress in men with breast cancer. American Journal of Clinical Oncology. 2006;24:95.
- Distress management. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Jan. 18, 2012.