Understand the outcomes of invasive breast cancer by exploring its prognosis. Learn about the factors that affect prognosis, the different stages of breast cancer

Male Breast Cancer

Online Consultation

Ismail Munir

Overview

Male breast cancer is a rare type of cancer that occurs in the breast tissue of men. 
&nbsp;

Male breast cancer is a rare disease, accounting for less than 1% of all breast cancer cases<a href="#accordion">[3]</a>. The incidence and prevalence of male breast cancer can vary by region and population. According to the American Cancer Society, in 2023, an estimated 2,8000 new cases of invasive breast cancer will be diagnosed in men in the United States, with approximately 530 deaths from the disease<a href="#accordion">[1]</a>. The lifetime risk of developing breast cancer in men is about 1 in 1,000<a href="#accordion">[1]</a>. In Europe, the incidence of male breast cancer is estimated to be around 1 per 100,000 men per year<a href="#accordion">[2]</a>. 
&nbsp;

The incidence rate of male breast cancer has been increasing over the past few decades, possibly due to better diagnostic methods and increased awareness<a href="#accordion">[2]</a>. 

Male breast cancer is thought to develop as a result of genetic mutations or hormonal imbalances that affect the growth and division of cells in the breast tissue. There are several known risk factors for male breast cancer, including age, family history, <a href="https://merisehat.pk/disease/obesity">obesity</a>, and certain medical conditions that affect hormone levels. 

Due to the lack of awareness regarding male breast cancer, most men are diagnosed at a more advanced stage than women. 
&nbsp;

There are several types of male breast cancer, which can be classified based on histology or molecular characteristics: 
&nbsp;

<ol>
	<li>&nbsp;Invasive Ductal Carcinoma: This is the most common type of male breast cancer, accounting for about 80% of cases<a href="#accordion">[1]</a>. It begins in the milk ducts of the breast and can spread to nearby tissues.</li>
	<li>&nbsp;Ductal Carcinoma In Situ (DCIS): This is a non-invasive type of breast cancer that involves cells lining the breast ducts. Unlike invasive ductal carcinoma, the cancer cells do not spread to the surrounding tissue. It is usually detected by a mammogram and may be treated with surgery to remove the affected tissue.</li>
	<li>&nbsp;Inflammatory Breast Cancer: This is a rare but aggressive type of breast cancer that can occur in men or women. It typically presents as a red, swollen, and warm breast, and may be accompanied by itching, pain, or a thickening of the skin. Inflammatory breast cancer can be mistaken for an infection.</li>
	<li>&nbsp;Paget&#39;s Disease Of The Nipple: This is a rare type of breast cancer that begins in the breast ducts and spreads to the nipples. It can also spread to the areola. Nipple changes such as itching, scaling, oozing, and redness may appear. Moreover, a breast lump may also be present. Paget&rsquo;s disease accounts for 5% of male breast cancers<a href="#accordion">[1]</a>. It may occur with invasive ductal carcinoma or DCIS.</li>
	<li>&nbsp;Lobular Carcinoma In Situ (LCIS): This is a non-invasive type of breast cancer that begins in the milk-producing glands of the breast (lobules). It is usually detected by a biopsy and may be monitored or treated with surgery. Since men have few lobules in their breast tissue, this type of cancer is rare in men. </li>
	<li>&nbsp;Invasive Lobular Carcinoma (ILC): It accounts for only 2% of male breast cancers<a href="#accordion">[1]</a>. Similar to lobular carcinoma in situ, it develops in the milk-producing lobules but can spread to other parts of the breast and body. 
	&nbsp;</li>
</ol>

There are also other types of breast cancers, such as phyllodes, angiosarcomas, and sarcomas. These can develop in the fat, muscle, or connective tissue. 

Invasive breast cancers can be further divided into the following subtypes:

<ul>
	<li>Papillary carcinoma</li>
	<li>Micropapillary carcinoma</li>
	<li>Adenoid cystic carcinoma</li>
	<li>Medullary carcinoma</li>
	<li>Tubular carcinoma</li>
	<li>Low-grade adenosquamous carcinoma</li>
	<li>Mucinous carcinoma</li>
	<li>Metaplastic carcinoma</li>
	<li>Mixed carcinoma (features of both invasive lobular and ductal) 
	&nbsp;</li>
</ul>

Male breast cancer can also be classified into the following subtypes.

<ul>
	<li>Hormone Receptor-Positive Or Negative - Cancer cells may have estrogen (ER+) or progesterone receptors (PR+). Breast cancers expressing these receptors are called &ldquo;hormone receptor-positive&rdquo;. They are responsive to hormonal therapy.</li>
	<li>HER2 Positive Or Negative - HER2 gene helps tumor cell growth. Its presence on cancer cells will classify it as HER2 positive. These cancers are more aggressive. </li>
	<li>Triple-Negative - Cancer cells that do not express estrogen, progesterone, or HER2 receptors, are called triple-negative. This type is more common in younger people and tends to grow fast. </li>
</ul>

The classification of male breast cancer is important for determining the best treatment approach and predicting the prognosis of the disease<a href="#accordion">[4]</a>. 
&nbsp;

<a href="https://merisehat.pk/disease/gynecomastia">Gynecomastia </a>Vs Male Breast Cancer

Gynecomastia is a condition characterized by the enlargement of breast tissue in males. It is a relatively common condition and can be caused by various factors, including hormonal imbalances, certain medications, and underlying medical conditions. While gynecomastia itself is not typically a cause for concern, it is important to note that men with this condition may have a slightly increased risk for male breast cancer. 

Male breast cancer is a rare but serious condition that occurs when malignant cells form in the breast tissue of men. Symptoms of male breast cancer can include a lump or swelling in the breast, nipple discharge, or changes to the skin around the breast. While having gynecomastia does not necessarily mean that one will develop male breast cancer, it is important to be aware of the potential risk and to monitor the breast tissue for any changes. Regular breast exams and mammograms may be recommended for men at increased risk for male breast cancer. 
&nbsp;

Note: If you notice any changes in or near your breast, contact a healthcare professional immediately. 
&nbsp;

Signs and Symptoms

The signs and symptoms of male breast cancer can include:

<ol>
	<li>&nbsp;A painless (not always) lump or thickening in the breast tissue</li>
	<li>&nbsp;Changes in the size or shape of the breast</li>
	<li>&nbsp;Changes in the texture or color of the overlying skin, such as dimpling or puckering</li>
	<li>&nbsp;Peau d&rsquo;orange </li>
	<li>&nbsp;Skin ulceration</li>
	<li>&nbsp;Nipple retraction or discharge (usually clear or bloody)</li>
	<li>&nbsp;Redness or scaling of the nipple or breast skin</li>
	<li>&nbsp;Pain or tenderness in the chest or underarms 
	&nbsp;</li>
</ol>

It&#39;s important to note that many of these symptoms can also be caused by other conditions, such as gynecomastia or breast infection. Furthermore, not all breast lumps are malignant, most are benign. However, any breast lumps or changes in the breast tissue should be evaluated by a healthcare provider<a href="#accordion">[5]</a>. 
&nbsp;

Causes

Uncontrolled cell growth in the breast tissue results in male breast cancer. It is unclear as to what causes these abnormal changes. However, genetic mutations and hormone imbalances are known to contribute to its development. Men with mutations of the BRCA1 or BRCA2 tumor suppressor genes have a higher risk of breast cancer. 
&nbsp;

Male breast cancer is a rare disease, and there is no established screening test for routine use in men who do not have any symptoms or known risk factors for the disease. However, men who are at high risk for male breast cancer due to genetic mutations, family history, or other factors may be advised to undergo regular screening.

Screening for male breast cancer typically involves a clinical breast exam by a healthcare provider. The American Cancer Society recommends that men at high risk for breast cancer undergo a clinical breast exam every six to 12 months, starting at age 35 or earlier if there is a known genetic mutation or other risk factors. In case of a genetic mutation, men may be offered screening mammography. 

Early detection is key to the successful treatment of male breast cancer. Men who are at high risk for the disease should be aware of the symptoms and discuss screening options with their healthcare provider<a href="#accordion">[1]</a>. 
&nbsp;

Diagnosis

The diagnosis of male breast cancer begins with a detailed history and clinical examination. During the history, the healthcare professional will inquire about the patient&rsquo;s symptoms, their family history of breast cancer, the patient&rsquo;s past medical history, and whether they have had any exposure to radiation or estrogen in the past. While conducting the clinical exam, the doctor will evaluate for any nipple changes, pain, breast lumps, lumps in the armpits or chest, and any changes to the overlying skin.

If a man is suspected of having male breast cancer based on clinical symptoms, imaging tests, or other factors, a diagnostic workup may be performed to confirm the diagnosis and determine the extent of the disease. The diagnostic tests for male breast cancer may include<a href="#accordion">[4]</a>: 
&nbsp;

<ol>
	<li>&nbsp;Imaging Tests</li>
</ol>

Imaging tests such as mammography, ultrasound, and magnetic resonance imaging (MRI) can be used to detect and evaluate breast abnormalities in men. A diagnostic mammogram helps identify abnormal breast tissue. An ultrasound scan is recommended if a breast lump is found to evaluate for changes seen in a mammogram. It can differentiate between fluid-filled cysts and solid lumps. Furthermore, it can be used to check for enlarged lymph nodes in the armpits. If found, a needle biopsy may be done to detect cancer cells. Other tests such as a PET scan, CT scan, or bone scan are employed to detect metastasis and stage the disease. 
&nbsp;

<ol start="2">
	<li>&nbsp;Biopsy</li>
</ol>

A biopsy involves taking a small tissue sample from the breast and examining it under a microscope to determine whether cancer cells are present. Biopsies can be performed using several methods, including fine needle aspiration, core needle biopsy, or surgical biopsy. Core needle biopsy is more commonly used to diagnose breast cancer. Fine needle aspiration biopsy (FNA) is typically done to detect the spread of cancer in the nearby lymph nodes. 
&nbsp;

<ol start="3">
	<li>&nbsp;Genetic Testing</li>
</ol>

​​​​​​​Genetic testing may be recommended for men with a family history of breast or ovarian cancer, as certain genetic mutations can increase the risk of developing male breast cancer.

The diagnostic tests for male breast cancer are similar to those used for female breast cancer but may require different imaging techniques and biopsy procedures due to the differences in breast anatomy between men and women. 
&nbsp;

Similar to female breast cancer, breast cancer in men is staged according to the TNM classification. The stages of male breast cancer are: 
&nbsp;

<ul>
	<li>Stage 0 - This is another name for ductal carcinoma in situ. Cancer cells are only present in the ducts.</li>
	<li>Stage I - The cancer cells have not spread to the lymph nodes and the tumor is small at this stage. </li>
	<li>Stage II - This stage is characterized by a tumor that is smaller than 20mm and has spread to a few nearby axillary lymph nodes. If the tumor is between 20mm-50mm and hasn&rsquo;t spread to axillary lymph nodes, it is classified as stage IIA. While stage IIB is characterized by a tumor that has spread to the lymph nodes. Stage II also includes tumors that are larger than 50mm but haven&rsquo;t spread to a few axillary lymph nodes.</li>
	<li>Stage III - This involves the spread of cancer cells to several lymph nodes, and also the chest wall or skin</li>
	<li>Stage IV - This stage involves the spread of cancer cells to other parts of the body, including the bones, brain, liver, or lungs. </li>
</ul>

Approximately 40% of male breast cancers are diagnosed at stage III or IV<a href="#accordion">[7]</a>. 
&nbsp;

The prognosis typically depends on the stage of male breast cancer. The overall 5-year survival rate is 40% to 65%<a href="#accordion">[7]</a>. Following are the 5-year survival rates for various stages<a href="#accordion">[7]</a>:

<ul>
	<li>Stage I: 75%-100%</li>
	<li>Stage II: 50%-80%</li>
	<li>Stage III: 30%-60%</li>
	<li>Stage IV: 20%-30% 
	&nbsp;</li>
</ul>

Treatment

The treatment of male breast cancer typically involves a combination of surgery, radiation therapy, chemotherapy, and/or hormonal therapy, depending on the stage and characteristics of cancer. The goals of treatment are to remove cancer, prevent its recurrence, and preserve the patient&#39;s quality of life<a href="#accordion">[1]</a>. 
&nbsp;

<ol>
	<li>&nbsp;Surgery: Surgery is the primary treatment for male breast cancer and involves removing the cancerous tissue from the breast. This may involve a mastectomy (removal of the entire breast) or a lumpectomy (removal of the tumor and surrounding tissue). A sentinel lymph node biopsy may also be conducted. It is used to identify the first place the cancer cells may have spread. Lymph nodes are removed and analyzed for the presence of cancer cells. </li>
	<li>&nbsp;Radiation Therapy: Radiation therapy uses high-energy radiation to kill cancer cells. It may be used after surgery to kill any remaining cancer cells and reduce the risk of recurrence.</li>
	<li>&nbsp;Chemotherapy: Chemotherapy involves using drugs to kill cancer cells and may be used in combination with surgery and/or radiation therapy for more advanced or aggressive cancers.</li>
	<li>&nbsp;Hormonal Therapy: Hormonal therapy involves using medications to block the production or activity of hormones such as estrogen, which can promote the growth of some types of breast cancer. This may be used for hormone receptor-positive breast cancers. Tamoxifen is a common hormone therapy used for male breast cancer. </li>
	<li>&nbsp;Targeted Therapy: Thee treatments only work on specific types of cancer cells. 
	&nbsp;</li>
</ol>

The treatment approach for male breast cancer is similar to that for female breast cancer, but may require some adjustments due to the differences in breast anatomy and hormone levels between men and women. 
&nbsp;

There are several potential complications associated with male breast cancer, including: 
&nbsp;

<ol>
	<li>&nbsp;Lymphedema: Removal of lymph nodes during surgery can lead to lymphedema, a condition in which fluid builds up in the tissues, causing swelling and discomfort.</li>
	<li>&nbsp;Recurrence: Male breast cancer can recur, even after treatment, so ongoing monitoring and follow-up care are necessary.</li>
	<li>&nbsp;Spread To Other Parts Of The Body: If male breast cancer is not detected and treated early, it can spread to other parts of the body, such as the bones, liver, or lungs. This is called metastasis. </li>
	<li>&nbsp;Side Effects Of Treatment: The treatments for male breast cancer, including surgery, radiation therapy, chemotherapy, and hormonal therapy, can cause side effects such as fatigue, nausea, hair loss, and sexual dysfunction.</li>
	<li>&nbsp;Emotional And Psychological Effects: A diagnosis of cancer can have significant emotional and psychological effects, including anxiety, depression, and changes in body image and self-esteem. 
	&nbsp;</li>
</ol>

Men with breast cancer need to work closely with their healthcare team to manage these potential complications and receive appropriate follow-up care. 
&nbsp;

There are several known risk factors for male breast cancer, including<a href="#accordion">[1]</a>: 
&nbsp;

<ol>
	<li>&nbsp;Age: The risk of male breast cancer increases with age, with most cases occurring in men over the age of 60.</li>
	<li>&nbsp;Family History: Men with a family history of breast or ovarian cancer, especially if it is related to a BRCA1 or BRCA2 gene mutation, are at increased risk of developing male breast cancer.</li>
	<li>&nbsp;Klinefelter Syndrome: Men with <a href="https://merisehat.pk/disease/klinefelter-syndrome">Klinefelter syndrome</a>, a genetic condition in which there is an extra X chromosome, are at increased risk of developing male breast cancer.</li>
	<li>&nbsp;Radiation Exposure: Men who have previously received radiation therapy to the chest area for another condition, such as lymphoma, are at increased risk of developing male breast cancer.</li>
	<li>&nbsp;Liver Disease: Men with liver disease, such as <a href="https://merisehat.pk/disease/cirrohsis">cirrhosis</a>, are at increased risk of developing male breast cancer due to increased levels of estrogen in the body.</li>
	<li>&nbsp;Obesity: Obesity is associated with an increased risk of male breast cancer, possibly due to higher levels of estrogen in fat tissue.</li>
	<li>&nbsp;Alcohol Consumption: Heavy alcohol consumption has been linked to an increased risk of male breast cancer.</li>
	<li>&nbsp;Hormone Therapy: Men who have received hormone therapy for prostate cancer may be at increased risk of developing male breast cancer. 
	&nbsp;</li>
</ol>

There are some lifestyle factors and preventative measures that may help reduce the risk of developing male breast cancer, including<a href="#accordion">[1]</a>: 
&nbsp;

<ol>
	<li>&nbsp;Maintaining A Healthy Weight: Obesity has been linked to an increased risk of male breast cancer, so maintaining a healthy weight through diet and exercise may help reduce the risk.</li>
	<li>&nbsp;Quitting Alcohol: Heavy alcohol consumption has been linked to an increased risk of male breast cancer, so quitting alcohol may help reduce the risk.</li>
	<li>&nbsp;Regular Exercise: Regular physical activity has been shown to reduce the risk of many types of cancer, including male breast cancer.</li>
	<li>&nbsp;Avoiding Radiation Exposure: Men who have received radiation therapy to the chest area for another condition, such as lymphoma, are at increased risk of developing male breast cancer, so avoiding unnecessary radiation exposure may help reduce the risk.</li>
	<li>&nbsp;Genetic Counseling And Testing: Men with a family history of breast or ovarian cancer, especially if it is related to a BRCA1 or BRCA2 gene mutation, may benefit from genetic counseling and testing to assess their risk of developing male breast cancer and consider preventative measures. 
	&nbsp;</li>
</ol>

It&#39;s important to note that while these preventative measures may help reduce the risk of male breast cancer, they do not guarantee that the disease will not develop. 
&nbsp;

Key Points

<ul>
	<li>Male breast cancer is a rare type of cancer that occurs in the breast tissue of men.</li>
	<li>Male breast cancer is a rare disease, accounting for less than 1% of all breast cancer cases.</li>
	<li>Male breast cancer is thought to develop as a result of genetic mutations or hormonal imbalances that affect the growth and division of cells in the breast tissue.</li>
	<li>Invasive ductal carcinoma is the most common type of male breast cancer, accounting for about 80% of cases.</li>
	<li>Ductal carcinoma in situ (DCIS) is a non-invasive type of breast cancer that involves abnormal cells in the milk ducts.</li>
	<li>Inflammatory breast cancer is a rare and aggressive type of breast cancer that can occur in men or women.</li>
	<li>Paget&#39;s disease of the nipple is a rare type of breast cancer that begins in the nipple and spreads to the surrounding skin.</li>
	<li>Lobular carcinoma in situ (LCIS) is a non-invasive type of breast cancer that begins in the milk-producing glands of the breast.</li>
	<li>The signs and symptoms of male breast cancer can include a painless lump or thickening in the breast tissue and changes in the size or shape of the breast.</li>
	<li>Male breast cancer is more common in older men, with the risk increasing with age.</li>
	<li>Men with a family history of breast cancer, particularly in a first-degree relative (such as a mother, sister, or daughter), are at increased risk.</li>
	<li>Some inherited genetic mutations, such as BRCA1 or BRCA2 mutations, can increase the risk of male breast cancer.</li>
	<li>Male breast cancer is a rare disease, and there is no established screening test for routine use in men who do not have any symptoms or known risk factors for the disease.</li>
	<li>Screening for male breast cancer typically involves a clinical breast exam by a healthcare provider, as well as imaging tests such as a mammogram or ultrasound.</li>
	<li>Imaging tests such as mammography, ultrasound, and magnetic resonance imaging (MRI) can be used to detect and evaluate breast abnormalities in men.</li>
	<li>A biopsy involves taking a small tissue sample from the breast and examining it under a microscope to determine whether cancer cells are present.</li>
	<li>The treatment of male breast cancer typically involves a combination of surgery, radiation therapy, chemotherapy, and/or hormonal therapy, depending on the stage and characteristics of cancer.</li>
	<li>Surgery is the primary treatment for male breast cancer and involves removing the cancerous tissue from the breast.</li>
	<li>Hormonal therapy involves using medications to block the production or activity of hormones such as estrogen, which can promote the growth of some types of breast cancer.</li>
	<li>Removal of lymph nodes during surgery can lead to lymphedema, a condition in which fluid builds up in the tissues, causing swelling and discomfort.</li>
	<li>A diagnosis of male breast cancer can have significant emotional and psychological effects, including anxiety, depression, and changes in body image and self-esteem.</li>
	<li>The risk of male breast cancer increases with age, with most cases occurring in men over the age of 60.</li>
	<li>Men with Klinefelter syndrome, a genetic condition in which there is an extra X chromosome, are at increased risk of developing male breast cancer.</li>
	<li>Heavy alcohol consumption has been linked to an increased risk of male breast cancer.</li>
	<li>Obesity has been linked to an increased risk of male breast cancer, so maintaining a healthy weight through diet and exercise may help reduce the risk.</li>
	<li>Regular physical activity has been shown to reduce the risk of many types of cancer, including male breast cancer.</li>
	<li>Several ongoing research efforts are exploring new and innovative approaches to understanding and treating male breast cancer. 
	&nbsp;</li>
</ul>

[1] American Cancer Society. (2021). Breast cancer in men.

[2] Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006;367(9510):595-604. doi: 10.1016/S0140-6736(06)68226-3. PMID: 16488803.

[3] Korde LA, Zujewski JA, Kamin L, et al. Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol. 2010;28(12):2114-2122. doi:10.1200/JCO.2009.25.5729.

[4] National Cancer Institute. (2021). Male breast cancer treatment (PDQ) - health professional version.

[5] American Cancer Society. (2022). Signs and symptoms of breast cancer in men.

[6] Mayo Clinic. (2021). Male breast cancer.

[7] Khattab A, Kashyap S, Monga DK. Male Breast Cancer. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

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