MALE BREAST CANCER

Male breast cancer is a rare cancer accounting only less than 1% of all breast cancer in. The incidence has remained stable over the past 4 decades. It is usually seen in men over 60 and the incidence increases with advancing age.

Why do Men Develop Breast cancer?
Like many cancers there is no one specific factor, which causes this cancer. Various studies indicate that it may be hormonally driven as in women due to the imbalance between sex hormones.
Klinefilter syndrome is rare genetic disorder, which is known to be associated with male breast cancer. This syndrome is associated with small testes, loss of sperm production and enlargement of breasts.
Other factors implicated are obesity and family history of female breast cancer especially if more number of first degree relatives are affected at early age.
Only BRCA 2 mutations predispose to male breast cancer as opposed to both BRCA 1 and 2 in the case of female breast cancer. Again the incidence of such mutations are very low as in the case of female breast cancer.

Type of Cancer:
Approximately 90% of the cancer in men are invasive type meaning they do not remain confined to the breast and has a tendency to invade the adjacent tissue or the lymph glands or spread elsewhere. This is higher than compared to female breast cancer. Only 10% are non-invasive (DCIS) which has the potential to develop as invasive cancer.
Male breast cancer also differs from female counterpart in that they have higher hormone receptors so those drugs that block this hormone activity can manipulate them.

How do they present?
They commonly present as lump in the breast. If somebody notices a lump in the breast that was not present earlier especially in the older age group they should seek advice from the GP. They can also present as nipple retraction of recent onset,ulceration, nipple discharge and bleeding. They are often confined to one side. Since there is a less amount of breast tissue compared to women the chances of detecting a small lump is high. But at the same time the chances of the cancer affecting the adjacent structures is also high as there is not much breast tissue to prevent it.
Boys of pubertal age may develop painful/or painless lump in or both the breast which is quite normal for the age. They are not cancers or predispose to cancers but will spontaneously regress over a period of time.
In some cases they can also present as enlargement of glands in the arm pits.
In very advanced cancers they can present with tumour spreading to liver, bones, brain and lung. In these cases patients are often very ill.

How do we diagnose?
Ultrasound scan of the breast is performed to visualise the lump and biopsy is taken which usually gives the diagnosis. The core needle biopsy can be performed under local anaesthesia using a special needle either under the ultrasound guidance or without it.
Mammogram (Special x rays to see the breast) can also performed to visualise the mass. In any case the biopsy is necessary to confirm the diagnosis. Some times a fine needle is also passed to aspirate the tissue to establish the diagnosis. Generally the fine needle aspiration is painless, can be used without local anaesthesia but yields lower result compared to core needle biopsy.

Following confirmation of the cancer further tests in the form of CT scan, chest X ray or Ultrasound scan to check if cancer has spread to any other part of the body will be carried out in appropriate cases. A management plan will be devised following meeting of all the cancer specialists taking into consideration the type of cancer level of spread and fitness of the patient.

What is the Treatment available?

Cancer confined to the breast:
If the cancer has not spread anywhere and there is no other contra indications then surgery is recommended. It usually entails removal of all the breast tissue and the glands underneath the armpit on the affeceted side. In some cases if the tumour is not invasive then one or two glands may be taken out as samples from the armpit instead of complete removal after injecting a special dye in the breast which eventually travel to the glands in the armpit to identify the affected nodes. This procedure is called sentinel node biopsy. Further information about sentinel node is given elsewhere.
They may also receive radiotherapy following surgery to achieve more local control of the disease.

What is adjuvant therapy?
This is in the form of either hormone or chemotherapy to kill any cancer calls that might have spread elsewhere yet could not be identified by the available conventional tests. Male breast cancers often express receptors for hormones so that can be treated with Tamoxifen, which blocks these hormones. The role of Chemotherapy is not quite firmly established as in female breast cancers but available evidence suggests a benefit.

Cancer spread to other organs:
They are often treated primarily by hormone therapy or chemotherapy as the first line treatment. There are other hormones used as second line treatment if the first line treatment fails. They at most keep the tumour at bay rather than cure it.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885