Breast cancer and men: who’s at risk?
Updated: November 5, 2012 6:04AM
Although the American Cancer Society estimates breast cancer will kill nearly 40,000 women this year, breast cancer is not solely a women’s issue.
The American Cancer Society also estimates that about 2,000 men will be diagnosed with invasive breast cancer this year, and that 410 of them will die from it.
While it is true that breast cancer is rare among men — the lifetime risk about 1 in 1,000 — the prognosis is generally worse for men than women. This is because men tend to wait longer to report symptoms, either because of embarrassment or because they attribute the symptoms to another cause, giving cancer the opportunity to grow and spread.
Several risk factors contribute to increased risk of breast cancer in men:
• history of radiation exposure to the chest (such as during treatment for Hodgkin’s disease)
• increased levels of estrogen due to Klinefelter’s syndrome, cirrhosis of the liver, or obesity (fat cells transform androgen hormones into estrogen)
• a family history of breast cancer
• BRCA2 gene mutation
• use of Finesteride (Propecia) for prevention of prostate carcinoma or treatment of enlarged prostate.
Breast cancer in men usually manifests itself as a painless, palpable lump away from the nipple. Most of the time, when men find a lump associated with pain or tenderness behind the nipple, it is because of gynecomastia, not cancer.
Gynecomastia is simply swelling of breast tissue in men due to an imbalance of estrogen and testosterone. It can be temporarily seen in newborns, boys undergoing puberty, and in older men undergoing hormonal changes. Generally, gynecomastia is not a serious problem but in some cases it is a symptom of an underlying health condition such as liver or testicular problems.
Certain medications can also cause gynecomastia, including: anti-androgens to treat prostate cancer, anabolic steroids, some AIDS medications, anti-anxiety medications, tricyclic antidepressants, antibiotics, H2-receptor blockers to treat stomach ulcers and severe heartburn, chemotherapy, some heart medications, alcohol, street drugs such as marijuana, amphetamines, heroin or methadone, and some plant oils, such as tea tree or lavender, in personal care products.
Just like women, men with any breast related symptoms should undergo mammographic and possible sonographic evaluation. Biopsy will be needed if the mammographic/sonographic findings are suspicious.
Breast cancer in men is staged in the same way as in women and survival rate is dependent on the stage at which it is diagnosed. For instance, a tumor that is less than 2 centimeters in size that has not spread to the lymph nodes carries a 98 percent survival rate at five years. That rate drops to 86 percent if the tumor presents at 2 to 2.5 centimeters and has spread to three lymph nodes. The average size of a cancer in men is about 2.5 centimeters.
Treatment for male breast cancer is similar to that for women: lumpectomy or mastectomy, with radiation and/or chemotherapy. Most male breast cancers are estrogen receptor positive and so treatment may involve medicines that block that hormone, such as tamoxifen.
Although men do not need to perform regular breast self-exams, they should promptly note and report the following symptoms to their primary care physicians:
• Palpable lump
• Nipple discharge
• Focal breast pain
• Nipple or skin puckering
• Change in the size or appearance of the breast/nipple
Do not ignore symptoms or assume they are normal. Usually, breast symptoms in men are due to gynecomastia but without evaluation, one cannot be certain. With prompt diagnosis, male breast cancer can be caught and treated before it metastasizes.
Dr. Mita Majmundar is director of breast imaging and intervention at Adventist Midwest Health.