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Breast Cancer in Men

Definition

Breast cancer is a disease in which cancer cells grow in the breast tissue. Although male breasts do not fully develop, they do contain most of the same basic breast structures as women. Male breasts include small glands called lobules, ducts, and the nipple. These structures are also surrounded by fatty tissue. All of these structures are susceptible to developing breast cancer.
Breast cancer in men is rare, accounting for about 1% of all breast cancers. This makes awareness of the disease uncommon. Because of this, the cancer is often diagnosed in advanced stages. Like all other cancers, early diagnosis and treatment are important for the most favorable outcome.
Types of breast cancer found in men are:
  • Infiltrating ductal carcinoma—Cancer starts in the ducts of the breast and spreads into surrounding tissues. This is the most common type of breast cancer in men.
  • Ductal carcinoma situ—Early stage cancer confined to the ducts. This type has the highest cure rate.
  • Infiltrating lobular carcinoma—A rare cancer that starts in the lobules of the breast and spreads into surrounding tissues.
  • Paget’s disease—A very rare cancer that starts in the ducts and spreads to the nipple and areola.
  • Inflammatory—A very rare, but aggressive cancer that occurs with visible changes in the skin around the breast and nipple.
Lymph Nodes and Vessels
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Causes

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues including the lymph nodes. Cancer that has invaded the lymph nodes can then spread to other parts of the body. The lymph nodes associated with breast cancer are in the armpit, above the collarbone, and in the chest.
It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors

Factors that may increase your risk of developing breast cancer include:
  • Advancing age
  • Family history of breast cancer
  • Genetic mutations, such as BRCA1, BRCA2, and others
  • Exposure to radiation, especially in the chest
  • Exposure to increased levels of estrogen, which may occur with:

Symptoms

When breast cancer first develops, there may be no symptoms at all. As the cancer grows, it can cause the following changes:
  • One or more lumps in the breast, which may or may not be painful
  • One or more lumps in lymph nodes near the breast, under your arm, or collarbone that which may or may not be painful
  • Changes in the skin or nipple, such as dimpling, puckering, or nipple retraction
  • Redness, irritation, or ulceration of the skin in the breast area
  • Discharge from the nipple, which may be clear or bloody

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. This includes a thorough manual breast exam and blood tests.
In most cases, diagnosis can be confirmed with a biopsy. A sample of the suspicious tissue will be removed and sent to a lab to look for cancer cells.
Types of biopsies include:
  • Fine-needle aspiration—A thin needle is used to extract fluid or cells from the suspicious tissue.
  • Core needle—Removal of a small cylinder of suspicious tissue.
  • Surgical—Removal of a sample of the lump, or the entire lump with surrounding healthy tissue.
  • Samples of lymph tissue and nipple discharge.
Imaging tests can help with diagnosis and determine the extent of cancer. These may include:
If cancer is present, your doctor may order other tests to learn more about the type of cancer. These may include:
  • Blood tests—To look for tumor markers and genetic mutations.
  • Tissue evaluation—To look for estrogen or progesterone receptors, and the presence of HER2/neu and Oncotype DX. These are used to help plan therapy.
The physical exam, combined with all of your test results, will help to determine the type and stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, breast cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

Cancer treatment varies depending on the stage and type of cancer.
A combination of therapies is most effective. For example, radiation may be used before surgery to shrink the tumor or after to make sure all the cancer has been removed.
Treatment options include:

Surgery

The goal of surgery is to remove the tumors and any affected tissue.
Surgical procedures include:
  • Modified radical mastectomy—Removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles. This is the most common procedure.
  • Radical mastectomy—Removal of the whole breast, the lymph nodes under the arm, and the chest wall muscles under the breast. This is only done when the tumor is large and growing into the chest muscles.
  • Axillary lymph node dissection— Removal of the lymph nodes under the arm. This is done to help determine whether cancer cells have entered the lymphatic system.
  • Sentinel node biopsy— A small amount of blue dye and/or a radioactive tracer is placed in the area where the tumor was located. The lymph nodes that pick up the substance are removed. Those remaining lymph nodes should be removed if any sentinel nodes contain cancer.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink remaining tumors.
Radiation therapy can be:
  • External—Radiation directed at the breast from a source outside the body.
  • Internal—Radioactive materials are placed into the breast in or near the cancer cells.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, or IV. The drugs enter the bloodstream. They travel through the body killing mostly cancer cells. Some healthy cells are killed as well.

Medications

The following therapies may be used in conjunction with chemotherapy:
  • Biologic therapy—The use of medications or substances made by the body to treat cancer. Biologic response modifier (BRM) therapy is the use of medications to increase or restore the body's natural defenses against cancer.
  • Targeted therapy—Uses medications to interfere with specific characteristics that are needed for the growth of the cancer cells. For example, medications can block the growth of new blood vessels or block chemical signals that allow cancer cells to grow and function.
  • Hormone blocking therapy—Designed to take advantage of the fact that many breast cancers are estrogen sensitive. Estrogen binds to the estrogen-sensitive cells and stimulates them to grow and divide. Anti-estrogen drugs prevent the binding of estrogen. This stops the cells from growing and prevents or delays breast cancer from returning.

Other Medications

Cancer treatments can cause some side effects like loss of appetite, nausea, anemia, increased risk for infection, or pain. Other medications or treatments may be needed to minimize these problems through your cancer treatment.

Prevention

There are no current guidelines to screen for breast cancer in men. Finding breast cancer early and treating it promptly is the best way to prevent death. Since breast cancer does not cause symptoms in the early stages, be aware of any changes in your body and talk to your doctor about them.

RESOURCES

American Cancer Society http://www.cancer.org

National Cancer Institute http://www.cancer.gov

CANADIAN RESOURCES

Canadian Cancer Society http://www.cancer.ca

Health Canada http://www.hc-sc.gc.ca

References

Bradley KL, Tyldesley S, et al. Contemporary systemic therapy for male breast cancer. Clin Breast Cancer. 2013 Oct 1;[Epub ahead of print].

Breast cancer in men. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003091-pdf.pdf. Accessed January 7, 2014.

Breast cancer in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 1, 2012. Accessed January 7, 2014.

Hotko YS. Male breast cancer: Clinical presentation, diagnosis, treatment. Exp Oncol. 2013;35(4):303-310.

Male breast cancer treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/Patient. Updated September 18, 2013. Accessed January 7, 2014.

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