Breast cancer in men: A rare but real concern

Breast cancer is commonly associated with women, but it's essential to acknowledge that this disease can also affect men. Male breast cancer, though relatively rare, is a pressing issue. Accounting for only about 1% of all breast cancer cases, it is often overlooked. In this article, we will shed light on the prevalence, risk factors, signs, and the crucial importance of early detection for male breast cancer.

Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in the USA reveals that between 2005 and 2010, out of 289,673 cases of breast cancer, only 2,054 were diagnosed in men, constituting just 0.7% of all breast cancer cases. Internationally, a meta-analysis study reported varying incidences of male breast cancer, with the highest rates found in Brazil (3.4 cases per 100,000 man-years) and the lowest in Japan and Singapore (0.1 per 100,000 man-years).

In India, institution-based studies indicate that male breast cancer comprises less than 1 percent of all breast cancer cases, and it primarily affects elderly men, typically in their 6th or 7th decade of life. The risk of male breast cancer rises with age.

It's important to understand the risk factors for male breast cancer — particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

Risk factors:

Several factors contribute to the risk of breast cancer in men. One significant factor is age, with the likelihood of developing breast cancer increasing as men grow older. Typically, the average age at which men are diagnosed with breast cancer is around 68, although in India, this age tends to be somewhat younger compared to Western countries.

Another crucial factor is the presence of high estrogen levels. Estrogen stimulates the growth of breast cells, whether they are normal or abnormal. Men can experience elevated estrogen levels due to various reasons, including the use of hormonal medications, being overweight (which leads to increased estrogen production), exposure to environmental estrogens (like those found in certain foods or chemicals), and heavy alcohol consumption, which can impede the liver's ability to regulate estrogen levels. Additionally, men with liver disease may exhibit lower levels of androgens (male hormones) and higher levels of estrogen, which can increase the risk of non-cancerous breast tissue growth (gynecomastia) and breast cancer.

Family history also plays a significant role in breast cancer risk for men. A strong family history of breast cancer, particularly if other male family members have had the disease, can elevate the risk. Additionally, the presence of proven breast cancer gene mutations in the family, such as abnormal BRCA1 or BRCA2 genes, increases the likelihood of male breast cancer. Notably, there's a notable association between male breast cancer and abnormal BRCA2 genes, often accompanied by a history of both male breast cancer and prostate cancer within the family.

Lastly, exposure to radiation, particularly chest radiation therapy for conditions like lymphoma, bone tumors, hypertrophic scars, or keloids, can raise the risk of developing breast cancer in men.

Following are the signs which if present help should be immediately sorted:

A lump felt in the breast, Nipple pain, An inverted nipple, Nipple discharge (clear or bloody), Enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Breast enlargement can be idiopathic or due to certain medications, heavy alcohol use, or weight gain. Gynecomastia itself does not cause cancer, the high estrogen state which causes cancer also causes gynecomastia.

A small study about male breast cancer found that the average time between first symptom and diagnosis is over a year and a half. This long time between the symptom and diagnosis is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. if more public awareness is created men will learn that just like women, they need to go to their doctor right away if they detect any persistent changes to their breasts.

Diagnosis is made by evaluation of the signs and symptoms by

MammogramUltrasound of BreastCytology of Nipple discharge if presentBiopsy(core needle) of the Breast LumpImaging by PET CT/ MRI/ CT scan/ Bone scan. etc for evaluating distant spread.
Treatment

Male Breast cancer is generally a hormone-positive disease. If detected early, it can be treated by surgery followed by hormonal therapy. Chemotherapy and radiation are needed if the disease presents in an advanced stage.

In Males, the loss of breast and body disfigurement is not as impactful as in a female. Although, the loss of a nipple does have a psychological impact on males. Therefore, the need for early detection is as important in Male breast Cancer:

To improve survival, De-escalation of treatment, Minimising body disfigurement

Male breast cancer is a rare but significant health concern that should not be ignored. Awareness of risk factors and the importance of early detection can save lives and improve the outcomes for men facing this disease. It's essential to empower men to be proactive about their breast health and seek medical attention if they notice any warning signs.

(Dr Mandeep Singh Malhotra is a Director of Surgical Oncology at CK Birla Hospital, Delhi)