What is Male Breast Cancer?

While breast cancer is most commonly thought of as a woman’s disease, it also affects about 1 percent of men.

Breast cancer occurs when cells begin growing abnormally in breast tissue and form a tumor. These cells may spread through the breast to the lymph nodes under the arm and elsewhere in the body. Breast cancer is usually detected in males by noticing a lump underneath the nipple and areola. Early detection is critical, as men usually don’t assume a lump would be breast cancer and often wait too long before consulting with their doctor. The majority of men diagnosed are over the age of 50.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of breast cancer in men and women. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health. 

Signs and Symptoms

Noticing signs and symptoms early on is the key to effective treatments and a good prognosis. Often times, men don’t notice the signs because they wouldn’t assume a lump on the breast to be breast cancer. The lump would typically be found underneath the nipple and areola. The symptoms of breast cancer are the same between men and women. If you notice any symptoms of breast cancer, please contact your primary care physician.

Symptoms of male breast cancer may include:

• A painless lump felt in the breast
• Skin changes on the breast including dimpling or redness
• Pain or discharge from the nipple
• An inverted nipple
• Sores on or around the nipple
• Enlarged lymph nodes under the arm 

Types of Male Breast Cancer

There are several types of male breast cancer. The most common types are ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma. Most breast cancers are carcinoma (called adenocarcinoma), which start in the cells that create glandular tissue. The adenocarcinomas develop in the ducts or the lobules of the breasts. Other less common breast cancers are sarcomas, phyllodes, Paget’s disease and angiosarcomas, which develop in the muscle, fat, or connective tissue. In situ cancer is cancer that has not spread. Invasive or infiltrating cancers have spread into the surrounding breast tissue.

Ductal carcinoma in situ (DCIS). This type of cancer accounts for 1 out of 10 cases in males, and it is highly curable with surgery. This is known as a pre-invasive cancer type, as the cells that line the ducts have changed to cancer cells but have not invaded or spread into surrounding tissue outside of the breast. Some cases of DCIS do go on to become invasive cancers, and there is currently no way of predicting which cases will develop into invasive cancers.

Lobular carcinoma in situ (LCIS). Also known as lobular neoplasia, these cells look like cancer cells and grow in the milk-producing glands, but they have not yet spread through the walls of the lobules. This particular type is not considered a pre-invasive cancer because it does not ever turn into invasive cancer. However, it does lead to increased risk for developing invasive cancer in either breast. This type of cancer is rarely, if ever, diagnosed in men.

Infiltrating (invasive) ductal carcinoma (IDC). This is the most common type of breast cancer that starts in the ducts and spreads through the walls and begins growing in the fatty tissue of the breast. This type of cancer can spread to other parts of the body through the lymphatic system and bloodstream. At least 8 out of 10 breast cancers diagnosed in males are IDC’s.

Infiltrating (or invasive) lobular carcinoma (ILC). This type begins in the lobules and it can spread to other parts of the breast and other parts of the body. It is very rare in males and accounts for only 2% of all diagnosed cases.

Paget disease of the nipple. This type starts in the breast duct and spreads to the nipple, and sometimes to the areola. The skin of the nipple typically looks red, scaly, crusty, with areas that ooze, bleed, itch, or burn. It’s possible to also have an underlying lump in the breast.

Inflammatory breast cancer. This is an aggressive, but rare type of breast cancer. It causes the breast to be red, swollen, warm, and tender (rather than developing a lump) and can often be mistaken for an infection.

Special types of invasive breast carcinoma. These types of breast cancer are rare and prognosis can be better or worse than typical invasive ductal carcinoma. They are treated like the standard invasive carcinoma types. 

• Adenoid cystic (or adenocystic) carcinoma
• Low-grade adenosquamous carcinoma (this is a type of metaplastic carcinoma)
• Medullary carcinoma
• Mucinous (or colloid) carcinoma
• Papillary carcinoma
• Tubular carcinoma
• Metaplastic carcinoma (including spindle cell and squamous, except low grade adenosquamous carcinoma)
• Micropapillary carcinoma
• Mixed carcinoma (has features of both invasive ductal and lobular)

Diagnosis

Most men are not aware that changes in breast tissue may be breast cancer and require evaluation. Early diagnosis is critical to the most positive outcomes. To determine if someone has breast cancer, we perform a physical examination and ask questions about symptoms. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Biopsy: A biopsy examines a small bit of breast tissue for cancer cells. Breast tissue can be removed for examination by a thin needle, or through surgery when removing an entire suspicious lump.

Examination of nipple discharge: A sample of discharge may be taken to examine under a microscope for cancer cells.

Mammogram: A mammogram is an X-ray exam of the breast.

Ultrasound: An ultrasound uses sound waves to make images of the breast that provide details about a suspicious lump. 

Causes

The vast majority of male breast cancer patients have no identifiable cause.

Risk Factors

Risk factors that can contribute to breast cancer include:

Age: The average age of men diagnosed with breast cancer is 68. 

Family history: Family history can increase the risk of breast cancer in men. 

Genetic conditions: Men with Klinefelter syndrome have higher levels of estrogen, which makes them susceptible to breast cancer. A family history of the hereditary breast cancer gene BRCA2 is also a risk factor for breast cancer.Inherited mutations in breast cancer genes BRCA1 and BRCA2 increase the risk of breast cancer.

Having liver disease: Breast cancer can occur in men with a history of liver disease. 

Radiation exposure: Having radiation to the chest before age 30 may increase the risk of male breast cancer.

Conditions affecting the testicles. Having any kind of swelling in the testicles, an injury to the testicles, or surgical removal of the testicles can increase the risk of breast cancer. 

Obesity. Being overweight or obese, especially over the age of 50, can increase the risk of developing breast cancer.

Prevention      

Risk factors for male breast cancer cannot be controlled.

Prognosis

Prognosis depends upon how early the cancer is diagnosed, the size and location of the tumor, and if the cancer has spread. Men diagnosed in the early stages of breast cancer have a good chance for a cure. 

Treatment and Recovery

Male breast cancer treatment depends upon the size and location of the breast tumor and how far the cancer has progressed. The goal is to eliminate the cancer.

Chemotherapy

After surgery, or if cancer has spread elsewhere in the body or is likely to grow quickly, special drugs designed to kill cancer cells can be given as a pill or injected into the bloodstream. The amount and duration of the chemotherapy depends upon the extent of the disease and the combination of the chemotherapy drugs. 

Radiation therapy

After surgery, or if cancer has spread elsewhere in the body, radiation therapy may be prescribed. This therapy uses high-energy radiation to kill cancer cells. Similar to getting an X-ray, the radiation is directed specifically to the area of the breast where cancer was removed. Most often, radiation treatments are given five days a week for several weeks. 

Surgery

The most common breast cancer surgery in men is called a modified radical mastectomy. During the surgery, the nipple, the area around the nipple and the surrounding breast tissue and lymph nodes under the arm are removed. Some patients with smaller breast cancers may be candidates for more conservative surgery. 

Hormone therapy

Hormone therapy, given as a pill, slows or stops the growth of hormone-sensitive tumors. This therapy is given for about five years and more recently 10 years after surgery to remove a hormone-sensitive tumor. 

Targeted therapy

Targeted therapy is the use of drugs or other substances to precisely target breast cancer cells. This treatment is given orally or intravenously with and without chemotherapy to stop cancer growth. Additional treatments target known genes that signal the breast cancer cells to grow and divide. 

Follow-up care

Follow-up care after treatment for male breast cancer is important. Follow-up care will help control side effects associated with treatment or cancer.

Complications

Breast cancer sometimes recurs, so follow-up care for years after successful treatment is important. Certain complications of male breast cancer may occur, including:

Lymphedema: If the lymph nodes are removed during surgery, complications may occur with fluid retention. The lymph nodes carry the lymph fluid, which helps to fight infection. When the lymph nodes are removed, the normal flow of lymph can be affected, leading to a build-up of fluid in the arm, hand, chest, trunk or back.

Related Conditions

Men with breast cancer are at risk for development of a second breast cancer, making regular follow-up care important.