While breast cancer is often associated with women, men can also develop this disease, though it is much less common. Male breast cancer occurs in the small amount of breast tissue present behind the nipples in men.
Symptoms
The most common symptom of male breast cancer is a hard, painless lump in one of the breasts. Other symptoms can include:
- Nipple retraction (where the nipple turns inward)
- Nipple discharge, which may be clear or bloody
- Swelling of the breast area
- Changes to the skin covering the breast, such as redness or dimpling
- Pain or tenderness in the breast area
Benign Condition: Gynaecomastia
Most breast lumps in men are caused by gynaecomastia, a non-cancerous condition where male breast tissue becomes enlarged. While it is much more common and generally not dangerous, any breast changes should be evaluated by a healthcare professional.
When to Speak to Your GP
It’s important to speak to your GP if you notice any changes in your breast tissue, such as lumps, swelling, or nipple changes. While these symptoms are more likely to be caused by conditions other than cancer, they still require further investigation to rule out any serious issues.
Causes and Risk Factors
The exact cause of male breast cancer remains unclear, but several factors are believed to increase a man’s risk, including:
- Age: Most cases occur in men over 60.
- Family History: Men with a family history of breast cancer (in either male or female relatives) are at greater risk.
- Obesity: Being overweight or obese (with a body mass index of 30 or higher) can increase the risk, as excess fat tissue can raise levels of estrogen, which may contribute to breast cancer development.
Treating Breast Cancer in Men
Treatment for male breast cancer often involves:
- Surgery: The main treatment is usually the removal of the cancerous tissue, often along with a portion of the breast.
- Hormone-Blocking Therapy: Medication such as tamoxifen is frequently used to block the effects of hormones that stimulate cancer cell growth in breast tissue.
- Radiotherapy and Chemotherapy: These treatments may be used after surgery to prevent cancer recurrence or manage advanced disease.
Outlook
The prognosis for male breast cancer tends to be worse compared to female breast cancer, primarily due to lower awareness and later diagnosis. Early detection greatly improves the likelihood of successful treatment. The survival rate depends on how far the cancer has spread at the time of diagnosis. When detected early, male breast cancer can often be effectively treated.
Reducing Risk
To reduce the risk of breast cancer, and improve overall health, men should:
- Drink Alcohol in Moderation: Excessive alcohol consumption is linked to various health problems, including cancer.
- Maintain a Healthy Weight: A balanced diet and regular physical activity can help keep weight in a healthy range and lower cancer risk.
Awareness of male breast cancer and early medical consultation for any unusual symptoms can lead to more timely diagnosis and better outcomes.
Symptoms of breast cancer in men
Breast cancer in men often presents differently than in women due to the smaller amount of breast tissue. The most common and often earliest symptom is a hard lump in one of the breasts, typically painless. Here is a detailed list of symptoms:
Common Symptoms
- Painless Lump: Usually found under the nipple and areola (the dark skin surrounding the nipple).
- Nipple Retraction: The nipple may begin to pull inward.
- Nipple Ulceration: The nipple may become hard, inflamed, or sore, with possible ulceration.
- Nipple Discharge: Fluid may leak from the nipple, which can occasionally be bloody.
Benign Condition: Gynaecomastia
Most lumps found in male breast tissue are caused by gynaecomastia, a common and non-cancerous enlargement of male breast tissue.
Advanced Symptoms
If breast cancer spreads beyond the breast tissue (known as metastatic breast cancer), additional symptoms may develop, including:
- Bone Pain: Pain in the bones may indicate cancer has spread to these areas.
- Swelling of Lymph Nodes: Typically in or around the armpit.
- Shortness of Breath: If cancer has spread to the lungs.
- Fatigue: Feeling unusually tired all the time.
- Nausea: General discomfort or sickness.
- Jaundice: Itchy skin with yellowing of the skin and whites of the eyes, indicating liver involvement.
When to Seek Medical Advice
You should see a GP if you notice:
- A lump in your breast
- Problems with your nipples, such as retraction, soreness, ulceration, or discharge
While these symptoms are often caused by non-cancerous conditions, they should still be evaluated to rule out the possibility of breast cancer or other underlying conditions. Early detection is key to effective treatment.
Causes of Breast Cancer in Men
While the exact cause of breast cancer in men remains unclear, several risk factors are known to increase the likelihood of developing this condition:
1. Age
- Increased Risk with Age: Similar to women, the risk of developing breast cancer in men rises with age. The majority of cases occur in men aged 60 to 70 years. Breast cancer is rare in younger men.
2. Genetics and Family History
- Genetic Mutations: Certain genetic mutations, especially in the BRCA2 gene, are linked to an increased risk of breast cancer. BRCA1 mutations can also contribute but to a lesser extent.
- Family History: A higher risk exists for men with a first-degree relative (mother, sister, or brother) who has had breast cancer.
- Genetic Testing: While routine testing for genetic mutations isn’t common in the NHS, it may be recommended for high-risk cases and is available privately.
3. Oestrogen Levels
- Higher Oestrogen Levels: Elevated or prolonged exposure to oestrogen can increase the risk of breast cancer in men. Factors contributing to higher oestrogen levels include:
- Hormone Treatments: Synthetic oestrogens used to treat prostate cancer or taken by transgender women can raise levels.
- Obesity: Excess fat tissue can increase oestrogen production.
- Cirrhosis of the Liver: Long-term alcohol misuse or other liver damage can result in hormonal imbalances, including higher oestrogen levels.
- Klinefelter Syndrome: A rare genetic condition in which males are born with an extra X chromosome, leading to lower testosterone and a relative increase in oestrogen levels.
4. Occupational Risks
- Hot Work Environments: Men working in high-temperature settings, such as blast furnaces, steelworks, rolling mills, and car manufacturing plants, may have a higher risk due to potential damage to testicles or exposure to chemicals that alter hormone levels.
- Chemical Exposure: Elevated risks have been observed among men in perfume and soap manufacturing, possibly due to exposure to certain chemicals, although this connection has not been definitively proven.
5. Radiation Exposure
- Radiation Therapy: Men who have undergone radiotherapy targeted at the upper chest are at increased risk of developing breast cancer. Though the risk is seven times higher, the overall likelihood remains low.
Conclusion
Breast cancer in men is relatively rare, but awareness of risk factors is important for early detection and management. If you experience any symptoms, such as a lump in the breast or changes to the nipple, seek medical attention promptly.
Diagnosing Breast Cancer in Men
GP Examination
If you exhibit symptoms of male breast cancer, such as a hard, painless lump, your GP will conduct a physical examination and assess any other signs, such as swollen lymph nodes. If your GP suspects breast cancer, you will be referred for further diagnostic tests.
Mammogram
- What it is: A type of X-ray that creates detailed images of breast tissue.
- Procedure: Your breast is compressed between two plates while an X-ray is taken. This is repeated for both breasts. The procedure may be slightly uncomfortable but shouldn’t be painful.
- Purpose: Helps detect any changes or abnormalities in the breast tissue.
Ultrasound
- What it is: Uses high-frequency sound waves to produce an image of the inside of the breasts.
- Procedure: A handheld probe (transducer) is moved across your chest to create an image on a screen.
- Purpose: Identifies lumps or abnormalities in the breast tissue.
Biopsy
- Purpose: A definitive test to confirm or rule out cancer by analyzing a tissue sample in a laboratory.
- Core Biopsy: The most common biopsy used for diagnosing male breast cancer. After a local anaesthetic is administered to numb the area, a hollow needle is used to extract small samples from the breast lump. This test also helps determine if the cancer has started to spread and checks for oestrogen receptors on cancerous cells, which can affect treatment options (such as using hormone therapy).
Staging the Cancer
- Definition: Staging describes how far the cancer has spread at the time of diagnosis.
- Importance: Early-stage diagnosis may offer a possibility for a cure. Later-stage diagnosis may focus on managing symptoms and slowing cancer progression.
- Ductal Carcinoma In Situ (DCIS): A type of cancer where cells are contained within the breast ducts and cannot spread. Untreated DCIS may progress to invasive breast cancer.
Coping with a Diagnosis
Receiving a breast cancer diagnosis can evoke various emotions, including shock, fear, and embarrassment, particularly since breast cancer is commonly perceived as a female-only condition. Feelings of isolation or depression are common among men with breast cancer due to the relatively limited support available compared to women.
- Depression Management: If you experience prolonged feelings of sadness or disinterest, consult your GP for treatment options, including counseling or medication.
- Support Networks: Connecting with other men facing breast cancer can be helpful. Charities like Breast Cancer Now and Cancer Research UK offer online forums and support networks for affected individuals.
Screening
Routine screening for breast cancer is not recommended for men, even those considered at high risk, due to the rarity of the condition.
Treating Breast Cancer in Men
Overview of Treatment Approach
- Treatment largely depends on the stage and spread of the cancer.
- Most hospitals use a multidisciplinary team (MDT) approach, with specialists collaboratively deciding the most effective treatment plan.
- Treatment options include surgery, radiotherapy, hormone therapy, chemotherapy, and biological therapy.
Treatment Plan
- Localized Cancer: If the cancer is confined to the breast, treatment often involves surgery to remove the breast (mastectomy), potentially followed by radiotherapy, hormone therapy, or chemotherapy to prevent recurrence.
- Advanced Cancer: If the cancer has spread, treatment focuses on relieving symptoms and slowing its progression using hormone therapy, chemotherapy, or palliative radiotherapy.
Surgery
- Mastectomy is the most common surgery, involving removal of the entire breast and often the lymph nodes (sentinel lymph node biopsy).
- Post-surgery recovery may involve several days in the hospital. Most men can resume light activities after a few weeks, but strenuous activities should be avoided initially.
Post-Surgery Recovery
- Care Instructions: Keep the wound clean; monitor for signs of infection, such as redness or discharge.
- Returning to Work: Timing depends on personal recovery and any further treatments.
- Exercise Program: Gradual physical activity is recommended.
Potential Complications
- Numbness/Tingling: Caused by nerve damage; typically temporary.
- Lymphoedema: Swelling due to lymphatic system disruption; managed through massage and compression garments.
Radiotherapy
- Used to eliminate residual cancer cells post-surgery or to slow cancer spread.
- Typical treatment spans 3-6 weeks, with side effects like fatigue, nausea, and skin irritation.
Hormone Therapy
- Tamoxifen is widely used for ER+ cancers to block oestrogen effects.
- Side Effects: Reduced libido, erectile dysfunction, mood changes, nausea.
- Aromatase Inhibitors may be used if tamoxifen is unsuitable, lowering oestrogen by blocking aromatase activity.
- Side Effects: Joint pain, hot flushes, fatigue.
Chemotherapy
- Recommended when hormone therapy is ineffective.
- Administered as tablets or injections, typically over 6 months.
- Side Effects: Include nausea, hair loss, infection susceptibility.
Biological Therapy
- Targets the HER2 protein in certain breast cancers using trastuzumab (Herceptin).
- Administration: Via drip in hospital.
- Side Effects: Potential heart issues, allergic reactions, fatigue.
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