Understanding Male Breast Cancer and
How To Manage It

Your guide to understanding all aspects of male breast cancer

“I have cancer. Cancer doesn’t have me.”
Marco Calderon

Early detection and diagnosis always increase your chances of receiving successful treatment and beating all forms of cancer – especially male breast cancer. Detecting male breast cancer early will significantly boost your odds of survival. Hence, it is important to adhere to the recommended screening protocol for your age group so that you and your physician can detect and test any anomalies or changes. 

You can read the section that details the various types of cancer before embarking on the journey to understand male breast cancer better. Read more

Let’s understand
the anatomy first

The breast is the tissue covering the chest or pectoral muscles. The glandular tissue is made up of 15 to 20 sections called lobes, and each lobe has smaller structures called lobules. This entire network of lobes and lobulesis linked by thin tubes called ducts. The breast also contains a network of blood vessels, lymph vessels, and lymph nodes. This network drains lymph fluid and transports white blood cells. Groups of lymph nodes are found near the breast, under the arm, in the chest, and above the collar bone.

What is male breast cancer?

Often associated with women, breast cancer in men is a rare form of cancer affecting breast tissues in a man’s body. Found largely in older men, male breast cancer occurs when the cells in the male breast begin to defy their life cycle and grow abnormally and uncontrollably to form a malignant tumour. Cancer may sometimes spread or metastasize through the breast cells and tissue to the lymph nodes and to other parts of the body. As with all other forms of cancer, an early diagnosis is associated with better treatment outcomes and a greater chance of complete recovery.

Types of Male Breast Cancer

All humans are born with a small amount of breast tissue, that consists of milk-producing glands (lobules), ducts that carry milk to the nipples, and fat. Women, with the onset of puberty begin to develop breast tissue, whereas men don’t. However, since men possess breast tissue, they can still develop breast cancer. Types of breast cancer occurring in men include

Ductal carcinoma

The most common form of male breast cancer, it begins in the ducts in breast tissue.

Inflammatory breast cancer

This is a type of cancer affecting the skin of the breast. In this type of breast cancer, the breast typically looks red and swollen and may feel warm.

Other types of cancer

These include rare types of breast cancers that can occur in men, e.g. Paget disease of the nipple.

What causes male breast cancer?

Clinical practitioners and researchers do not know the exact causes of male breast cancer. There are certain risk factors (detailed below) that can increase your chance of developing it; however, having one or more risk factors does not mean that you will definitely get breast cancer. On the other hand, having no risk factors also does not mean you will not get the disease. Male breast cancer is likely to be caused by a combination of these factors, rather than just one.

What are the Risk Factors?

There are some factors that can put men at higher risk of developing breast cancer. Hence mandatory screening may be recommended by your physician. Being associated with a risk factor does not necessarily mean that you will develop breast cancer

Age: Older men are more prone to breast cancer. Male breast cancer is most often diagnosed in men in their 60s.
Exposure to oestrogen: Oestrogen-related drugs, such as those used for hormone therapy for prostate cancer, increase the risk of breast cancer
Genetic disposition: Cases of breast cancer in close relatives also puts one at a higher risk of breast cancer
Obesity: Obesity is associated with higher levels of oestrogen in the body, thereby increasing the risk of breast cancer in men

Other medical conditions:

  • Klinefelter’s syndrome:  A genetic syndrome in which boys are born with more than one copy of the X chromosome. It causes abnormal development of the testicles. As a result, men with this syndrome produce lower levels of certain male hormones (androgens) and more female hormones (oestrogen); leading to a higher risk of breast cancer
  • Liver disease: Certain conditions (such as liver cirrhosis) can affect hormones, reducing male hormones and increasing female hormones, thus increasing the risk of breast cancer.
  • Testicular disease or surgery: A history of inflamed testicles (orchitis) or surgery to remove a testicle (orchiectomy) can also increase the risk of male breast cancer.
What Can be Done to
Lower Your Risk of Getting
Male Breast Cancer?

Making some key lifestyle changes are known to help reduce your risk of breast cancer. 

Evidence suggests that taking appropriate steps to avoid risk factors like obesity may reduce the risk of breast cancer. Studies suggest that avoiding hormone therapy (especially therapies with high levels of oestrogen) may also reduce the risk of breast cancer in men.

What are the Symptoms?

Major symptoms for male breast cancer include:

A lump or swelling, which is often (but not always) painless

Nipple retraction, ulceration, and discharge

Skin puckering or dimpling on the breast

Redness or scaling of the nipple or breast skin

Discharge from the nipple

Other symptoms for a more advanced and spread stage of cancer may include:

Swelling in the lymph glands, in or near the underarm area

Breast pain

Bone pain

Screening and Diagnosis

Men are typically not screened regularly for breast cancer, due to the small amount of breast tissue in the body. Regular breast cancer screenings are only recommended for men with higher than average risk due to an inherited gene mutation or a family history of breast cancer.

» Self-examinations: Self-examinations can be performed by regularly checking the chest area for visual symptoms, along with a simple test of feeling for lumps/ growths

» Annual physical exams: Annual physical exams can be conducted by the physician who will feel for lumps in the breast tissue and under the arm

Screening tests for male breast cancer

Screening tests may be done when you have no cancer symptoms at all. 

The main objective of breast cancer screening is to detect precancerous changes in at the cellular level, which if untreated can lead to cancer. The secondary objective is to find the cancer at an early stage, when treatment is usually more successful. 

It is important to remember that your physician does not necessarily think you have cancer if he or she suggests a screening test. They could just be following a normal screening protocol for your age group.

The Mammogram

What to expect

A mammogram or x-ray of the breast is the most common screening test used to detect breast cancer. This test is adept at finding tumours which cannot be detected by physical breast examinations alone. If your doctor detects an abnormality during screening, he or she may suggest a diagnostic mammogram to evaluate the abnormality further. Many factors influence the successful outcome of a mammogram in detecting cancer – such as age and weight of the patient, size and location of tumour and breast tissue density – to name a few. 

Everyone experiences mammograms differently. Some people feel pain during the procedure, while others feel nothing at all. It is normal to feel some discomfort and pressure against your breasts from the testing equipment. It is important that you choose a doctor and clinical team that you are comfortable with to perform your mammogram.

During a mammogram:

  • You will first be asked to undress the upper part of your body (down to your waist).
  • The radiographer will then position you so your chest area is on the x-ray machine.
  • Next, your breast will be firmly pressed with a plate. This will help keep the area still so that a clear image can be taken. You might find this uncomfortable or even painful, but this will last only as long as the mammogram takes.
  • In most cases, you will have two x-rays of each breast taken, from different angles.

Breast Ultrasound

What to expect

A breast ultrasound is a painless procedure that utilizes sound waves to make images of the internal body organs. Ultrasounds are often used in addition to a mammogram, to detect if a breast lump is a fluid-filled sac (cyst) or a solid mass which might be cancerous. They also pinpoint the position of a tumour and this guides the physician to the exact spot to insert a needle during biopsy.

During a breast ultrasound:

  • You will first be asked to undress the upper part of your body (down to your waist) and lie on your back on a bed or examination table.
  • The specialist will instruct you to place your arm over your head.
  • Next, the specialist will cover a small instrument with a special gel, and move it around your chest and the surrounding area.
  • The ultrasound should take about 10-15 minutes. If you experience any pain, be sure to inform your doctor.

Biopsy

What to expect

involves the removal of a sample of breast cells or tissues for laboratory testing and is the only definitive method to diagnose breast cancer. It is a way to evaluate a suspicious area or lump in your breast to determine whether it is cancerous. 

In order to perform the biopsy, your doctor will ask you to remove the clothes from the top half of your body or undress completely. It is important that you choose a doctor and clinical team that you are comfortable with to perform your procedure. 

Using a fine needle, your doctor will remove a small sample of tissue either from your breast tissue or from the lymph node area (armpit), or both. Before your doctor starts the procedure, he or she will typically inject a local anaesthetic into the area to numb it. You may feel a little pain or a sensation of pressure for a short time during the biopsy. 

For a few days after the biopsy, your chest area may feel sore and bruised. Don’t hesitate to talk to your clinical team about pain medication if you feel you might need it. The pain and bruising will generally subside in a couple of weeks. If it persists, please contact your doctor immediately.

Staging Male Breast Cancer

If your doctor confirms that you have breast cancer, further tests may be done to study the cancer cells and determine: 

  • If the disease has spread beyond the breast (i.e. determine the stage of cancer).
  • How quickly the cancer will grow.
  • How likely it is to spread through the body.
  • What sort of treatments might work.
  • The likelihood of the cancer to recur (come back). 

This process is called staging. It helps determine how much the cancer has progressed and determine the most suitable treatment plan.

Stage 0
cancer generally means that the cancer is limited to the inside of the duct and is non-invasive. Stage 0 breast tumours include ductal carcinoma in situ (DCIS) and are usually treated by surgery and radiation therapy.
Stage I
It is still early in cancer progression as these cancers are still relatively small and either have not spread to the lymph nodes (N0) or there is a tiny area of cancer spread in the sentinel lymph node (N1mi).
Stage II
These cancers tend to be larger than stage I cancers and/or have spread to a few nearby lymph nodes. Systemic therapy is often recommended for men with stage II breast cancer to shrink the tumour before surgery, prior to radiotherapy.
Stage III
This stage includes more advanced tumours (large or growing into nearby skin or muscle) and cancers that have spread to many nearby lymph nodes.
Stage IV
cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. Breast cancer most commonly spreads to the bones, liver, and lungs. As the cancer progresses, it may spread to the brain, but it can affect any organ and tissue.

Once equipped with more information from these tests, the doctor can share a proper diagnosis and suggest treatment based on the cancer staging.

Treatments for male breast cancer

Treatment for breast cancer depends upon the type of cancer and how far it has spread. There are several different treatment options available for treatment, including

Surgery
Surgery for men with breast cancer is usually a modified radical mastectomy (removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles).

Radiation therapy
Radiation therapy is advised by the doctor to target and kill the cancer cells. There are two kinds of radiation therapy:

External radiation therapy: Administered using a machine to direct radiation at the cancer from outside of the body.

Internal radiation therapy: Administered by inserting a seed, wire, needle or catheter, near the site of the cancer, placing a radioactive substance inside the tissue. Adjuvant radiation therapy is used to keep any rogue cancer cells in check.

Hormone therapy 
Hormone therapy removes hormones or blocks their action and stops cancer cells from growing. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.

Targeted therapy:
uses drugs that attack specific abnormalities within cancer cells or that direct your immune system to kill cancer cells.

Chemotherapy 
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For treating breast cancer in men, doctors often use chemotherapy in combination with radiotherapy, which is also known as chemoradiotherapy.

Oral or intravenous administration of these drugs affect cancer cells throughout the body. Regional chemotherapy, meanwhile, involves applying chemotherapy drugs to a particular part of the body and only treats that area.

It is advisable to consult the doctor for possible side-effects of chemotherapy.

Managing your emotions
After a cancer diagnosis, you may experience a whole host of emotions. Refer to this section to understand how to cope with your emotions through your cancer journey. Read more
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