While rare, men do develop breast cancer. Nipple blood discharge is the first symptom that they become aware of. Though breast cancer is most commonly thought of as a disease that affects women, breast cancer does occur in men. More commonly found in older men, although it can occur at any age.

Men diagnosed with male breast cancer at an early stage have a good chance for a cure. Most all cancers found early and before it spreads the best outcome. Treatment typically involves surgery to remove the breast tissue. Other treatments, such as chemotherapy and radiation therapy, may be recommended based on your particular situation.

Male breast cancer comprises one percent of all breast cancer cases, yet no prospective randomized clinical trials specifically focused on MBC have been successfully completed. There is an increasing studies that the tumor biology of MBC differs from that of female breast cancer.

Doctors know that male breast cancer occurs when some breast cells divide more rapidly than healthy cells do. The accumulating cells form a tumor that may spread (metastasize) to nearby tissue, to the lymph nodes or to other parts of the body.

Everyone is born with a small amount of breast tissue. Breast tissue consists of milk-producing glands (lobules), ducts that carry milk to the nipples and fat.

During puberty, women begin developing more breast tissue, and men do not. But because men are born with a smaller amount of breast tissue, they can still develop breast cancer.

Gynecomastia

Gynecomastia is the most common male breast disorder. It is not a tumor but rather an increase in the amount of a man’s breast tissue. Usually, men have too little breast tissue to be felt or noticed. Gynecomastia can appear as a button-like or disk-like growth under the nipple and areola (the dark circle around the nipple), which can be felt and sometimes seen. Some men have more severe gynecomastia and they appear to have small breasts. Although gynecomastia is much more common than breast cancer in men, both can be felt as a growth under the nipple, which is why it’s important to have any such lumps checked by your doctor.

Gynecomastia is common among teenage boys because the balance of hormones in the body changes during adolescence. It is also common in older men due to changes in their hormone balance.

In rare cases, gynecomastia occurs because tumors or diseases of certain endocrine (hormone-producing) glands cause a man’s body to make more estrogen (the main female hormone). Men’s glands normally make some estrogen, but not enough to cause breast growth. Diseases of the liver, which is an important organ in male and female hormone metabolism, can change a man’s hormone balance and lead to gynecomastia. Obesity (being extremely overweight) can also cause higher levels of estrogen in men.

Some medicines can cause gynecomastia. These include some drugs used to treat ulcers and heartburn, high blood pressure, heart failure, and psychiatric conditions. Men with gynecomastia should ask their doctors if any medicines they are taking might be causing this condition.

Klinefelter syndrome, a rare genetic condition, can lead to gynecomastia as well as increase a man’s risk of developing breast cancer. This condition is discussed further in Risk Factors for Breast Cancer in Men (/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html).

To examine how MBC has been treated in the United States in recent years, and to identify factors associated with patient prognosis, a team led by Kathryn Ruddy, MD, MPH, and Siddhartha Yadav, MBBS at Mayo Clinic in Rochester, New York analyzed information from the National Cancer Database on men diagnosed with stage I-III breast cancer between 2004 and 2014.

A total of 10,873 patients with MBC were included, with a median age at diagnosis of 64 years. Breast-conserving surgery was performed in 24 percent of patients, and 70 percent of patients undergoing breast conservation received radiation. Forty-four percent of patients received chemotherapy, and 62 percent of patients whose tumors expressed the estrogen receptor received anti-estrogen therapy. During the study period, there was a significant increase in the rates of total mastectomy, contralateral prophylactic mastectomy, and post-breast conservation radiation, as well as an increase in the rate of genomic testing on tumors and the use of anti-estrogen therapy. Tamoxifen is the standard anti-estrogen medication recommended for treatment of hormonally sensitive MBC, but this study was not able to assess specific medications used.

Factors associated with worse overall survival were older age, black race, multiple comorbidities, high tumor grade and stage, and undergoing total mastectomy. Residing in higher income areas; having tumors that express the progesterone receptor; and receiving chemotherapy, radiation, and anti-estrogen therapy were associated with better overall survival.

Further information can be found under the journal reference: Adam J.N. Raymakers, Dean A. Regier, Stuart J. Peacock. “Health-related quality of life in oncology drug reimbursement submissions in Canada: A review of submissions to the pan-Canadian Oncology Drug Review.” Cancer, 2019.

WHERE BREAST CANCER STARTS

Breast cancers can start from different parts of the breast. Most breast cancers begin in the ducts that carry milk to the nipple (ductal cancers). Some start in the glands that make breast milk (lobular cancers). Men have these ducts and glands too, even though they aren’t normally functional. there are also types of breast cancer that start in other types of breast cells, but these are less common.

A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and are not really thought of as breast cancers.

Although many types of breast cancer can cause a lump in the breast, not all do. There are other symptoms of breast cancer you should watch for (/cancer/breast-cancer-in-men/detection-diagnosis-staging/signs-symptoms.html) and report to a health care provider.

Breast cancer can spread when the cancer cells get into the blood or lymph system and are carried to other parts of the body.

As for men, cancer also begins in the milk ducts (ductal carcinoma). Nearly all male breast cancer is ductal carcinoma.

Cancer that begins in the milk-producing glands (lobar carcinoma), is rare in men because they have few lobules in their breast tissue.

Other, rarer types of breast cancer that can occur in men include Paget’s disease of the nipple and inflammatory breast cancer.

Paget Disease of the Nipple

This type of breast cancer starts in the breast ducts and spreads to the nipple. It may also spread to the areola (the dark circle around the nipple). The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning and bleeding. There may also be an underlying lump in the breast. (http://www.cancer.org/cancer/breast-cancer-in-men/what-is-breast-breast-cancer-in-men.html.

Inflammatory Breast Cancer

Inflammatory breast cancer is an aggressive and fast growing breast cancer in which cancer cells infiltrate the skin and lymph vessels of the breast. It often produces no distinct tumor or lump that can be felt and isolated within the breast. But when the lymph vessels become blocked by the breast cancer cells, symptoms begin to appear.

Early IBC symptoms may include persistent itching and the appearance of a rash or small irritation similar to an insect bite. The breast typically becomes red, swollen, and warm. The skin may appear pitted like an orange peel, and nipple changes such as inversion, flattening or dimpling may occur.

A diagnosis of inflammatory breast cancer is classified as Stage 3 breast cancer and is diagnose through you physician’s clinical judgement and a biopsy. Typically, IBC grows rapidly and requires aggressive treatment. Most oncologists recommend both local treatment of the affected breast and systemic treatment (whole body treatment), which may include chemotherapy.

Surgery, radiation therapy, chemotherapy and hormone treatments may be included in the regimen. With aggressive treatment, the survival rate for inflammatory breast cancer patients has improved significantly in recent years.

Any changes to the body and breasts should be checked by your physician. Don’t let it go! Don’t ignore it.