Can Men Get Breast Cancer?

Men can get breast cancer, too. Unfortunately, all too often men with breast cancer fail to have a malignant breast lump diagnosed until the disease has spread.

When you think about breast cancer, the image of a woman likely comes to mind. Breast cancer is a serious concern for women. About one in eight will be diagnosed with breast cancer in their lifetime, according to the National Cancer Institute.

But that doesn’t mean that only women get breast cancer.

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Can men get breast cancer?

Men can get breast cancer, too. Unfortunately, all too often men with breast cancer fail to have a malignant breast lump diagnosed until the disease has spread.

The American Cancer Society notes nearly 300,000 American women are diagnosed with new cases of invasive breast cancer annually compared more than 2,700 new cases of invasive breast cancer in men. In all, breast cancer is about 100 times less common in men than women.

While those low odds may sound like breast cancer isn’t concerning for men, for those who develop it breast cancer is a serious and potentially fatal disease.

Men can have the same types of breast cancer that affect women, with one exception. Lobular carcinoma in situ, an uncommon condition in women marked by abnormal cells confined inside milk glands, doesn’t occur in men, according to the National Cancer Institute. Both and women and men with breast cancer are most likely to be diagnosed with infiltrating ductal carcinomas (IDC) — cancer that has spread beyond cells lining ducts in the breast.

More than 500 men are expected to die of breast cancer each year. For many, the poor outcome will be the result of men with cancer not seeking a diagnosis for a breast lump, a common sign of IDC, until their disease had spread.

“People don’t think about breast cancer being a male issue, but it does occur. While it’s in the very low range, between .09 and 1.2 cases per thousand, the problem is that men who do have breast cancer symptoms wait a long time to talk to their doctor about it, and that affects the outcome,” said Cletus A. Arciero, MD, surgical oncologist and Emory University School of Medicine professor of surgery.

In fact, when men with breast cancer are finally diagnosed, 60 to 80 percent of them already have stage III or stage IV cancer, and their malignancy has metastasized, according to Arciero.

Signs of cancer in men

The symptoms of breast cancer in men are the same as those in women. “A lump is the most common symptom,” Arciero said. “It is usually painless, but there can be pain associated it. Skin changes to the breast — something that is not healing — and any blood or other discharge coming out of a nipple would be of concern and requires a medical professional to evaluate.”

Other less common signs of breast cancer in men include skin dimpling or puckering on the chest, redness or scaling of breast skin, or a nipple turned inward.

When it comes to risk factors for male breast cancer, there are several similarities between those for men and women. For instance, hormones can play a role in certain types of breast cancer in both sexes.

“One risk factor for breast cancer in men is an inappropriately high level of estrogen — an estrogen/testosterone balance that goes out of whack,” Arciero said. “A testicular disorder, liver disease, diabetes and, to a certain extent, obesity and low physical activity are things that may lead to too much estrogen.”

Although some medications can raise estrogen levels in men, they are typically linked to male breast enlargement (gynecomastia) instead of a risk for male breast cancer, according to Arciero.

Genetic factors also raise the risk for male breast cancer, especially Klinefelter syndrome, a congenital condition affecting about 1 in 1,000 men. Men with the syndrome often have smaller than usual testicles, are infertile, and have low levels of male hormones and an excess of estrogen. About one in 100 men with Kliknefelter syndrome develop breast cancer, according to the American Cancer Society.

A far more common genetic risk factor for male breast cancer is one that affects women, too — a mutation in the BRCA1 or BRCA2 gene. “For males with a BRCA1 mutation, there’s about a one percent increase in the risk for male breast cancer. But a BRCA2 mutation, which is more common in male breast cancer, is linked to more aggressive forms of the disease and raises the risk about 7 percent,” Arciero said.

Women with BRCA mutations can have prophylactic mastectomies or opt for regular surveillance and screenings with MRIs and mammograms. For men with a BRCA mutation, Arciero advises being aware of any obvious changes in their breasts and reporting them to their doctor.

Another risk factor for breast cancer in men, as well as women is radiation exposure to the chest as a child or young adult.

Men with breast cancer, like women with the disease, receive treatment targeted to the stage and type of their breast cancer,  including surgery, radiation, and chemotherapy .

There have not been many chemotherapy clinical trials and retrospective research performed on men with breast cancer simply because the numbers of men with the disease are low. So, the same chemotherapies used to treat woman are also used to treat male breast cancer.

“We do have some studies showing that, for men who need endocrine therapy (to treat estrogen-positive breast cancer), the drug tamoxifen works better in men than aromatase inhibitors,” Arciero noted.

The difference in treatment between men and women

There’s one main difference between the treatment women and men with breast cancer receive: Men typically need more aggressive surgery.

“If you are a fit older male who develops breast cancer, there is not a whole lot of tissue there,” Arciero said. “So, if you have a lump, it is probably going to involve your nipple, or be very close to it, and probably going to require a mastectomy.”

“Up to 70 to 80 percent of women with breast cancer can undergo breast conserving surgery. For men, it’s a much lower percentage,” he explained. “For example, a woman with an average breast size can have a 2-cm tumor that doesn’t even come close to the skin or underlying muscle, and we can remove the tumor and preserve the breast. But in a man with the same size tumor, there’s not enough room, and surgery could involve removing more skin and the underlying muscle.”

Arciero doesn’t suggest men need to have regular breast exams and mammograms like women do, but they do need to be aware of their bodies. Men and their wives or partners should be alert to any changes that could indicate breast cancer.

“If a male finds a lump or sees changes to their nipple or breast area that are new or troublesome, they should have that looked at, instead of hoping it goes away,” Arciero said. “Men need to realize that, if their breast cancer is found early, they should have a very good outcome equivalent to what you’d find in a woman with breast cancer.”

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