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Breast cancer – a rare, but possible diagnosis for men

Although breast cancer in men is rare, it does happen. In the United States, about one percent of all breast cancers occur in men.1  

We still have much to learn about breast cancer in men because the diagnosis is so rare. Most of what we know about breast cancer is related to breast cancer in women. While there are some similarities between breast cancer in women and men, there appear to be some differences. Here, we give a brief overview. This summary may be helpful if you or a man you know (or love) has been diagnosed with breast cancer.  

What are the numbers?

In 2013, it is estimated that among U.S. men there will be:2   

  • 2,240 new cases of breast cancer (compared to 232,340 among women) 
  • 410 breast cancer deaths (compared to 39,620 among women) 

Breast cancer rates in men have remained stable over the past 30 years. 

The male breast

Boys and girls begin life with similar breast tissue. Over time, however, men do not have the same complex breast growth and development as women. At puberty, high testosterone and low estrogen levels stop breast development in males.  

In adult women, breast tissue is a complex network of lobules and ducts in a pattern that looks like bunches of grapes (see image). Lobules are small round sacs that produce milk and ducts are the canals that carry milk from the lobules to the nipple openings during breastfeeding. In men, some milk ducts exist, but they remain undeveloped. Lobules are most often absent.  

Types of breast cancer

For men (and women), most breast cancers begin in the milk ducts of the breast (invasive ductal carcinomas). Fewer than five percent of male breast cancers begin in the lobules (invasive lobular carcinoma).3-4 In rare cases, men can be diagnosed with inflammatory breast cancerductal carcinoma in situ (a non-invasive breast cancer) or Paget disease of the breast (Paget disease of the nipple).5-6 

Breast cancer screening

Breast cancer screening tests such as clinical breast exams and mammograms are used to find breast cancer in people with no symptoms. These tests are not recommended for most men. However, some men at higher risk of breast cancer may benefit from screening, including those with:7 

If you have concerns about your risk of breast cancer, talk to your health care provider. 

Breast cancer screening recommendations for men at higher risk

The National Comprehensive Cancer Network (NCCN) recommends that men at higher risk for breast cancer:7 

  • Have a clinical breast exam every six to 12 months, starting at age 25 
  • Consider having a mammogram at age 40 (depending on the findings from this first mammogram and the amount of breast tissue, yearly mammograms may be recommended) 

Men at higher risk for breast cancer should also be aware of the warning signs of breast cancer. 

Warning signs

For men, breast cancer most often presents as a painless lump or thickening in the breast. However, any change in the breast or nipple can be a warning sign of breast cancer including:5-6,8   

  • Change in the size or shape of the breast 
  • Dimpling, puckering or redness of the skin of the breast  
  • Itchy, scaly sore or rash on the nipple  
  • Pulling in of the nipple (inverted nipple) or other parts of the breast 
  • Nipple discharge 

If you notice any of these signs or other changes in your breast, chest area or nipple, see your health care provider right away. Some men may be embarrassed about a change in their breast or chest area and put off seeing a provider, but this may result in a delay in diagnosis. Survival is highest when breast cancer is found early.  

Risk factors

Although some factors have been found to increase the risk of breast cancer in men, most men who are diagnosed have no known risk factors (except for older age). 

Age

Getting older increases the risk of breast cancer. Older age is the most common risk factor for breast cancer in both men and women. In men, most breast cancer occurs between the ages of 65 and 67 (this is a bit older than it is for women).5,16-17 

Genetic conditions, gene mutations and family history

Klinefelter's syndrome

Klinefelter's syndrome is a rare condition that occurs when men are born with two X chromosomes instead of one (XXY instead of XY). Men with Klinefelter's syndrome have a 20 to 50 times greater risk of breast cancer compared to men without this condition.5 

BRCA2 gene mutations

Men (and women) with an inherited BRCA2 (BReast CAncer gene 2) mutation have an increased risk of breast cancer.5,9-10 Men can inherit a BRCA2 mutation from either parent. And, a man who has a BRCA2 mutation can pass the mutation on to his children.  

Breast cancer in men is more likely than breast cancer in women to be related to an inherited gene mutation. Up to 40 percent of male breast cancers may be related to BRCA2 mutations, while only five to 10 percent of female breast cancers are considered to be due to a gene mutation.11 So, it’s usually recommended that men diagnosed with breast cancer have genetic testing for possible BRCA2 mutations (learn more about genetic testing).  

Even among men who have a BRCA2 mutation, breast cancer is uncommon. Men who carry a BRCA2 mutation have about a seven percent chance of developing breast cancer by age 70.12 In comparison, women who carry a BRCA2 mutation have a 40 to 60 percent chance of developing breast cancer by age 70.13  

Other genes are under study for a possible link to male breast cancer.14 

Family history

Whether or not a man carries a BRCA2 mutation, having a family member with breast cancer increases the chances of developing breast cancer.8,15-16 

Radiation exposure

Exposure to large amounts of radiation early in life (such as radiation treatment for childhood cancer) may increase breast cancer risk.6,9,16 

Other risk factors

Although data are limited at this time, some conditions related to hormone levels in the body are under study for a possible link to breast cancer in men, including:5-6,8-9,15-16,18 

  • Gynecomastia (enlargement of the breast tissue; the most common benign breast condition in men) 
  • Heavy alcohol use 
  • Chronic liver disease 
  • Obesity  
  • Some hormone drugs used to treat prostate cancer  

Treatment

Treatment for breast cancer is basically the same for men and women. It includes surgery (usually mastectomy for men) plus some combination of radiation therapy, chemotherapy and/or targeted therapy. Because most breast cancers in men are hormone receptor-positive, treatment usually includes hormone therapy with tamoxifen. 

Learn more about treatment for breast cancer in men. 

Survival

Breast cancer survival for men is about the same as for women of the same age and cancer stage at diagnosis (more on cancer stage).6,19 However, men tend to be diagnosed at a later stage than women.3,18 This may be because they are less likely to report symptoms. 

The most important factors related to breast cancer survival for both men and women are tumor size and whether or not cancer has spread to the lymph nodes.3,6 

The five-year relative survival rate for men with breast cancer is 84 percent.17 This means men with breast cancer are, on average, 84 percent as likely as men in the general population to live five years beyond their diagnosis. The 10-year relative survival rate for men with breast cancer is 72 percent.20 Remember, these rates are averages and vary depending on each man’s diagnosis and treatment. 

Race/ethnicity differences in survival

Similar to women, there appear to be racial and ethnic differences in breast cancer survival rates among men. African American men are more likely to die from their breast cancer than white men.4,17,20 Although data are limited, African American men tend to be diagnosed with larger, later stage breast cancers than white men.4,20-21 The reasons behind these differences are unclear at this time, but this topic is under study. 

Support

Because most people think of breast cancer as something that only affects women, men who are diagnosed may feel embarrassed or isolated.16 For example, a man may likely be the only man with breast cancer at his treatment center. These feelings can be hard for friends and family to understand. Finding sources of social support may help. Counseling and other types of support are also available. A health care provider may be helpful in finding these resources. 

In-person support groups for men with breast cancer can be hard to find. However, there are support groups for men with any cancer diagnosis. And, there may be online support groups where men with breast cancer can share common experiences. Some organizations may even be able to help men with breast cancer connect with other male survivors for one-on-one telephone or online support. See resources below. 

  

After Breast Cancer Diagnosis
http://www.abcdbreastcancersupport.org/get-support/get-a-mentor/ 


CancerCare
http://www.cancercare.org/ 


Cancer Support Community
http://www.cancersupportcommunity.org/ 


Imerman Angels
http://www.imermanangels.org/
 

 

Komen Support Resources  

 
  • Our breast care helpline 1-877 GO KOMEN (1-877-465-6636) provides free, professional support services and help finding local support groups. Our trained and caring staff are available to you and your family Monday through Friday from 9:00 a.m. to 10:00 p.m. EST and from 6:00 a.m. to 7:00 p.m. PST. 
 

 

Summary

Although breast cancer occurs much more often in women, more than 2,000 men may be diagnosed in the U.S. this year. Though many aspects of breast cancer differ between men and women, treatment and prognosis are similar. As with any cancer diagnosis, social support is important. Connecting with other men living with breast cancer (or other types of cancer) can be helpful.  

According to Sharon H. Giordano, MD, MPH, Chair, Department of Health Services Research and Professor, Department of Breast Medical Oncology at the University of Texas MD Anderson Cancer Center, "Many people do not realize that men can also get breast cancer. Raising awareness is important because men often present with more advanced stage disease than women due to delays in diagnosis. Male patients also often struggle to find gender appropriate information about breast cancer, so I hope that the information in this article will be helpful to male breast cancer patients and their families." 

References

  1. American Cancer Society. Breast Cancer Facts and Figures 2011-2012. Atlanta, GA: American Cancer Society, 2011. 
  2. American Cancer Society. Cancer Facts and Figures 2013. Atlanta, GA: American Cancer Society, 2013. 
  3. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 101(1):51-7, 2004. 
  4. Chavez-Macgregor M, Clarke CA, Lichtensztajn D, Hortobagyi GN, Giordano SH. Male breast cancer according to tumor subtype and race: A population-based study. Cancer. 2013 Jan 22. [Epub ahead of print]. 
  5. Wisinski KB and Gradishar WJ. Chapter 64: Male Breast Cancer. In Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 34thrd edition. Lippincott, Williams and Wilkins, 2010. 
  6. National Cancer Institute. Male breast cancer treatment. , 2012. 
  7. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast cancer screening and diagnosis, Version 1.2012, www.nccn.org 2012. 
  8. Mayo Clinic Staff. Male breast cancer. Mayo Clinic. www.mayoclinic.com/health/male-breast-cancer/DS006612012. 
  9. Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 367(9510):595-604, 2006. 
  10. National Cancer Institute. Genetics of breast and ovarian cancer (PDQ). www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/HealthProfessional/page2, 2012. 
  11. Thorlacius S, Sigurdsson S, Bjarnadottir H, et al. Study of a single BRCA2 mutation with high carrier frequency in a small population. Am J Hum Genet. 60(5): 1079–1084, 1997. 
  12. Tai YC, Domchek S, Parmigiani G, Chen S. Breast cancer risk among male BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst. 99(23):1811-4, 2007. 
  13. Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol. 25(11):1329-33, 2007. 
  14. Orr N, Lemnrau A, Cooke R, et al. Genome-wide association study identifies a common variant in RAD51B associated with male breast cancer risk. Nat Genet. 44(11):1182-4, 2012. 
  15. Brinton LA, Richesson DA, Gierach GL, et al. Prospective evaluation of risk factors for male breast cancer. J Natl Cancer Inst. 100(20):1477-81, 2008. 
  16. Ruddy KJ, Winer EP. Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship. Ann Oncol. 2013 Feb 20. [Epub ahead of print]. 
  17. Howlader N, Noone AM, Krapcho M, et al., editors. SEER Cancer Statistics Review, 1975-2009: Fast Stats. Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2009_pops09/, 2012. 
  18. Brinton LA, Carreon JD, Gierach GL, McGlynn KA, Gridley G. Etiologic factors for male breast cancer in the U.S. Veterans Affairs medical care system database. Breast Cancer Res Treat. 119(1):185-92, 2010. 
  19. Anderson WF, Jatoi I, Tse J, Rosenberg PS. Male breast cancer: a population-based comparison with female breast cancer. J Clin Oncol. 28(2):232-9, 2010. 
  20. O'Malley CD, Prehn AW, Shema SJ, Glaser SL. Racial/ethnic differences in survival rates in a population-based series of men with breast carcinoma. Cancer. 94(11):2836-43, 2002. 
  21. Crew KD, Neugut AI, Wang X, et al. Racial disparities in treatment and survival of male breast cancer. J Clin Oncol. 25(9):1089-98, 2007. 

 

Posted June 3, 2013