There is still a misconception that breast cancer is a “female only” disease, but in fact, men can get breast cancer too.
There is still a misconception that breast cancer is “exclusive” to women, but in fact, men can get breast cancer too.
While male breast cancer is relatively rare, accounting for about 1% of all breast cancers, the low awareness of the disease among men has led to delays in the timely diagnosis and treatment of male breast cancer patients.
What factors are associated with breast cancer in men?
The exact cause of breast cancer in men is unknown and may be related to the following factors.
- Genetic factors. About 10% of men with breast cancer have mutations in genes such as BRCA2, which explains why many men with breast cancer have a family history of breast cancer and sometimes prostate cancer.
- Hormone levels in the body. Increased estrogen action or an imbalance between estrogen and androgen action may contribute to the development of male breast cancer. For example, obesity increases estrogen levels in men, which increases the risk of breast cancer, and adult mumps, cryptorchidism, orchitis, epididymitis, congenital inguinal hernia, and orchiectomy all increase the likelihood of breast cancer in men.
- Environmental factors. Long-term exposure to radiation increases the risk of breast cancer in men, which may be related to hormone level disturbances caused by radiation-induced testicular dysfunction. In addition, some scholars believe that long-term exposure to high temperatures and styrene and formaldehyde also predispose men to the development of breast cancer.
- Other. Lack of physical exercise, alcohol consumption and other poor lifestyle habits are also risk factors.
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What are the manifestations?
Most male breast cancer patients are seen because they “feel a painless lump. In men, breast lumps are usually located under or around the areola. Because men have less breast tissue, the breast is closer to the chest wall. Therefore, breast lumps may adhere to the skin and deep muscles at an early stage. In addition, symptoms such as nipple indentation, fluid or blood spillage may also occur.
Because of the rich network of lymphatic vessels under the nipple areola, the rate of axillary lymph node metastasis is significantly higher in male breast cancer patients than in female patients. Male breast cancer develops at a later age, with an average age of 67 years at diagnosis.
How is it diagnosed?
As with women, the diagnosis of male breast cancer relies on physician examination, breast ultrasound, mammography, magnetic resonance imaging (MRI), and breast biopsy.
In conjunction with a diagnosis of breast cancer, physicians also test for molecular staging, which is the expression of hormone receptors (HR), human epidermal growth factor receptor-2 (HER-2), and other expressions of breast cancer. A foreign study that summarized data on male breast cancer from 93 cancer centers in 9 countries found that 99.3% of patients were estrogen receptor positive, with 93.4% being strongly positive, meaning that the vast majority of male breast cancer patients could benefit from endocrine therapy.
How to treat?
Surgery
The surgeon will take into account the stage of the tumor, the patient’s wishes, and other factors to determine the surgical approach. Modified radical breast cancer surgery is still the most common surgical approach.
For early-stage breast cancer without axillary lymph node metastasis on examination and imaging, physicians typically perform a simple mastectomy combined with an anterior lymph node biopsy.
For male breast cancer patients, breast-conserving surgery is generally not indicated.
Chemotherapy
The information on chemotherapy for male breast cancer is limited, but the studies that have been done suggest that male breast cancer can benefit from chemotherapy.
The choice of chemotherapy regimens is usually made with reference to those for female breast cancer, commonly anthracycline- and/or paclitaxel-containing chemotherapy regimens.
However, because male breast cancer tends to be in older patients and often has comorbidities, physicians will fully evaluate the possible benefits and risks of chemotherapy. Metastatic male breast cancer is incurable, and treatment for this group of patients is aimed at reducing symptoms and improving quality of life, avoiding some of the more toxic treatment options.
Radiotherapy
A higher proportion of men with breast cancer undergo postoperative radiotherapy compared with women with breast cancer, and the following conditions are usually treated with radiotherapy after surgery:
- Large tumor size;
- Extensive tumor invasion of the skin, areola, or muscle;
- Metastasis in the axillary lymph nodes.
Considering the older age of onset of male breast cancer patients, physicians pay extra attention to radiation damage to surrounding normal tissues while administering radiation therapy, especially for patients with left-sided breast cancer, and avoid damage to the heart and its blood vessels whenever possible.
Endocrine therapy
Because male breast cancer patients are often estrogen and progesterone receptor positive, endocrine therapy is more effective. The most commonly used endocrine therapy drug for men is tamoxifen, but its adverse effects (weight gain, sexual dysfunction, and thromboembolism) often lead to discontinuation and interruption of therapy in about 20% of patients.
Aromatase inhibitors are another class of endocrine therapeutics, such as anastrozole and letrozole. Some studies have found that these drugs can dramatically reduce estrogen levels in men, but increase testosterone levels by a factor of 1, which can cause other disorders. Therefore, doctors generally do not recommend the direct use of aromatase inhibitors for men with hormone receptor-positive breast cancer. However, using an aromatase inhibitor along with surgery or medication to lower testosterone levels can better perform the effects of an aromatase inhibitor while reducing side effects and also reducing the risk of prostate cancer.
Targeted therapy
While there are no studies to support this, it is possible to treat some male breast cancers in the context of the use of targeted therapies in the female breast cancer scenario, for example, in human epidermal growth factor receptor-2 (HER-2)-positive patients who may be considered for targeted anti-HER-2 therapy. Patients can consult with their physicians about the effects and adverse effects of targeted anti-HER-2 therapy, and they will be given tailored treatment recommendations.
How does treatment work?
What are the effects of treatment?
While the incidence is low, breast cancer in men is more likely than in women to invade skin and muscle tissue and cause metastasis and spread of cancer cells. In addition, male breast cancer is more advanced because of the older age of onset, longer duration of disease, and more untimely visits. Some patients also have to give up some treatment options due to their advanced age and poor physical condition, which cannot bear the side effects of treatment. All of these reasons contribute to the poor outcome and low survival rate of male breast cancer compared to female breast cancer. However, after excluding the effects of these factors, the survival rates for male and female breast cancer are similar.
In conclusion, the development of male breast cancer is the result of a multifactorial synergy, and treatment options are similar to those for female breast cancer, including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted therapy. Given that male patients are usually older at presentation and often detected late, male breast cancer usually has poorer outcomes and lower survival rates compared to female breast cancer.