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Breast Cancer in Men
According to the National Institutes of Health, male breast cancer cases make up less than 1 percent of all cases in the United States. Most men diagnosed are over the age of 55. Men can develop the following types of breast cancer:
- Invasive (infiltrating) ductal carcinoma
- Ductal carcinoma in situ
- Inflammatory breast cancer
- Paget’s disease
How are men diagnosed with breast cancer?
Most men find the presence of breast cancer themselves when bathing in the shower. It commonly presents as a palpable firm lump in the breast, commonly underneath the nipple and areola. Men have a tendency to delay having it diagnostically evaluated until it grows larger. So when a man finds a lump in his breast or notices that the nipple is inverting, it's important to see the doctor right away and be referred for diagnostic evaluation in a breast imaging center.
The method used for diagnostically evaluating whether a man has breast cancer is very similar to how it is also done for women. The man will have a mammogram. Mammograms can be particularly uncomfortable for men since they usually have less breast tissue requiring a tugging of the breast to get adequate tissue compression. Ultrasound may also be used. A core needle biopsy is then done for a pathological diagnosis.
What is the treatment for male breast cancer?
The treatments for breast cancer in men are similar to those of women, with the exception of surgical options. Given breast volume and tumor location, the standard of care for men is to have mastectomy surgery, rather than lumpectomy. The nipple can be spared if the tumor is not too close to it. Lymphatic mapping is done, just as it is for women, and the sentinel lymph nodes are removed from the armpit area so they can be checked for spread of the cancer. Male breast cancers are usually hormone receptor positive tumors so hormonal therapy (usually tamoxifen) is commonly part of the systemic treatment. Chemotherapy may be recommended as well if the lymph nodes are positive or if the tumor has high risk features. Radiation treatments are commonly recommended if the lymph nodes are positive.
Genetic testing is recommended for any man who develops breast cancer. Genetic testing determines whether there is a damaged gene being passed from generation to generation that could increase the risk for breast and other cancers. The relevant genes include BRCA1, BRCA2, PTEN, PALB2 and CHEK2. Only 10% of male breast cancers are caused by mutation in one of these genes, but identifying a mutation could alert other family members to take precautions to reduce their cancer risk.
Today, some men opt to have breast reconstruction similarly to what women having mastectomies also have done. The most common form for men is a small breast implant followed by nipple reconstruction and areola tattooing. This has become important for some men so they are comfortable in a gym or on a beach without a shirt on. It may not be covered by all insurance plans, however.
What is the prognosis for male breast cancer?
Although breast cancers developing in men are very similar to breast cancers that develop in women after menopause they are more likely to be associated with positive lymph nodes and survival is not quite as good. Survival for male breast cancer is similar to that of women diagnosed with breast cancer before menopause.