Breast Cancer in Men: Understanding the Risks and Symptoms

When we say “breast cancer”, we tend to picture someone with female anatomy. However, this is not always true. We are all born with breast tissue, regardless of biological sex. Both male and female bodies carry some amount of breast tissue since birth. This breast tissue develops during puberty for females and does not develop for males. That does not mean the breast tissue itself does not exist.

Male breast cancer is rare, but not unheard of; it occurs in roughly 1% of the male population. We understand that the number might not seem like much. However, it is important to understand this rare cancer so that those affected can intervene early.

This blog delves into the symptoms, causes, and treatment measures for male breast cancer.

Understanding Male Breast Anatomy

There is a bit of breast tissue in all of us. In fact, female and male chests are more or less similar until puberty. The breast tissue is stored behind the nipple and areola. The internal structure of the chest area in men and women is similar in many ways. Male and female bodies have glandular tissue, fat, a nipple, and a rudimentary ductal system. The variation lies in the size of some of these elements. For instance, the ducts are smaller in male bodies than in female bodies. They also have less glandular tissue as compared to women.

During puberty, estrogen is produced in both men and women. Female bodies continue to produce estrogen, leading to the development of breast tissue. The estrogen production in male bodies is temporary, and the breast tissue does not develop. Male bodies begin producing testosterone, which overtakes the effects of estrogen.

As men age, the hormonal balance can change. Certain health conditions may also cause a hormonal imbalance. Conditions like chronic liver disease, obesity, or hyperthyroidism may affect testosterone production. Hormonal imbalance can sometimes lead to the breast tissue expanding, a phenomenon known as gynaecomastia. This condition need not always mean the person has cancer. Oftentimes, gynaecomastia is a temporary issue. The hormonal imbalance during puberty causes temporary gynaecomastia, which reduces within six months to a year. Older males may also develop gynaecomastia as their testosterone production reduces.

What is Male Breast Cancer?

Male breast cancer is a rare condition. While breast cancer generally conjures up images of women, men, too, can get breast cancer. There is breast tissue in everyone. In female bodies, this breast tissue develops during puberty.

Breast cancer in men starts in the breast tissue. Breast cancer occurs in every country in the world. Approximately 0.5–1% of breast cancers occur in men.

Breast cancer awareness for men is limited. Oftentimes, the lump in the breast tissue is dismissed if you are male. Regardless of sex, both male and female individuals should screen for any suspicious lumps, especially in their chest area.

Types of Male Breast Cancer

For breast cancer in men, the cancer is typically located in the breast ducts. The ducts connect the lobule glands to your nipple. Let’s look at the types of breast cancer typically found in males:

• Ductal Carcinoma: 9 out of 10 male breast cancers are invasive ductal carcinoma. In this condition, the cancer starts in the ducts and spreads to different parts of the breast. Invasive breast cancer will metastasize to different parts of the body, too. Ductal carcinoma in situ is a less common cancer among men. In this condition, the cancer starts in the ducts but does not spread out to the rest of the breast tissue.
• Lobular Carcinoma: Invasive lobular carcinoma forms in the lobules of the breast tissue. Lobular carcinoma is also invasive, which means it can spread through the breast tissue and also reach other parts of the body. In males, this type of breast cancer is uncommon. Male breast tissue contains few lobules, if any.

Breast cancer cells require a hormone receptor to which they can attach and multiply. Male breast cancer cells typically attach to progesterone and estrogen, continuing to divide and multiply. Male breast cancer is most commonly linked to estrogen, called the estrogen receptor-positive invasive ductal carcinoma.

Causes of Breast Cancer in Men

Breast cancer in men is most commonly caused by a change in the DNA of the breast cells. These breast cells mutate and begin multiplying rapidly. Unlike healthy cells, these cancerous cells don’t die. Eventually, the cancer cells form clumps and form tumours. When the cancer metastasizes, the tumour breaks apart, cancer cells traveling through the bloodstream and lymph nodes, to reach other parts of the body. This phenomenon is called metastatic cancer. Research on what causes healthy cells to turn into cancerous cells is still underway.

There are several risk factors that may increase the chances of men developing breast cancer, including:

• Genetic Predisposition: Breast cancer genes can be passed down to a male offspring, too. These genes include the BRCA1 gene mutation and the BRCA2 gene mutation. The PTEN gene, which causes Cowden Syndrome, the TP53 gene, which causes Li-Fraumeni Syndrome, and the MMR gene, which causes Lynch Syndrome, are less common mutations that cause lumps in the breast tissue. Having any of these syndromes can increase the risk of breast cancer in men. You are more likely to develop breast cancer or be a cancer gene carrier if you have a parent or sibling with breast or ovarian cancer. Certain breast cancer genes run in families, regardless of gender.
• Age: Male breast cancer is typically diagnosed in men over the age of 60. While breast cancer can affect men at any age, it is most common in older men. As men get older, their chances of developing breast cancer increase.
• Hormonal Imbalance: Certain health conditions like cirrhosis of the liver or obesity can cause a hormonal imbalance in men, where estrogen levels go up. About 80% of breast cancer cases in men and women are hormone receptor-positive. This means that the cancer cells require a hormone to which they can attach themselves. High estrogen levels can increase the risk of men developing breast cancer.
• Radiation Therapy: If you have had radiation therapy directed towards your chest before, your risk of breast cancer increases.
• Testicular Problems: Testicular problems can increase your risk of developing breast cancer. If you have had surgery to remove a testicle, injured your testicle, or have health conditions that target the testicles, there may be some inflammation, which can affect your hormones.

Symptoms of Breast Cancer in Men

Symptoms of breast cancer in men and similar to those in women. The most common symptom, and usually the first sign, is a firm and painless lump in one of the breasts or in your armpit. The lump is most commonly found behind the nipple. Here are some other symptoms for which you should watch out:

• A lump in the armpit. Your armpit is home to lymph nodes, one of the most common locations for a breast cancer lump. While the cancer begins in the breast tissue, it can spread to your lymph nodes, causing them to swell.  Not all armpit lumps are cancerous, but it is best to consult a doctor if you notice one.
• The skin on your chest may look dimpled. Imagine the skin of an orange for reference. All dimpling may not indicate cancer. However, you should seek medical advice if you notice a change in the skin on your chest.
• Redness, flakiness, or scaly skin is also a common symptom of breast cancer in men. Typically, this skin symptom will appear near the nipple or on the chest.
• You may feel tenderness or pain in your chest or underarm. Breast pain typically follows a new lump or skin changes.
• There may be nipple discharge, either bloody or clear. In some cases, your nipple may even become inverted. An inverted nipple is sunken inward. 

Diagnosis

There are several ways to diagnose male breast cancer, including:

• Clinical Breast Exam: This is typically the first course of action if you have concerns about a lump in your breast tissue. A healthcare professional will feel for lumps or other abnormalities in the breast tissue. One aspect of this examination is a visual examination where your Doctor will look for visible lumps in the chest and underarm area. The next aspect is careful palpation of the chest, underarms, and collarbone area.
• Imaging Tests: The next step is an imaging test. Imaging tests for breast cancer include mammography, ultrasound, and MRI. Mammograms are the most common imaging tests for breast cancer for both men and women. Your healthcare provider may also perform an ultrasound to get more information about the tumour.
• Biopsy: The healthcare provider removes a tissue sample from the affected area and examines it under a microscope to check for cancer or other abnormalities. A biopsy is a confirmation of cancer. There are various types of biopsies, including fine needle aspiration, core needle biopsy, and surgical biopsy.

Once your screening is complete and the cells turn out to be cancerous, pathologists will look for hormone receptors. These testing methods will ultimately decide your treatment plan.

Staging and Grading

Once you have been diagnosed with breast cancer, the next step is to check if it has spread. The spreading of cancer is called staging. The stage of cancer determines how much cancer is present in your body. Your treatment plan is devised according to the stage of cancer you have. The survival statistics are also calculated depending on the cancer’s stage.

Healthcare providers use the TNM system, which refers to Tumour, Node, and Metastasis. They assess the size of the primary tumour in the breast. Then, they check if the cancer has spread to any lymph nodes. Metastasis determines if the cancer has left the breast tissue and spread to the rest of the body. Here is a more elaborate understanding of the stages:

• Stage 0: Cancer is confined to the ducts or nipple
• Stage 1: There is a small tumour, but there is no lymph node involvement
• Stage 2: The tumour has grown in size and may have spread to a few lymph nodes
• Stage 3: More lymph nodes are affected, and the cancer has spread to the surrounding tissue.
• Stage 4: The cancer has metastasized and spread to distant body parts. 

The staging and grading of breast cancer in men is the same as in women. While staging refers to the extent of the cancer’s spread, grading refers to how aggressive the cancer cells appear. There are three grades:

• Grade 1: well-differentiated, normal-ish cells.
• Grade 2: Moderately differentiated, slightly different from normal cells.
• Grade 3: Poorly differentiated, aggressive, and very different from normal cells.

Understanding the staging and grading is part of your prognosis. It helps determine the best-suited treatment plan for you. In male patients, staging and grading play a crucial role because there is a significant delay in diagnosis for men. 

Treatment Options

Your treatment for Breast Cancer will depend on the stage of cancer you have. The treatment plan is most likely to be a combination of methods, including:

• Surgical method: For men with breast cancer, surgery is often the first step of treatment. Depending on the cancer’s stage, either your entire breast may be removed or only the lump may be removed. Removing the entire breast is called a mastectomy. A mastectomy is typically the surgical option for severe cases of breast cancer. Tumour removal is called a lumpectomy, which is a breast-conserving procedure. There is also a type of mastectomy called radical mastectomy, which removes the entire breast tissue, lymph nodes, and some chest muscle.
• Radiation: Radiation is a common treatment option for breast cancer in men and women. Radiation typically follows a lumpectomy. Once the tumour has been removed, there may be cells left behind. Radiation takes care of these remaining cells. Surgical intervention may not always catch minute tumour cells that are close to the skin. Radiation penetrates through layers of skin and tissue to get to the cancerous cells.
• Chemotherapy: Chemotherapy refers to the external medication that kills the cancer cells. Tumours that haven’t spread can be targeted through chemotherapy. Chemotherapy helps shrink the tumour before surgery. Radiation and chemotherapy are often used together. Both treatment methods are often used after surgery to ensure the tumour does not grow back, either in the chest or anywhere else in the body. The treatment methods follow one after another.
• Hormone Therapy: High estrogen levels can increase the likelihood of breast cancer in men. Most cases of invasive breast cancer are linked to certain hormones. Estrogen is one such hormone to which cancer cells can get attached through hormone receptors. Doctors use hormone therapy to lower estrogen levels or block their effects.
• Targeted Therapy: Targeted therapy is exactly what the name suggests; it targets specific types of cancer cells. For instance, some forms of targeted therapy work on breast cancers with hormone receptors.

Prevention and Awareness

Breast cancer is significantly more common in women. However, this does not mean that men cannot develop breast cancer. Breast cancer in men is a rare condition, thereby lacking awareness. Understanding breast cancer in men allows us to identify risk factors and provide early intervention. Awareness of male breast cancer also teaches men to perform self-exams, maintain a healthy lifestyle, and, most of all, go for regular screenings if there is a family history of cancer.

Conclusion

Breast cancer is not limited to women. While they are the general majority of patients for breast cancer, men can still develop it. Oftentimes, there is a delay in the diagnosis of male breast cancer because of the lack of awareness. Understanding the risk factors, symptoms, causes, and preventive measures can help you and your loved ones stay safe and seek early intervention.