Male Breast Cancer

 

 

 

 

 

 

 

 

 

 

 

Male breast cancer accounts for about 1% of all breast cancers. Although rare, it is often detected later and may cause the cancer to become further progressed and more fatal. Breast cancer in men has the same causes as for women, higher levels of estrogen, family history, genetics, lifestyle or other exposures. Genetics and the mutation of specific genes such as BRCA1 and BRCA2 can increase the risk. Symptoms of breast cancer in men can be a change or inversion to the nipple, dimpling of the skin, redness, itching of the nipple as well as any type of discharge from the nipple. Breast cancer that has metastasized (spread) to the bones may also produce bone pain at the sites and like other cancers symptoms can include weight loss and weakness.

 

Yes, it’s rare we hear about men with breast cancer but there are many reasons why:

 

Who’s checking - Most men are not being checked for early detection and possibly by the time it is diagnosed, it is found in other areas or organs.

 

Stigma - Many men do not feel comfortable speaking about a breast cancer diagnosis since this disease is usually associated with women, daughters and pink ribbons.

 

The number - There are approximately 2600 men diagnosed with this disease each year, however more often men will die from this disease due to a late diagnosis compared to women.

 

Male or female, it’s important to seek medical advice when symptoms are present or there is an increased risk. Surveillance for early detection and an earlier diagnosis can help save lives.

 

Symptoms

Symptoms of breast cancer for men are no different than they are for women. What is different is men need to be aware they can be diagnosed with breast cancer and know any symptoms, needs to be checked. Soreness of breast or lumps and bumps may not be just because of a hard workout in the gym or other heavy lifting, etc

 

• Mass located under the nipple

• Inverted or retraction of nipple

• Nipple discharge- may be bloody or clear

• Skin dimpling or puckering

• Itching of the nipple area

• Redness or scaling of the nipple

 

 

 

 

 

 

Often, men delay going to their healthcare professional early but earlier detection of breast cancer can make the difference in saving a life.

 

Risk Factors

Average man in the United States has a risk factor of 0.1% of developing Breast Cancer in a lifetime. This rate increases in men with BRCA1 and BRCA2 mutations to 1-5% with BRCA1 and 5-10% with BRCA2 (see more information regarding Genetics below).

There are many factors to consider regarding your risk factor such as family history, genetics, lifestyle, diet and nutrition, stress, weight and exercise. All of these must be considered. The problem is, most of the information regarding these calculations are based on a female's risk but the same factors should be discussed and applied for the male.

 

See this check list for risk factors for Hereditary Breast Cancer

 

• Have you or any family member (male or female) had breast cancer?

• Has Breast Cancer occurred in more than one relative on the same side of the family?

• Has any man in your family had breast cancer?

• Has Breast Cancer been diagnosed in you or a family member earlier than 50 years of age?

• Do you have an "Ashkenazi Jewish"(central or eastern Europe) heritage with a personal or family history of breast cancer?

• Does anyone in your family have a history of pancreatic, colon, early-age prostate cancer or melanoma?

 

If you answered "yes" to any or most of these questions, we suggest you meet with a genetics counselor to understand your cancer risk. Education is an important tool in prevention. 

 

Examinations: Self Check, Mammogram, Ultra Sound & MRI

It is even more important for a male to learn how to perform a self examination check since mammograms and ultra sounds are not commonly prescribed.

 

As with a female, one must first become familiar with their own breast in order to notice when changes take place. Follow below to learn how to self check yourself.

 

How to Perform a Male Self Breast Exam

 

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In addition you can request to have your physician perform a breast check during your annual physical. A male can get a mammogram. Size doesn't matter!

 

At this time there is limited insurance coverage for routine check ups for a male to have a mammogram for prevention. If there is a family history or genetic testing (see Genetics below) has determined there is a high risk, then a mammogram would be helpful in the detection of early on set breast cancer. Having a baseline mammogram performed would be recommended. Hopefully routine mammograms for the male will become a regular screening tool and one that HIS is in full support of lobbying for.

 

The same goes for Ultra Sound and breast MRI. Depending on your risk factors, sometimes the MRI is used alternately every 6 months with a mammogram for yearly screenings.

 

Diagnosis - Biopsy

Whether you detect a lump on your own or from another test method, further testing will be needed for diagnosis. Often all of the above modalities are used leading up to a diagnosis. In addition a biopsy may also be required. There are several ways this can be performed. Your doctor may elect to choose one of the following methods; Breast Cyst Aspiration, Stereotactic Biopsy, Needle/Wire Guided and/or Ultra Sound guided biopsy.

 

Once a diagnosis has been made from a biopsy the next step(s) will be determined by the information received.

 

What is staging?

Staging describes the severity of a person's cancer based on the size and/or extent (reach) of the original (primary) tumor and whether or not cancer has spread in the body. Staging is important for several reasons:

 

 

• Staging helps the doctor plan the appropriate treatment.

• Cancer stage can be used in estimating a person's prognosis.

• Knowing the stage of cancer is important in identifying clinical trials that may be a suitable treatment option for a patient.

• Staging helps healthcare providers and researchers exchange information about patients; it also gives them a common terminology for evaluating the results of clinical trials and comparing the results of different trials.

 

Staging is based on knowledge of the way cancer progresses. Cancer cells grow and divide without control or order, and they do not die when they should. As a result, they often form a mass of tissue called a tumor. As a tumor grows, it can invade nearby tissues and organs. Cancer cells can also break away from a tumor and enter the bloodstream or the lymphatic system. By moving through the bloodstream or lymphatic system, cancer cells can spread from the primary site to lymph nodes or to other organs, where they may form new tumors. The spread of cancer is called metastasis.

 

All cancers are staged when they are first diagnosed. This stage classification, which is typically assigned before treatment, is called the clinical stage. A cancer may be further staged after surgery or biopsy, when the extent of the cancer is better known. This stage designation (called the pathologic stage) combines the results of the clinical staging with the surgical results.

 

A cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads. New information about how a cancer changes over time simply gets added onto the original stage designation. The cancer stage designation doesn't change (even though the cancer itself might) because survival statistics and information on treatment by stage for specific cancer types are based on the original cancer stage at diagnosis.

 

*Above information provided by Oncology Nurse Advisor

 

The TNM system is one of the most widely used cancer staging systems. This system has been accepted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). Most medical facilities use the TNM system as their main method for cancer reporting.

 

The TNM system is based on the size and/or extent (reach) of the primary tumor (T), the amount of spread to nearby lymph nodes (N), and the presence of metastasis (M) or secondary tumors formed by the spread of cancer cells to other parts of the body. A number is added to each letter to indicate the size and/or extent of the primary tumor and the degree of cancer spread.

 

Primary Tumor (T)

TX: Primary tumor cannot be evaluated
T0: No evidence of primary tumor
Tis: Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called preinvasive cancer)
T1, T2, T3, T4: Size and/or extent of the primary tumor

 

Regional Lymph Nodes (N)
NX: Regional lymph nodes cannot be evaluated
N0: No regional lymph node involvement
N1, N2, N3: Degree of regional lymph node involvement (number and location of lymph nodes)

 

Distant Metastasis (M)
MX: Distant metastasis cannot be evaluated
M0: No distant metastasis
M1: Distant metastasis is present

 

For example, breast cancer classified as T3 N2 M0 refers to a large tumor that has spread outside the breast to nearby lymph nodes but not to other parts of the body. Prostate cancer T2 N0 M0 means that the tumor is located only in the prostate and has not spread to the lymph nodes or any other part of the body.

 

For many cancers, TNM combinations correspond to one of five stages. Criteria for stages differ for different types of cancer. For example, bladder cancer T3 N0 M0 is stage III, whereas colon cancer T3 N0 M0 is stage II.

 

 

 

 

 

 

 

 

 

 

 

*Above Information from NIH- National Cancer Institute

 

Genetics (BRCA1 & 2)

BRCA originate from the words BReast and CAncer. For men, there is an increased risk of 1% with the BRCA1 mutation and 6% with the BRCA2 which is about 80 times greater than the lifetime risk of men without these genetic mutations. If you have a first degree relative(s) including a man diagnosed with breast cancer, you may want to ask if anyone has received genetic testing or speak with your doctor about being tested yourself. See more under genetics of male breast cancer.

 

Hormones

Hormones, especially a higher level of estrogen (found in women and men) can increase the risk of developing breast cancer. Below is a list of how or why one might have a higher level.

 

• Taking hormonal medicines

• Being overweight, which increases the production of estrogen

• Having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body)

• Being heavy users of alcohol, which can limit the liver's ability to regulate blood estrogen levels

• Having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.

Hormones can play a large part in the development and growth of breast cancer. When a biopsy is performed, part of the diagnosis will include whether the cancer is Estrogen and/or Progesterone dominant or negative. Depending on the findings the information will partly determine the course of actions needed following any surgical procedures.

 

Approximately 9 out of 10 breast cancers in men are diagnosed as hormone receptor positive. This can include either estrogen receptor (ER) positive and/or progesterone receptor (PR) positive. This is helpful as then men can be treated with hormone therapy

At this time, Tamoxifen is the preferred hormone treatment as it is the best studied hormone drug for breast cancer in men.

Tamoxifen (Nolvadex) works to prevent estrogen from binding to its receptor on breast cancer cells. The treatment regimen is to remain on Tamoxifen from 5-10 years post surgery for the best results and is taken in pill form one daily.

 

Other Hormone therapy drugs include Aromatase Inhibitors.

 

This group of drugs includes anastrozole (Arimidex®), letrozole (Femara®), and exemestane (Aromasin®). They work by blocking an enzyme (aromatase) in fat tissue that converts male hormones from the adrenal glands into estrogen. Aromatase inhibitors are taken daily as pills. They have been very effective in treating breast cancer in women, but they have not been well-studied in men and are used if Tamoxifen stops working.

Fulvestrant (Faslodex)
Fulvestrant is a drug that also acts on the estrogen receptor, but instead of blocking it, this drug eliminates it. In postmenopausal women, this drug is often effective even if the breast cancer is no longer responding to tamoxifen. In one small study of men with advanced breast cancer who had previously been treated with at least one other hormone drug, some of the men saw their tumors shrink with fulvestrant. It is given by injection every 2 weeks for a month, then monthly. 

Luteinizing hormone-releasing hormone (LHRH) analogs and anti-androgens
LHRH analogs such as leuprolide (Lupron®) and goserelin (Zoladex®) affect the pituitary gland. In men they turn off production of the male hormone testosterone by the testicles, leading to lower testosterone levels. They are given as shots either monthly or every few months. These drugs may be used by themselves, or combined with aromatase inhibitors or anti-androgens to treat advanced breast cancer in men.

Anti-androgens such as flutamide and bicalutamide work by blocking the effect of male hormones on breast cancer cells. These drugs are taken daily as pills.

 

Megestrol
Megestrol (Megace®) is a progesterone-like drug. It is unclear how it stops cancer cells from growing, but it appears to compete for hormone receptor sites in the cells. This is an older drug that is usually reserved for men who are no longer responding to other forms of hormone therapy. Megestrol may increase the risk for blood clots and frequently causes weight gain by increasing appetite.

Orchiectomy (castration)

Surgical removal of the testicles greatly lowers the levels of testosterone and other androgens (male hormones). Most male breast cancers have androgen receptors that may cause the cells to grow. Androgens can also be converted into estrogens in the body. Orchiectomy shrinks most male breast cancers, and may help make other treatments like tamoxifen more likely to work. This treatment was once quite common, but it is now used less often because of new non-surgical approaches to lowering androgen levels, such as the LHRH analogs discussed previously.

 

Possible side effects of hormone therapy
Although some of these drugs have unique side effects (see descriptions above), in general they can cause loss of sexual desire, trouble having an erection, weight gain, hot flashes, and mood swings. Be sure to discuss any such side effects with your cancer care team because there may be ways to treat them.

*Some of the above hormone information was borrowed from The American Cancer Society

Read more about long term hormone therapy...