Men have breast tissue just like women, although in smaller proportions, and like women can develop all types of breast disease including breast cancer, although it's rare, affecting only 300 men each year in the UK, compared to over 45,000 women.
Male breast cancer risk factors
The biggest risk factor for men, as it is for women, is increasing age. Most cases of male breast cancer are diagnosed in men of 60 to 70 year-olds or even older, although it can occur in men of any age. Other factors such as radiation exposure, especially when young, can also increase the risk for men and women.
Genes play a big part in male breast cancer, with ten to 20 per cent probably linked to inherited faulty genes (especially the BRAC2 gene) compared to around only three per cent of breast cancers in women. Also, men with a rare genetic condition called Klinefelter's syndrome are 20 to 50 times more likely to get breast cancer than normal men.
Men with Klinefelter's syndrome have an extra, female, X chromosome, making them XXY, and often have slightly more breast tissue than normal.
Another relevant factor is having high blood oestrogen levels. Most men do have a low natural level of oestrogen, which is not as high as in women, but if a man is overweight his fat tissue will manufacture excess oestrogen, raising his blood levels. Other diseases such as chronic liver disease can also cause high oestrogen levels.
Male breast cancer symptoms
Men tend to notice the same sort of symptoms as women – a lump, pain, or bleeding or discharging nipple, but the commonest symptom in men is a painless lump. Men may also notice a general swelling of their previous minimal breast size or the nipple being pulled into the chest wall – 'retraction' or 'tethering' – or swollen glands in the armpit.
Investigations and tests for male breast cancer
As for women, the tests for any breast symptoms, looking for any disease as well as cancer, include a mammogram – an x-ray of the breast tissue, or an ultrasound of the breast and armpit, and then a biopsy. This is a sample taken from the suspicious area and then examined under the microscope to look for cancer cells. Other tests may be done to look for secondary spread such as:
•CT scan of liver and lungs
Treatment for male breast cancer
The most common type of breast cancer in men and women is a ductal carcinoma but other sorts do occur. Treatment of all breast cancers in men includes:
In particular, hormone therapy such as tamoxifen is useful in men as around 90 per cent of male breast cancer cells are oestrogen receptor positive, which means they are oestrogen sensitive, needing oestrogen to grow. For men with this type of cancer cell, hormone therapies can be used to block oestrogen effects on any remaining cancer cells, preventing growth and reducing the chance of recurrence.
However hormone therapies such as tamoxifen can cause hot flushes and loss of sex drive. Newer hormone therapies including the aromatase inhibitors have been shown to be useful in preventing recurrence of breast cancer in post-menopausal women but it isn't clear yet how effective they are in breast cancer in men.
The biological therapies target HER2 receptors which are present in some types of breast cancer cell. So all breast cancer cells, in men and women, are examined for this receptor type and biological therapy used if they are positive.
Male breast cancer support
Men can find the diagnosis of breast cancer very difficult, as they may feel isolated and unsupported, they may feel their masculinity threatened and find it difficult to discuss their diagnosis with friends or family. Local support from other male sufferers is available through Breast Cancer Care and Cancer Research UK.