Breast Cancer in Men

Statistics Regarding Men and Breast Cancer

Breast cancer in men is rare—less than 1 percent of all breast carcinomas occur in men. Consider the latest statistics available from the American Cancer Society (ACS):

The ACS estimates that in 2009, approximately 1,910 new cases of invasive breast cancer were diagnosed among men in the United States. Breast cancer is about 100 times more common among women. The average age at diagnosis is 67, although men of all ages can be affected with the disease.

What are risk factors for breast cancer in men?

Risk factors may include:

• Radiation exposure
• Estrogen administration
• Diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter's syndrome

Also, there are definite familial tendencies for developing breast cancer.

• An increased incidence is seen in men who have a number of female relatives with breast cancer.
• An increased risk of male breast cancer has been reported in families in which a BRCA2 gene mutation has been identified.

What is the most common type of breast cancer in men?

Infiltrating ductal cancer is the most common tumor type, but intraductal cancer, inflammatory carcinoma, and Paget's disease of the nipple have been seen as well.
Lobular carcinoma in situ is very rare in men.

What are the symptoms of breast cancer in men?

The following are the most common symptoms of breast cancer in men. However, each individual may experience symptoms differently. Symptoms may include:

• Breast lumps
• Nipple inversion
• Nipple discharge (sometimes bloody)
• A pain or pulling sensation in the breast

The symptoms of breast cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What are the similarities to breast cancer in women?

Lymph node involvement and the hematogenous pattern of spread (through blood) are similar to those found in female breast cancer. The staging system for male breast cancer is identical to the staging system for female breast cancer. Prognostic factors that have been evaluated include the size of lesion and the presence or absence of lymph node involvement, both of which correlate well with prognosis.

Overall survival rates are similar to that of women with breast cancer. The impression that male breast cancer has a worse prognosis may stem from the tendency toward diagnosis at a later stage.

Treatment for Men with Breast Cancer

Specific treatment for male breast cancer will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

The primary standard treatment is a modified radical mastectomy because breast- conserving therapy is not an option due to the lack of glandular breast tissue in men. Other treatment may include:

• Radiation therapy - Radiation therapy is a process that precisely sends high levels of radiation directly to the cancer cells. Radiation done after surgery can kill cancer cells that may not be seen during surgery. Radiation may also be done:
  
  
  • Before surgery to shrink the tumor.
  • In combination with chemotherapy.
  • As a palliative treatment (therapy that relieves symptoms, such as pain, but does not alter the course of the disease).

Radiation therapy is usually delivered by external beam radiation. External radiation (also called external beam therapy) is a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.

• Chemotherapy - Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.
• Hormone therapy - In some cases, hormones can kill cancer cells, slow the growth of cancer cells, or stop cancer cells from growing. Hormone therapy as a cancer treatment involves taking substances to interfere with the activity of hormones or to stop the production of hormones.

Before you begin hormone therapy, your physician may recommend a hormone receptor test. This lab test is performed on a tissue sample to determine if estrogen and progesterone receptors are present. A hormone receptor test can help to predict whether cancer cells are sensitive to hormones. Tamoxifen is the standard endocrine treatment for men with hormone-sensitive disease. However, more recent studies have suggested a benefit to aromatase inhibitors as well, which are a class of drug that are now routinely used in women with breast cancer.

The hormone estrogen is present in men, as well as in women. Estrogen can increase the growth of breast cancer cells in some men. Hormone therapy may be recommended for men whose breast cancers test positive for estrogen receptors. Antiestrogens, such as tamoxifen, are most often used in hormone therapy of breast cancer in both men and women.

• Adjuvant therapy - Radiation therapy, chemotherapy, or hormone therapy are given after surgery for the removal of cancer as a safety factor to kill any cancer cells that cannot be seen. Adjuvant therapy may be considered on the same basis as it is for a woman with breast cancer because there is no evidence that the prognosis is different between men and women.