Breast cancer in male is rare: According to statistics, one in 800 men will develop it during their lifetime. Nevertheless, men should go to the doctor if there are changes in the breast area so that he can act quickly if necessary. Read more about the causes, symptoms, diagnosis and treatment of male breast cancer here!
ICD codes for breast cancer in male : D05 | C50
Breast cancer in male: Rare but possible
Not only women get breast cancer, i.e. a malignant growth of the breast tissue. In rare cases, men can also develop breast cancer. However, they only make up one percent of all breast cancer cases.
On average, breast cancer develops in men at the age of 72. The median age at onset in women is lower at around 64 years.
Breast cancer in male is often diagnosed at a later stage than in women. One reason is that there is no breast cancer screening program for men (like mammography screening for women). In addition, many men (and sometimes also doctors) do not think of breast cancer first when they see changes in the male breast area. This is probably a key reason why the chances of a cure for breast cancer are worse in men than in women.
Causes of breast cancer in male
There are a number of known risk factors for male breast cancer. However, there are also many sufferers for whom no conspicuous risk factor can be identified afterwards.
In about a quarter of patients (more often than in women), breast cancer in male is based on a genetic predisposition : As in women, certain genetic changes (mutations) can significantly increase the risk of breast cancer. These mutations can either occur spontaneously or be inherited from the parents. Mutations in the BRCA1 and BRCA2 genes have been researched the best. They not only increase the risk of breast cancer, but also of some other types of cancer such as prostate cancer, pancreatic cancer and colon cancer.
Another link between genes and breast cancer is Klinefelter’s syndrome – a congenital abnormality in the number of chromosomes in men. Those affected have one or more extra “female” X chromosomes. This is associated with a 20- to 60-fold increased risk of breast cancer.
If you have a family history of breast cancer, you may want to have a genetic test done. Ask your doctor if this makes sense in your case. Especially if both women and men in your blood relatives already have breast cancer, your risk of breast cancer is also significantly increased. In some cases, early detection tests are also advisable.
The male body not only produces male sex hormones (androgens such as testosterone), but also small amounts of female sex hormones (estrogens, progesterone). A shift in the balance of hormones can promote breast cancer in male. This shift can be caused by various factors.
For example, when a man produces significantly more estrogen than normal. This happens, for example, with the Klinefelter syndrome described above. But also if you are very overweight, because the fat tissue produces hormones that increase the estrogen level. Affected men are therefore more susceptible to breast cancer.
An increased level of female sex hormones in men also results from an external supply of estrogen. An example is taking estrogen supplements for sex reassignment (male to female).
The normal balance of sex hormones is also disrupted when men produce less testosterone than normal. This also increases the risk of male breast cancer. The cause of low testosterone levels can be, for example, cirrhosis of the liver, undescended testicles or another malformation of the testicles (in childhood), previous inflammation of the testicles (orchitis) or inflammation of the epididymis (epididymitis). Men who have had their testicles removed (orchiectomy), for example because of testicular cancer, also produce significantly less testosterone.
Bodybuilders may also have an increased risk of breast cancer if they take performance-enhancing hormones (anabolic steroids). These doping agents are similar in structure to testosterone. It is known that excess testosterone is partially converted into estrogen in the male body. The same is suspected for anabolic steroids. Therefore, anabolic steroids could disturb the hormone balance in such a way that male breast cancer is promoted.
Long-term or high-dose radioactive radiation in the breast region increases the risk of breast cancer – in both men and women. Affected are about people whose upper body was irradiated – for example due to a cancer such as lung cancer.
Other risk factors
Other risk factors for breast cancer in male are diabetes, prostate cancer and an overactive thyroid. High alcohol consumption and lack of exercise (encourages obesity!) can also promote male breast cancer. Men who often come into contact with oil, exhaust fumes or high temperatures at work are also at risk.
Symptoms of breast cancer in male
The following symptoms can indicate breast cancer and should therefore be clarified by a doctor:
- Lumps or hardening in the breast.
- Indentations of the breast skin or nipple.
- Inflammation or discharge from the breasts.
- Inflammation or sores in the chest area that do not heal.
- Enlarged or hardened lymph nodes in the armpit.
In advanced stages of cancer, patients often show weight loss and reduced performance. If the tumor has already formed metastases, other symptoms are possible. For example, skeletal metastases are often characterized by bone pain. Cough and shortness of breath can be signs of lung or pleura metastases. Liver metastases trigger digestive problems.
Diagnosis of breast cancer in male
The first point of contact when there is a suspicion of breast cancer in a man is usually the general practitioner. If necessary, he can refer the patient to specialists, such as a specialist in men’s diseases (andrologist, urologist) or a breast cancer center.
In order to clarify the suspicion of breast cancer, the doctor goes through various steps with you. First, he will ask you about your previous medical history and your symptoms (anamnesis). This is followed by one physical examination. Among other things, the doctor scans both chest areas and the lymph node stations.
The doctor then carries out imaging examinations, on the one hand a mammography (breast X-ray), on the other hand he uses the breast tissue ultrasound device (mammasonography).
In women with suspected breast cancer, magnetic resonance imaging (magnetic resonance imaging, MRI) with a contrast agent is often performed. Whether such an examination can also support the diagnosis of breast cancer in male has not been finally clarified. However, some doctors recommend an MRI of the chest, especially for men, since breast cancer in male often grows into the chest wall (MRI provides more precise images).
Not every tissue change in the breast is malignant. By taking a tissue sample (biopsy), the doctor can determine whether it is actually cancer. He takes a small sample of the abnormal tissue and has it examined in the laboratory. If it is cancer, the laboratory also examines how much the cells have already changed and whether the tumor needs hormones to grow. This is important for therapy planning.
Additional examinations can show whether and how far the breast cancer has already spread in the body. The procedure is similar to that for female patients. For example, a bone scintigraphy helps to detect metastases in the skeleton. Lung metastases can be seen on X-rays of the chest (x-ray thorax) by means of liver metastases on ultrasound of the upper abdomen.
If the doctor suspects that the man’s breast cancer has already spread to other organs, he may also arrange for a computer tomography with a contrast agent to reveal as many metastases as possible.
Treatment of breast cancer in male
Breast cancer in male is not as well studied in studies as in women. Like the diagnosis, the treatment is therefore based on the recommendations for female breast cancer. First and foremost is the surgical removal of the tumor. Depending on how far advanced the breast cancer is and how high the individual risk is, further therapies follow. The doctor also treats any concomitant diseases.
By participating in studies, you can advance male breast cancer research. Ask your doctor if you are interested.
Breast cancer in male is usually operated on. In most cases, the entire breast tissue has to be removed (mastectomy), because men have very little breast tissue overall and the tumor is often located in the very center. If the tumor is very small in relation to the breast, breast-conserving surgery may also be possible surgery may be possible, leaving healthy tissue behind.
During the procedure, the doctor also removes directly adjacent lymph nodes and has them examined in the laboratory during the breast cancer surgery. If they are already affected by cancer, it usually removes the entire neighboring lymph node area at the same time.
After an operation, all removed tissue parts are sent to the laboratory and examined there for histological examination. Among other things, doctors can determine the exact size of the breast cancer focus and use this to plan further therapy.
After the operation, the doctor often also carries out radiation therapy (adjuvant radiation). He wants to kill any tumor residues with it. Radiation is necessary, for example, if the tumor measures two centimeters or more in diameter or if neighboring lymph nodes are affected by cancer (then also radiation of the lymphatic drainage tract). In the case of tumors that do not grow in a hormone-dependent manner, the doctor also irradiates the chest wall after the operation.
Anti – hormone therapy
Breast cancer in male almost always grows dependent on hormones (more precisely: estrogens). Cancer cells have numerous estrogen receptors on their surface. Then an anti-hormone therapy with tamoxifen (after the operation, i.e. adjuvant) comes into question. Tamoxifen occupies the estrogen receptors and thus blocks cancer growth. This can reduce the risk of recurrence.
Tamoxifen is usually taken for at least five years after surgery. Possible side effects include reduced sexual desire, impotence, hot flashes and mood swings.
For women with estrogen-dependent breast cancer, there are other drugs available for hormone treatment, including so-called aromatase inhibitors. However, these are not usually recommended for breast cancer in male – according to studies, the administration of aromatase inhibitors in male patients is associated with a significantly increased mortality rate. The drugs are therefore only considered in certain cases, such as when the breast cancer is very advanced and has already formed metastases.
After breast cancer surgery (adjuvant), the doctor may also initiate chemotherapy. This can improve the patient’s prognosis. In the case of an advanced tumor, the doctor administers the chemotherapeutic agents (cytostatics) before the surgical intervention (neoadjuvant). This is intended to shrink the tumor so that it can then be removed more easily.
Chemotherapy drugs are very powerful drugs that kill cancer cells. But they can also have significant side effects. Therefore, the doctor decides whether chemotherapy makes sense depending on the tumor stage, age and state of health of the patient. He also takes into account how well the patient tolerates the chemotherapy and whether he actually wants such treatment.
Male breast cancer is sometimes HER2 positive. This means that there are numerous docking sites for growth factors (HER2/neu receptors) on the surface of the cancer cells. Treatment with antibodies against these receptors, such as trastuzumab, is an option here. In female patients, this antibody treatment is often very effective. Experts therefore assume that HER2-positive breast cancer in male can also be treated with trastuzumab. So far, however, there is no reliable evidence of this.
Breast cancer in male: rehabilitation and aftercare
Rehabilitation after breast cancer aims to alleviate the physical, psychological and social consequences of the disease and therapy. The rehabilitation plan includes, for example: A sports and exercise program, psychological counseling and support for professional reintegration.
As part of aftercare, healed patients are cared for for a longer period of time of time. In this way, the doctor can detect a possible breast cancer recurrence at an early stage. The follow-up examinations are carried out quite frequently at first, and later at longer intervals.
In principle, rehabilitation and aftercare for breast cancer in male are based on the corresponding recommendations for women with breast cancer.