What You Should Know about Male Breast Cancer

By Jane Farrell

Although it’s uncommon, breast cancer can occur in men, and it can be serious. According to the American Cancer Society, about 2,350 cases of invasive male breast cancer will be discovered in 2015, and about 440 men will die of the illness. Those figures highlight the importance of knowing as much as possible about male breast cancer. 

Overview

Male breast cancer is a disease in which malignant cells form in the tissues of the breast.

Radiation exposure, high levels of estrogen, and a family history of breast cancer can increase a man’s risk of breast cancer. Male breast cancer is sometimes caused by inherited gene mutations (changes).

Men with breast cancer usually have lumps that can be felt. Tests that examine the breasts are used to detect and diagnose breast cancer in men. Certain factors affect prognosis  and treatment options.

Breast cancer may occur in men at any age, but it is usually detected in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer.

Types of Male Breast Cancer

The following types of breast cancer are found in men:

• Infiltrating Ductal Carcinoma: cancer that has spread beyond the cells lining ducts in the breast, most men with breast cancer have this type of cancer
• Ductal Carcinoma in Situ: abnormal cells that are found in the lining of a duct; also called intraductal carcinoma
• Inflammatory Breast Cancer: a type of cancer in which the breast looks red and swollen and feels warm
• Paget Disease of the Nipple: a tumor that has grown from ducts beneath the nipple onto the surface of the nipple

Risk Factors

Risk factors for breast cancer in men may include the following:

• Being exposed to radiation
• Having a disease linked to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder)
• Having several female relatives who have had breast cancer, especially relatives who have an alteration of the BRCA2 gene
• Male breast cancer is sometimes caused by inherited gene mutations (changes)

The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up about 5% to 10% of all breast cancers. Some mutated genes related to breast cancer are more common in certain ethnic groups. Men who have a mutated gene related to breast cancer have an increased risk of this disease.

There are tests that can detect (find) mutated genes and are sometimes done for members of families with a high risk of cancer.

Lumps and other signs may be caused by male breast cancer or by other conditions. Check with your doctor if you notice a change in your breasts.

Diagnostic Tests

Physical Exam and History: an exam of the body to check general signs of health, including signs of disease, such as lumps or anything else that seems unusual, a history of the patient’s health habits and past illnesses and treatments will also be taken

Clinical Breast Exam (CBE): an exam of the breast by a doctor or other health professional – the doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual

Ultrasound Exam: a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes, which form a picture of body tissues called a sonogram

MRI (Magnetic Resonance Imaging): a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, this procedure is also called nuclear magnetic resonance imaging (NMRI)

Blood Chemistry Studies: a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body – an unusual (higher or lower than normal) amount of a substance can be a sign of disease

Biopsy: the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer, including:

• Fine-Needle Aspiration (FNA) Biopsy: the removal of tissue or fluid using a thin needle
• Core Biopsy: the removal of tissue using a wide needle
• Excisional Biopsy: the removal of an entire lump of tissue

If cancer is found, these tests can be done to measure the severity of the cancer cells:

• How quickly the cancer may grow
• How likely it is that the cancer will spread through the body
• How well certain treatments might work
• How likely the cancer is to recur

Tests include the following:

Estrogen and Progesterone Receptor Test: Measuring the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.

HER2 Test: Measuring the amount of HER2 in cancer tissue. HER2 is a growth factor protein that sends growth signals to cells. When cancer forms, the cells may make too much of the protein, causing more cancer cells to grow. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out if there is too much HER2 in the cells. The test results show whether monoclonal antibody therapy may stop the cancer from growing.

Survival Factors

Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured.

The prognosis and treatment options depend on the following:

• The stage of the cancer (whether it is in the breast only or has spread to other places in the body)
• The type of breast cancer
• Estrogen-receptor and progesterone-receptor levels in the tumor tissue
• Whether the cancer is also found in the other breast
• The patient’s age and general health

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. There are three ways that cancer spreads in the body and cancer may spread from where it began to other parts of the body.

Evaluating the Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Breast cancer in men is staged the same as it is in women. The spread of cancer from the breast to lymph nodes and other parts of the body appears to be similar in men and women.

The following tests and procedures may be used in the staging process:

• Sentinel Lymph Node Biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
• Chest X-Ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT Scan (CAT Scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Bone Scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
• PET Scan (Positron Emission Tomography Scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Stages of Breast Cancer

Stage 0 (Carcinoma in Situ)

Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues. At this time, there is no way to know which lesions could become invasive.

Paget disease of the nipple is a condition in which abnormal cells are found in the nipple only.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

In stage IA, the tumor is 2 centimeters or smaller. Cancer has not spread outside the breast.

In stage IB, small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes and either: no tumor is found in the breast; or the tumor is 2 centimeters or smaller.

Stage II

Stage II is divided into stages IIA and IIB.

In stage IIA, no tumor is found in the breast or the tumor is 2 centimeters or smaller. Cancer (larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes or in the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes.

In stage IIB, the tumor is:

larger than 2 centimeters but not larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or larger than 5 centimeters. Cancer has not spread to the lymph nodes.

Stage IIIA

no tumor is found in the breast or the tumor may be any size. Cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam); or

the tumor is larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or

the tumor is larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy).

Stage IIIB

In stage IIIB, the tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer may have spread to : up to 9 axillary lymph nodes; orthe lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. Click here to see the section on Inflammatory Male Breast Cancer for more information.

Stage IIIC

In stage IIIC, no tumor is found in the breast or the tumor may be any size. Cancer may have spread to the skin of the breast and caused swelling or an ulcer and/or has spread to the chest wall. Also, cancer has spread to:

• Ten or more axillary lymph nodes
• Lymph nodes above or below the collarbone
• Axillary lymph nodes and lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. Click here to See the section on Inflammatory Male Breast Cancer for more information.

For treatment, stage IIIC breast cancer is divided into operable and inoperable stage IIIC.

Stage IV

In stage IV, cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Treatments

Five types of standard treatment are used to treat men with breast cancer:

• Surgery
• Chemotherapy
• Hormone therapy
• Radiation therapy
• Targeted therapy

For more information, click here.

Reprinted courtesy of the National Cancer Institute (www.cancer.gov).