Definition and Overview

Carcinoma of the male breast is the most common type of breast cancer in men. The term carcinoma means that cancer begins in the lining of internal organs or epithelial tissue cells.

Contrary to popular beliefs, men can also get breast cancer because just like women, they also have breast cells and tissue that have the potential to develop the disease. However, male breast cancer is very rare accounting to less than 1% of all breast cancers. A man’s lifetime risk of breast cancer is one in 1,000. However, the mortality rate is higher in men than women due to lack of awareness and because men are less likely to assume that a lump in their breast is cancer. This causes a delay in seeking treatment.

Although carcinoma of male breast can occur at any age, most patients who are diagnosed with the condition are between the ages of 60 and 70 years old. Breast cancer in men rarely affects both breasts with up to 99% of cases affecting only one breast.

Other than cancer, men can also develop other breast disorders with gynaecomastia (male breast enlargement) being the most common. Characterised by disk-like growth under the nipple and areola, it is often caused by hormonal imbalance and commonly occurs in teenage boys and older men.

Causes of Condition

Young boys and girls have breast tissue consisting of tubular structures called ducts. These ducts start to grow and lobules (milk glands) start to develop when girls’ ovaries begin to produce oestrogen. Testes, on the other hand, produce male hormones, including testosterone, that suppress the development of lobules and growth of breast tissue, leaving them with underdeveloped ducts as well as a small amount of fat and connective tissue. Male breast cancer occurs when cancerous or malignant cells develop in or around the ducts.

The reasons why breast cancer develops are not yet fully understood. However, studies confirm that both genetic and environmental factors are likely to play a role. These include:

  • Liver cirrhosisCirrhosis is a medical condition that keeps the liver from producing proteins that help transport and deliver both female and male hormones through the bloodstream. Men with this condition typically have higher blood levels of oestrogen, which elevates their risk of breast cancer.

  • Genetics – Men who have inherited mutations in their BRCA-2 gene have a lifetime risk of about six in 100 of developing men’s breast cancer.

  • Klinefelter's syndrome – This is a chromosomal condition in which men inherit an extra female X chromosome resulting in various symptoms including small testes that do not produce enough testosterone, delayed or incomplete puberty, infertility, and breast enlargement.

  • Radiation exposure – Men who have undergone radiation therapy for the treatment of another type of cancer have an increased risk of breast cancer.

Key Symptoms

The most common male breast cancer symptom is the presence of a firm but painless mass below the nipple. Most patients do not have other symptoms while others also notice skin changes above the mass as well as redness and scaling of the nipple. Thus, men and women who have unusual lumps in their breast are encouraged to consult a medical professional as soon as possible. The survival rate for this condition largely depends on early detection as this increases treatment options.

Breast cancer that has spread to other parts of the body causes other symptoms depending on which organ has been affected.

Who to See and Types of Treatments Available

Men with breasts and who are suspected of having breast cancer undergo a biopsy (fine needle aspiration or needle biopsy), a standard, useful diagnostic tool in which a small amount of breast tissue is obtained and carefully analysed under a microscope. If biopsy results confirmed the presence of breast cancer, additional tests are performed to determine the stage of the disease (cancer staging). These include the following:

  • Bone scan (to determine if cancer has spread to the bones)

  • Computed tomography (CT) scan

  • Magnetic resonance imaging (MRI) scan

  • Ultrasound

  • X-rays

Treatment of carcinoma of male breast depends on many factors including the patient’s overall health condition, preference, age, and the stage of cancer. Treatment options for this disease are the same as for breast cancer in women.

Most men diagnosed with breast cancer undergo a modified radical mastectomy, a surgical procedure that removes the affected breast and surrounding lymph nodes. Depending on the severity of the condition, some parts of the chest wall muscles may also be resected. Surgery is often followed by adjuvant therapies especially in cases where the cancer has already spread to the lymph nodes. These therapies include chemo, hormone, targeted, and radiation therapies.

The five-year survival rates largely depend on the stage of the disease and how soon treatment is given from the onset of symptoms of breast cancer in men. For patients with stage 0 breast cancer (the cancer cells have not spread beyond the boundaries of the ducts), the survival rate is 100%. This is the reason why it is important to seek treatment as soon as signs of breast cancer in men start to show. The survival rates go down dramatically as the disease progresses. The five-year survival rate for patients with stage IV or metastatic cancer is 20%. Patients with stage IV breast cancer are offered palliative treatment, which goal is not to cure the disease but to manage symptoms and ensure that patients are comfortable as much as possible.

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