MALE BREAST CANCER – Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Stages of Male Breast Cancer and Management
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MALE BREAST CANCER – Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Stages of Male Breast Cancer and Management 

MALE BREAST CANCER – Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Stages of Male Breast Cancer and Management

Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Breast cancer may occur in men. Men at any age may develop breast cancer, but it is usually detected (found) in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer. Men diagnosed with male breast cancer at an early stage have a good chance for a cure.

The following types of breast cancer are found in men:

  1. 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
  2. Ductal carcinoma in situ: Abnormal cells that are found in the lining of a duct; also called intraductal carcinoma
  3. Inflammatory breast cancer: A type of cancer in which the breast look red and swollen and feels warm
  4. Paget disease of the nipple: A tumor that has grown from ducts beneath the nipple onto the surface of the nipple
  5. Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast), which sometimes occurs in women, has not been seen in men


 

CAUSES AND RISK FACTORS

  • Older age – Breast cancer is most common in men age 60 to 70
  • Family history of breast cancer or genetic alternations
  • Excessive use of alcohol
  • Exposure to estrogen and hyperestrogenism (high levels of estrogen)
  • Liver disease
  • Obesity
  • Radiation exposure
  • Klinefelter’s syndrome – this genetic syndrome occurs when a boy is born with more than one copy of the X chromosome. Klinefelter’s syndrome causes abnormal development of the testicles. As a result, men with this syndrome produce lower levels of certain male hormones – androgens – and more female hormones – estrogens


CLINICAL MANIFESTATIONS

Signs and symptoms of male breast cancer can include:

  • A painless lump or thickening in the breast tissue
  • Nipple pain
  • Changes to the skin covering breast, such as dimpling, puckering, redness or scaling
  • Changes to nipple, such as redness, scaling or a nipple that turns inward
  • Ulceration of the skin
  • Bloody or opaque discharge from the nipple
  • Enlarged lymph nodes under the arm


 

DIAGNOSTIC EVALUATIONS

  • Clinical breast exam
  • Mammogram
  • Breast ultrasound
  • Nipple discharge examination
  • Biopsy: using a needle to remove cells for testing
  • Estrogen and progesterone receptor test


 

STAGES OF MALE BREAST CANCER

Stage I: The tumor is no more than 2 centimeters (cm) in diameter (3/4 inch) and hasn’t spread to the lymph nodes

Stage II: The tumor may be up to 5 cm (2 inches) in diameter and may have spread to nearby lymph nodes. Or the tumor may be larger than 5 cm and no cancer cells are found in the lymph nodes

Stage III: The tumor may be larger than 5 cm (2 inches) in diameter and may involve several nearby lymph nodes. Lymph nodes above the collarbone may also contain cancer cells

Stage IV: Cancer at this stage has spread beyond the breast to distant areas, such as the bone, brain, liver or lungs

 

MANAGEMENT

Different types of treatment are available for men with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.

 

  1. Surgery: Surgery for men with breast cancer is usually a modified radical mastectomy (removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles). Breast-conserving surgery, an operation to remove the cancer but not the breast itself, is also used for some men with breast cancer. A lumpectomy is done to remove the tumor (lump) and a small amount of normal tissue around it. Radiation therapy is given after surgery to kill any cancer cells that are left
  2. Chemotherapy: Chemotherapy refers to the administration of toxic drugs that stop the growth of cancer cells. Chemotherapy may be given as pills, as an injection, or via an intravenous infusion, depending upon the types of drugs chosen. Combinations of different drugs are usually given and treatment is administered in cycles with a recovery period following each treatment. Some of the most common chemotherapeutic agents for treating breast cancer are cyclophosphamide, methotrexate, fluorouracil, and doxorubicin (adriamycin). In most cases, chemotherapy is administered on an outpatient basis. Chemotherapy may be associated with unpleasant side effects including hair loss, nausea and vomiting, and diarrhea
  3. Hormone therapy: Hormonal therapy prevents hormones from stimulating growth of cancer cells and is useful when the cancer cells have binding sites (receptors) for hormones. Male breast cancers usually have estrogen receptors and are most commonly treated with the drug tamoxifen, which blocks the action of estrogen on the cancer cells.
  4. Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy may be delivered either externally (using a machine to send radiation toward the tumor) or internally (radioactive substances placed in needles or catheters and inserted into the body). The way the radiation therapy is given depends on the type and stage of the cancer being treated
  5. Targeted therapy:  Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy being studied in the treatment of male breast cancer. Monoclonal antibody therapy uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. ​The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy (treatment given after surgery to lower the risk that the cancer will come back). Trastuzumab (herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2.