Male breast can­cer is un­com­mon, but de­layed di­ag­no­sis can al­low the dis­ease to progress be­fore treat­ment be­gins.

Men who no­tice an un­usu­al lump in their breast, nip­ple dis­charge or per­sis­tent dis­com­fort should seek med­ical at­ten­tion prompt­ly, as breast can­cer in males is of­ten de­tect­ed at a more ad­vanced stage.

Un­like women, who may un­der­go rou­tine breast can­cer screen­ing de­pend­ing on their age and risk fac­tors, men are not typ­i­cal­ly of­fered reg­u­lar mam­mo­grams or breast ex­am­i­na­tions for screen­ing. As a re­sult, many dis­cov­er the dis­ease them­selves af­ter notic­ing a change in their chest.

Dr Kathryn Rud­dy, an on­col­o­gist at Mayo Clin­ic Com­pre­hen­sive Can­cer Cen­ter, says a lump is the most com­mon symp­tom of male breast can­cer, al­though oth­er warn­ing signs can in­clude pain in the breast area and dis­charge from the nip­ple.

A breast lump may feel firmer than the sur­round­ing tis­sue and have ir­reg­u­lar edges. Be­cause men gen­er­al­ly have less breast tis­sue than women, the lump is of­ten lo­cat­ed close to the nip­ple.

The most com­mon type of breast can­cer in men is duc­tal car­ci­no­ma, which de­vel­ops in the ducts that car­ry milk in the breast.

“Since breast can­cer screen­ings, such as mam­mo­grams and breast ex­ams, aren’t typ­i­cal­ly rec­om­mend­ed for men, they usu­al­ly find a lump on their own,” Rud­dy ex­plains.

“If men no­tice an un­usu­al lump, ex­pe­ri­ence nip­ple dis­charge, or chest or breast dis­com­fort, they should seek med­ical at­ten­tion prompt­ly to de­ter­mine the cause.”

Age and fam­i­ly his­to­ry

among risk fac­tors

Al­though breast can­cer in men is rare, cer­tain fac­tors can in­crease the like­li­hood of de­vel­op­ing the dis­ease.

Rud­dy says the risk ris­es with age and is greater among men with a fam­i­ly his­to­ry of breast can­cer, par­tic­u­lar­ly male breast can­cer.

In­her­it­ed ge­net­ic mu­ta­tions, in­clud­ing BR­CA1 and BR­CA2, are al­so recog­nised risk fac­tors. Men with Kline­fel­ter syn­drome, a rare ge­net­ic con­di­tion in which a male is born with an ex­tra X chro­mo­some, face an in­creased risk.

Pre­vi­ous med­ical treat­ment may al­so con­tribute. For ex­am­ple, ra­di­a­tion ther­a­py to the chest wall, some­times used to treat lym­phoma, can in­crease the risk of breast can­cer.

Cer­tain ab­nor­mal­i­ties af­fect­ing the tes­ti­cles or liv­er can al­so al­ter hor­mone lev­els and raise the risk.

While the pres­ence of these fac­tors does not mean a man will de­vel­op breast can­cer, aware­ness of per­son­al and fam­i­ly med­ical his­to­ry can help iden­ti­fy those who may need clos­er med­ical at­ten­tion.

Di­ag­no­sis and stag­ing

When a man presents with symp­toms, doc­tors will usu­al­ly be­gin with breast imag­ing, which may in­clude a mam­mo­gram and ul­tra­sound. A mag­net­ic res­o­nance imag­ing (MRI) scan may al­so be used in some cas­es.

If the ex­am­i­na­tion and imag­ing re­sults raise con­cerns, a biop­sy may be rec­om­mend­ed. This in­volves tak­ing a sam­ple of breast tis­sue or cells for lab­o­ra­to­ry test­ing to de­ter­mine whether can­cer is present.

Once di­ag­nosed, male breast can­cer is staged us­ing the same sys­tem ap­plied to women, from stage 0 to stage 4.

Stage 0 refers to non-in­va­sive can­cer that has not spread in­to sur­round­ing breast tis­sue. Ac­cord­ing to Rud­dy, al­most all pa­tients di­ag­nosed at this stage can be cured.

At stage 4, the can­cer has spread be­yond the breast to oth­er parts of the body. Al­though treat­ment can help con­trol the dis­ease, it usu­al­ly can­not elim­i­nate it com­plete­ly.

Fe­male breast can­cers are more fre­quent­ly de­tect­ed at stages 0 and 1, while a greater pro­por­tion of male breast can­cers are di­ag­nosed at stages 2, 3 and 4.

This dif­fer­ence is sig­nif­i­cant be­cause men may not seek med­ical at­ten­tion im­me­di­ate­ly af­ter notic­ing a lump, al­low­ing the can­cer more time to grow or spread to lymph nodes be­neath the arm or oth­er parts of the body.

How­ev­er, Rud­dy notes that when breast can­cer is di­ag­nosed at the same stage, the prog­no­sis for men is no worse than that for women.

Treat­ment de­pends on the stage

Treat­ment op­tions de­pend large­ly on how far the can­cer has pro­gressed.

For men di­ag­nosed with stage 0 to stage 3 breast can­cer, surgery is gen­er­al­ly part of the treat­ment plan. A mas­tec­to­my, which in­volves re­mov­ing the breast tis­sue, is a com­mon op­tion, al­though some men may be suit­able for a lumpec­to­my, in which on­ly part of the breast tis­sue is re­moved.

At stage 4, treat­ment pri­mar­i­ly in­volves med­ica­tion in­tend­ed to fight can­cer through­out the body.

Oth­er treat­ments, in­clud­ing chemother­a­py, hor­mone or en­docrine ther­a­py and ra­di­a­tion, may be rec­om­mend­ed ac­cord­ing to the in­di­vid­ual cir­cum­stances and char­ac­ter­is­tics of the can­cer.

Much of the ev­i­dence guid­ing these treat­ments for men comes from re­search in­volv­ing women with breast can­cer, re­flect­ing the rel­a­tive rar­i­ty of the dis­ease in males.

Re­search aims to
im­prove treat­ment

Ef­forts are un­der way to ex­pand the ev­i­dence base specif­i­cal­ly for men.

The Trans­la­tion­al Breast Can­cer Re­search Con­sor­tium is en­rolling men in the ETHAN tri­al, which is de­signed to in­ves­ti­gate treat­ment ap­proach­es for male breast can­cer.

The tri­al in­volves men re­cent­ly di­ag­nosed with stage 1 to stage 3 dis­ease and ex­am­ines dif­fer­ent com­bi­na­tions of an­ti-oe­stro­gen and tar­get­ed ther­a­py med­i­cines be­fore surgery. Re­searchers hope to de­ter­mine which ap­proach­es are most ef­fec­tive at shrink­ing tu­mours be­fore an op­er­a­tion.

The find­ings could help im­prove treat­ment op­tions for men in the fu­ture.

Break­ing the si­lence

Be­yond the phys­i­cal ef­fects of the dis­ease, a male breast can­cer di­ag­no­sis can car­ry an emo­tion­al bur­den.

Be­cause breast can­cer is more com­mon­ly as­so­ci­at­ed with women, some men may feel iso­lat­ed, em­bar­rassed or re­luc­tant to dis­cuss their di­ag­no­sis.

Rud­dy en­cour­ages pa­tients to speak open­ly with their health­care teams about their emo­tion­al well-be­ing and, where pos­si­ble, con­nect with oth­er male breast can­cer sur­vivors through in-per­son or on­line sup­port groups.

She al­so urges men to pay at­ten­tion to changes in­volv­ing the chest wall, nip­ples, un­der­arms or neck and to seek med­ical ad­vice rather than dis­miss­ing symp­toms.

Men di­ag­nosed with breast can­cer are en­cour­aged to con­sid­er par­tic­i­pat­ing in clin­i­cal tri­als when suit­able op­por­tu­ni­ties are avail­able, help­ing re­searchers de­vel­op bet­ter ev­i­dence-based treat­ments.

Ear­ly de­tec­tion re­mains es­sen­tial. Recog­nis­ing changes, seek­ing prompt med­ical as­sess­ment and re­ceiv­ing ap­pro­pri­ate treat­ment can im­prove the chances of suc­cess­ful out­comes.