Article
MALE BREAST CANCER
In this article:
Although it occurs infrequently, breast cancer can affect men as well as women.
In many ways the disease appears similar in the two sexes. However, because male breast cancer is so uncommon, it has been difficult
for researchers to accumulate extensive data, and several aspects of the disease have been the subjects of disagreement.
In general, men tend to be somewhat older than women at the time of diagnosis, and the disease is often at a more advanced state.
Like woman, men are commonly treated with surgery for primary disease. For advanced disease, they usually receive some kind of hormone therapy,
which is even more effective in men than in women. Men are less likely than women to develop cancer subsequently in the
opposite breast, but more likely to have, or to have had, a second type of cancer.
In the past, men were thought to have a poorer prognosis than women, but it now appears that in cases that are otherwise comparable
any differences in prognosis are slight. The critical factors are prompt diagnosis and treatment.
In the United States male breast cancer accounts for 1 of every 100 cases of breast
cancer, and it represents about 0.2 percent of all malignancies in men. (In women, breast cancer represents 26 percent of all cancers.)
In 1984, approximately 900 in this country will be diagnosed with the disease, and about 300 will die of breast cancer.
In certain parts of the world male breast cancer is more common than in the United States.
The breast of the adult male is similar to the breast of a preadolescent girl. It consists primarily of a few branching ducts lined by flattened cells
and surrounded by connective tissue. In girls, these cells and ducts develop in response to hormones secreted during puberty.
In males, too, breast tissues are capable of responding to hormonal stimulation. Enlargement of the male breast due to growth of the ducts and supporting
tissues is known as gynecomastia. Approximately 40 percent of all adolescent boys experience temporary breast enlargement, probably in response to hormones being secreted by the testes.
Adolescent gynecomastia typically disappears within a year or two.
All of the types of breast cancer seen in women can occur in men, although some are quite rare.
Not surprisingly, lobular carcinomas are very unusual, because lobules are normally absent from the male breast.
Almost all breast cancers in men, like most breast cancers in women, are carcinomas. The most common kind is infiltrating ductal carcinomas, which accounts
for 73 percent of the cancers in men. Men can also develop Paget’s disease and inflammatory carcinoma. Various sarcomas may occur, too, although they are uncommon.
A painless lump, usually discovered by the patient himself, is by far the most common first symptom of male breast cancer.
Typically the lump appears beneath the areola, where breast tissue is concentrated.
However, a lump is seldom the only symptom. Men are more likely than women to have nipple discharge (sometimes bloody) and sign
of local spread, including nipple retraction, fixation to the skin or the underlying tissues, and skin ulceration. About half the men with breast
cancer have palpable axillary lymph nodes.
Most male breast cancers are not large. One study that reviewed a large number of cases found that 51 percent of the tumors
were less than 3 centimeters in diameter. The largest, however, measured 28 by 16 centimeters.
The fact that breast cancer in men has often spread locally before it is diagnosed – even though the small male breast should
facilitate early diagnosis – has been attributed to several factors. Indeed, the very smallness of the male breast could be a factor.
Lacking the bulk of the typical female breast, even a small carcinoma in a male lies close to the skin above it and the tissues of the chest wall beneath
it. Consequently, the cancer can more readily invade these nearby structures. It has also been suggested that the location of male tumors, centered
around the areola as most of them are, may facilitate the spread of cancer. Such centrally located tumors are thought by some to have easy access to
internal mammary lymph pathways.
However, many people are unaware that men can develop breast cancer, and neither individual men themselves nor their physicians regularly
examine men’s breasts. Furthermore, when men discover signs of breast cancer they tend to delay before seeing a physician. A 1972 review of cases
diagnosed since 1900 showed that men waited 18 months, on the average, before seeking medical advice; for men diagnosed since
1951, this dropped to 10 months, 9 such a delay may in part occur because some men perceive breast cancer as a flaw in their masculinity and are
reluctant to acknowledge its presence.
Age: The incidence of breast cancer in men, like breast
cancer in women, increases with increasing age. Although it has been reported
in a 5-year-old boy, it is rare before age 35. The average of men at diagnosis
is close to 65, about 5 years older than the average age for women.
The same procedures used to diagnose breast cancer in women can be used to diagnose breast cancer in men.
These include medical history, physical examination, mammography, and thermography. As always, a definitive diagnosis can be made only by biopsy.
Karyotyping, a technique used to determine a patient’s chromosome pattern, might be used if a disorder like Klinefelter’s syndrome is suspected.
Studies to evaluate estrogen excretion patterns might also be performed.
In examining a man for breast cancer, a physician must distinguish between a malignant breast tumor and benign conditions, primarily
gynecomastia, as well as cancers from other sites that have metastasized to the breast. Metastases to the breast from other types of cancer call for
treatment of the primary cancer, whatever it is. Primary breast cancer, in contrast, is potentially curable through surgery and, perhaps, adjuvant therapy.
(Men’s Health Network)
This newsletter is published and edited by Melvin Latimer
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