Imagine waking up in the morning and feeling a firm spot in your chest area in the shower. You might think you bruised yourself. Or lifted a few too many weights. Or, more likely, you don’t think anything at all. You almost definitely don’t think, “I wonder if that’s breast cancer?” Because breast cancer isn’t something men get, right? Wrong, of course. Men do get breast cancer and it requires urgent treatment. Here’s what to know about the disease.
We went to some of the nation’s top experts in breast cancer to bring you the most up-to-date information possible.
P. Hank Schmidt, M.D.Breast Surgical Oncologist
Veronica Jones, M.D.Breast Cancer Surgeon and Assistant Clinical Professor
Jonathan Stegall, M.D.Medical Director
If you’re a guy and you’re on top of your health game, you know a few things. Like colorectal cancer is real and you should get checked at your annual once you turn 45. And exercise is good and can help you avoid high cholesterol and diabetes.
What you probably don’t spend a lot of time thinking about is breast cancer. Because even if you know that men get it, you probably also know that the odds are really slim. Which is true, but so are the odds of getting struck by lightning, and you still don’t go swimming in a thunderstorm, do you?
Knowing the signs and symptoms of the disease and reaching out to your doctor the minute you suspect something could be wrong is crucial in the fight against male breast cancer. Delays in reporting a lump contribute to breast tumors in men being diagnosed at later stages than in women. The earlier breast cancer is found and treated—in men and women—the more curable it is. Here’s what you need to know.
Breast cancer in men is rare. The average guy has a one in 833 chance of developing the disease at some point in his lifetime compared to a one in eight chance for women. Nevertheless, that’s not zero percent risk: About 2,670 men in the United States were diagnosed with breast cancer in 2019, according to American Cancer Society estimates, and the rates are on the rise. One reason may be that people are living longer: Although breast cancer can develop at any age, it’s most common in men over age 60.
Approximately 400 to 500 men die of the disease each year. As with breast cancer in women, the chances of survival with male breast cancer is highest when caught early. The average 5-year survival rate (defined as the percentage of people in a study who are alive five years after diagnosis) for men with stage 0 or 1 breast cancer is 100%. For stage 2, the 5-year survival rate for men is 87% and for stage 3 it’s 75%. For advanced, stage 4 breast cancer that has spread to other organs or parts of the body (also called metastatic breast cancer) the 5-year survival rate is 25%.
What Causes Breast Cancer in Men?
Despite the fact that men don’t talk about their “breasts,” here’s a crazy-but-true fact: The tissue in men’s chest area includes both milk ducts and mammary glands—two essential components for women’s breasts. Because men aren’t exposed to large amounts of estrogen during puberty, this tissues typically remains small and undeveloped. The structures are still there, though, and the cells there can grow out of control just like those in women’s breast tissues can.
Exactly what triggers cancer in breast cells isn’t well understood, but there are a couple of primary suspects. The first is your genes. Genes tell all the cells in your body how to behave, and certain changes or mutations in the DNA of your genes can signal to normal breast cells to become cancerous. Some of these DNA mutations get passed down from your parents but others are caused by things like exposure to cancer-causing chemicals and the way you live your life.
These are some of the factors that increase a guy’s risk of developing breast cancer:
Gene Mutations. BRCA1 and BRCA2 gene mutations, inherited from your parents, greatly boost your risk of breast cancer. Men with the BRCA1 gene mutation have a one in 100 risk of developing the disease and men with BRCA2 have a seven in 100 chance, compared with the average man’s risk of one in 833. If you are diagnosed with breast cancer, your doctor may test you for these mutations in order to help determine the risk of recurrence and to help protect the health of your kids and other family members who may also be at genetic risk.
Family History. Having a close relative (mother, father, or sister) or several more-distant relations who’ve had the disease raises your risk whether you carry the BRCA genes or not. About one in five men who develops breast cancer has a family history of the disease.
Age. Simply getting older increases the risk of male breast cancer. The average age of diagnosis is 65.
Hormones. Higher levels of estrogen can increase the chances that a man will develop breast cancer. Cirrhosis of the liver can lead to higher estrogen, as can Klinefelter’s syndrome, a rare genetic disease in which men are born with an extra X chromosome.
Body Fat. You can’t control your genes or your age, but you can control your body mass index (BMI) through exercise, and that’s good news, because high levels of body fat have been linked to increased risk of breast cancer in men. Many cancer experts recommend 150 minutes per week of moderate exercise (about 20 minutes daily), or 75 minutes per week of vigorous exercise.
Male Breast Cancer Symptoms: Do You Have Them?
Having one or more of these symptoms doesn’t automatically mean you have breast cancer—but it’s better to be safe than sorry! Any new or unexplained changes in your nipple area, chest, or underarms should be checked out by a doctor.
A lump. This is the most common symptom of male breast cancer. Most of the time, a cancerous male breast cancer lump feels hard, painless, and won’t move around when you press on it. There can also be a thickening of the breast tissue or areas under the arm, where there are several lymph nodes.
Nipple issues or skin changes. Any changes to the nipple or skin of the chest area such as puckering, dimpling, or leaking fluid should be checked out ASAP. A red, scaly rash around your nipple, for instance, can be a symptom of Paget disease, a type of breast cancer that affects the skin. A rare cancer called inflammatory breast cancer can make the skin red, warm, and swollen.
A doctor will make a diagnosis for male breast cancer based on a few different tools. Usually, you’ll start with a physical exam, then be sent for imaging and other tests.
During a clinical breast exam, your doctor will use his or her hands to feel for lumps or swelling in the chest area.
Mammogram. This diagnostic tool takes a detailed x-ray of the breast tissue from the top and side to look for any abnormalities in the tissue.
Ultrasound. This diagnostic machine uses high-frequency sound waves to make an image of the breast tissue. If something unusual appears on your mammogram, an ultrasound can help distinguish between fluid-filled cysts (probably not cancer) and solid masses (need more testing).
During a biopsy, the doctor will take a tiny amount of fluid or tissue from the breast—either through a needle or with a scalpel—and test them for cancer. Biopsy is the only way to definitively diagnose or rule out male breast cancer.
What Kind of Male Breast Cancer Do I Have?
If a biopsy shows that a tumor is cancerous, doctors will run other tests to figure out what type of breast cancer it is. Those tests may involve:
Evaluating your tumor grade. Looking at the cells of a tumor under a microscope can help your medical team decide whether the tumor is high-grade (more likely to return) or low-grade (less likely to spread or come back), and how aggressively to treat the disease.
Molecular testing. Doctors often run tests on breast cancer cells to look for certain proteins, genes, and other features that will help dictate what medications and treatments will work best on that specific tumor.
Figuring out your type of cancer is important, as different tumor characteristics affect prognosis and treatment, including:
Hormone-positive tumors. This type of male breast cancer depends on estrogen or progesterone to grow. It can be treated with hormone-therapy drugs and often has a better prognosis—at least in the short-term—than other tumors. A majority of male breast cancers are hormone-receptor positive.
HER2-positive tumors. All breast cells contain a protein called HER2/neu. Tumors that make too much of these proteins are called HER2-positive. They tend to grow faster than HER2-negative tumors. On the plus side, they can be treated with targeted medications that work on the HER2 protein.
Triple-negative tumor. This type of cancer does not depend on estrogen or progesterone to grow and doesn’t have high levels of HER2. It tends to be more aggressive than other types of breast cancer.
What Is the Best Treatment for Male Breast Cancer?
Your doctor will probably recommend surgery to remove your breast cancer tumor, and you may need more care after that. The best combination of treatments for male breast cancer depends on the type and stage and whether it has spread to other areas of the body.
You will work with your cancer care team, including cancer surgeons, oncologists (cancer experts), and your primary care doctor before deciding which treatment options are best for you.
The most common surgery for men with breast cancer is known as a modified radical mastectomy. During this procedure, the surgeon will remove all breast tissue including the nipple and areola, sometimes part of the muscles in the chest wall, and some lymph nodes under the arm.
Another option for some men is a lumpectomy plus radiation therapy. In this surgery, the tumor is removed, but not all of the breast tissue. The patient will have radiation treatment later on to help kill any cancer cells that may have been left behind and keep it from growing back.
Following surgery, your doctor may recommend radiation therapy, which targets the chest wall, and sometimes also the regional lymph nodes.
In addition to surgery and radiation, your cancer care team may suggest certain medications that lower your odds of the cancer returning. These include:
Chemotherapy, a type of medication used to kill or shrink cancer cells.
Hormonal therapy, often used to treat hormone-positive cancers.
Other medications, used to encourage a person’s own immune system to kill cancer cells or to target specific proteins in some cancers (such as HER2-positive tumors).
Finding and talking to people who know exactly what you’re going through can make treatment less stressful. Here are some useful organizations and support groups that can offer resources during your breast cancer journey and help you meet other guys going through breast cancer treatment.
Not very. Only one in 833 men get breast cancer compared to one in eight women. That number rises to as many as seven in 100 men if you have a genetic predisposition to the disease. As many as 500 men die every year from breast cancer.
How will my doctor check for breast cancer?
The first thing your doctor will do is perform a clinical exam, where he or she will feel your chest area for anything out of the ordinary. Next, you may go for either a mammography or ultrasound imaging test. If your doctor sees something on one of these exams, you may also need a biopsy.
What’s my prognosis like?
Pretty good! For men with stage 0 or 1 breast cancer, the survival rate is 100%. For stage 2, the 5-year survival rate for men is 87% and for stage 3 it’s 75%. For advanced, stage 4 breast cancer that has spread to other organs or parts of the body (also called metastatic breast cancer) the 5-year survival rate is 25%.
What causes male breast cancer?
No one knows for sure. Genes, family history, your age, certain hormones, and body fat levels all play a role in determining your risk for the disease. Because breast cancer treatment success is directly tied to how early it’s discovered, see your doctor if you have any worries about something being wrong.
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