Key learning points:
– Male breast cancer is rare, accounting for around 1% of all breast cancer diagnoses
– The numbers of men being diagnosed is increasing
– Hormone status can direct treatment options
Male breast cancer, the term sounds like an oxymoron, but men too can get breast cancer, although it’s quite rare. In fact, less than 1% of all breast cancers are diagnosed in men. A diagnosis of breast cancer in a man is often met with scepticism with the following quotes being recorded: “I guess every article you ever read is about women with breast cancer… and nothing ever says, oh by the way chaps you can get it too.”1 Even so, about 400 men this year will be diagnosed with breast cancer in the UK, and sadly about 80 of these men die from the disease.2
Worryingly, the incidence of male breast cancer is rising.3,4 There is some speculation in to why this is, but no concrete answers have emerged. One proposal is that changes in diet and lifestyles over the last few decades have shifted the average body composition towards a more obese/overweight state. This may be a contributing factor as obesity is linked to cancer predisposition, and breast cancer is no exception.5,6 Raising awareness of breast cancer in men is therefore crucial and it is pleasing to see this starting to be achieved in several ways (see resources section). People may not be aware that male breast cancer has its own ribbon; pink with a tinge of blue
Signs, symptoms and risk factors of breast cancer in men
With limited public awareness about male breast cancer, men are on the whole less likely than women to report potential signs of breast cancer, such as lumps in their breast tissue. Because of this, the condition is often diagnosed later when it is harder to treat.
The main signs to lookout for are:
– A lump or thickening of the breast; near the nipple or in the armpit (often painless).
– Change in size or contours of breast.
– Discharge or bleeding from the nipple.
– Change in colour or appearance of areola.
– Redness or pitting of skin over the breast, like the skin of an orange.
– Occasionally the nipple retracts.
It is important to be aware that increases in size of both breasts are almost always non-cancerous. This is simply an enlargement of the natural breast tissue that all men have. This is called gynecomastia, informally known as ‘man-boobs’.
Risk factors for men are typically:
– Age: the number one risk factor (60+).
– Genetics: having breast cancer family history (specifically BRCA2 mutations).
– A genetic background of XXY also known as Klinefelter’s syndrome.
– Exposure to radiation (usually from previous treatment from a non-breast cancer).
– Prostate cancer.
– Obesity: fat cells actually produce estrogen (more fat = more estrogen).
– Estrogen administration (gender reassignment for example).
– Liver cirrhosis, as this can alter hormone balance.
Communicating with male breast cancer patients
It is often challenging to communicate with male breast cancer patients.1 In addition to the stress of a breast cancer diagnosis, there are often social and psychological factors to consider as breast cancer is typically considered a female disease. Even in a clinical setting, if a male breast cancer patient is accompanied by a woman, many people (staff and patients) naturally assume that he is there supporting the woman, as currently very few centres have sufficient resources to offer male-only breast clinics. Clear communication is necessary to support men in dealing with a breast cancer diagnosis and returning to as normal a life as possible following treatment. Surveys show that male breast cancer patients would benefit from receiving gender-specific information, with breast care nurses reported as being the most helpful in providing both information and practical support of all healthcare professionals.7 It should be recognised that the patients’ needs go beyond immediate diagnosis and treatment. One fifth of male breast cancer patients develop significant long-term emotional or psychological difficulties that seriously affect their quality of life after treatment for cancer.1 Being sensitive to this perspective of care can help alleviate feelings of fear. Most frequent is the fear of the cancer coming back after surgery (recurrence).8 Disclosing their diagnosis to family was influenced by perceptions of embarrassment, stigma and altered body image.1
The mainstay treatment for male breast cancer, as with the majority of cancer, is surgery. The aim is two-fold. Firstly, is complete removal (or ‘debulking’) of any tumour mass; secondly, is to discover if the primary tumour has spread to the lymph nodes in the armpit. Men with breast cancer usually have a mastectomy. This removes the cancer, residual breast tissue, and often nearby muscle and most of the lymph glands in the armpit.
Radiotherapy is a common follow on treatment for breast cancer in men. Rarely prescribed alone, this aims to destroy any remaining cancer cells and reduce the chance of recurrence.
Drug therapies are available for breast cancer. But few are tailored specifically for men. As male breast cancer is so rare, development of a gender-specific clinical trial has proved almost impossible due to insufficient numbers. For that reason, drug therapy tends to be based on treatments known to work well in women. Within this treatment category there are three options that can be chosen to treat male breast cancer. Chemotherapy, hormonal therapy and targeted therapies. Which treatment course men receive is dependent on several factors that are best discussed with their oncologist on a case by case basis. Chemotherapy is the treatment with one or a combination of anti-cancer drugs. These drugs are termed cytotoxics. Each drug works in a different way to target cancer cells dividing, spreading or recurring. Hormonal therapies work by blocking signals from outside the cell from instructing cancer cells to grow and divide. Typically more than 90% of male breast cancers are receptive to hormonal therapy. This is termed hormone positive breast cancer.
This means growth signals can be blocked by some drugs. Tamoxifen is the gold standard hormone treatment for male breast cancer.9,10 Tamoxifen temporarily occupies cell surface receptors on the cancer and prevents growth signals from transmitting into the cells. Tamoxifen increases men’s survival when used with other treatments.11
Targeted therapies, such as herceptin, specifically attack cancer cells directly. They do not usually affect healthy tissues and so do not cause side effects such as feelings of nausea and hair loss associated with chemotherapy. Unfortunately very few men are suitable for this treatment as herceptin relies on the presence of a particular receptor that is found only rarely in male breast cancer.
Caring for male patients who have breast cancer
Studies suggest that men requested more information following their diagnosis compared to women.6 This should be assessed on a case by case basis by the primary care nurse. However, from experience some men can feel information overload especially during after care. In addition, primary care nurses provide continuity of care for patients and should continue to promote collaborative and compassionate partnerships with both patients and their families.
Research into male breast cancer
Recently scientists have begun to compare male and female breast cancer at a genetic level, which is starting to reveal gender-specific differences.12,13
The UK charity Breast Cancer Now (see resources section) has established a national tissue bank aimed at collecting tissue and blood samples from male (and female) breast cancer patients, which are available to the research community. Currently patients at four UK sites (Leeds, London, Nottingham, and Sheffield) are invited to donate their surplus tissue and blood to the Breast Cancer Now tissue bank. The importance of this resource to researchers cannot be overstated; allowing access to rare samples that would otherwise be unavailable will help shape the future of research into male breast cancer by understanding more about the disease and, potentially, help identify unique targets for treating the disease.
The lack of public awareness of male breast cancer means men are less likely to report symptoms early which would benefit their treatment. This needs to change. Although breast cancer will always be a rare disease in men it is likely to be an increasing issue. Improved awareness by healthcare professionals is a necessary first step in the diagnosis and management of the condition.
John W Nick foundation
Protect the Pecs
His Breast Cancer
Breast Cancer Now
1. Iredale R, Brain K, Williams B, France E, Gray J. The experiences of men with breast cancer in the United Kingdom. European Journal of Cancer. 2006 42(3):334
2. Breast Cancer Now. Men with Breast Cancer. http://breastcancernow.org/ (accessed 15 Jun 2015)
3. Speirs V, Shaaban AM. The rising incidence of male breast cancer. Breast Cancer Ressearch and Treatment. 2009;115:429–430. doi 10.1007/s10549-008-0053-y
4. Giordano S, Cohen D, Buzdar A, Perkins G, Hortobagyi G. Breast carcinoma in men: a population-based study. Cancer. 2004;101:51 - 7
5. Popkin BM, Adair LS, Ng SW. NOW AND THEN: The Global Nutrition Transition: The Pandemic of Obesity in Developing Countries. Nutrition Reviews. 2012;70(1):3-21. doi:10.1111/j.1753-4887.2011.00456
6. Humphries MP, Jordan VC and Speirs V. Obesity and Male Breast Cancer: Provocative Parallels? BMC Medicine. 2015. 13:134
7. Iredale R, Williams B, Brain K, France E, Gray J. The information needs of men with breast cancer. British Journal of Nursing. 2007 May 10-23;16(9):540-4.
8. Armes, Jo et al. Patients’ supportive care needs beyond the end of treatment. Journal of Clinical Oncology. 2009;27:(36)6172
9. Zagouri F, Sergentanis TN, Chrysikos D, Dimopoulos MA, Psaltopoulou T. Fulvestrant and male breast cancer: a pooled analysis. Breast cancer research and treatment. 2015;149(1):269-75. doi:10.1007/s10549-014-3240-z
10. Jordan VC. Tamoxifen as the first targeted long-term adjuvant therapy for breast cancer. Endocrine Related Cancer. 2014;21(3):R235-46. doi:10.1530/erc-14-0092
11. Eggemann H, Ignatov A, Smith BJ, Altmann U, von Minckwitz G, Rohl FW et al. Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients. Breast cancer research and treatment. 2013;137(2):465-70. doi:10.1007/s10549-012-2355-3
12. Callari M, Cappelletti V, De Cecco L, Musella V, Miodini P, Veneroni S et al. Gene expression analysis reveals a different transcriptomic landscape in female and male breast cancer. Breast cancer research and treatment. 2011;127(3):601-10. doi:10.1007/s10549-010-1015-8.
13. Johansson I, Nilsson C, Berglund P, Lauss M, Ringner M, Olsson H et al. Gene expression profiling of primary male breast cancers reveals two unique subgroups and identifies N-acetyltransferase-1 (NAT1) as a novel prognostic biomarker. Breast cancer research: BCR. 2012;14(1):R31. doi:10.1186/bcr3116.
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