Male Breast Cancer

DEFINITION

Breast cancer does occur in men, although it is less common. Men do not think of themselves as at risk for breast cancer, so masses felt in the breast tissue will often be ignored, rather than seeking the help of a doctor. DNA normally controls how the cells grow and reproduce. In breast cancer, the DNA of these cells has a mutation that allows the cells to grow and reproduce at a very high rate. Instead of dying like a normal cell, these cells live a particularly long time and can spread through the body. In breast cancer, these abnormal cells form a mass in the breast that can metastasize to the lymph nodes and throughout the body. Men have the same types of cells in their breasts as women do, but in a smaller amount. Most commonly, breast cancer starts in the milk-producing ducts of the breasts. Breast cancer beginning in the duct is called invasive ductal carcinoma. Breast cancer that starts in the lobular part of the breast is called invasive lobular carcinoma. Breast cancer can come from other areas in the breast, including the nipple but this is less common. Men can also inherit some of the genes that put them at a higher risk for breast cancer, like BRCA-1 and BRCA-2 which also put a man at higher risk for prostate cancer. Breast cancer in men has a good chance of being cured, but only if it is found early. Risk factors include older age, high intake of alcohol, family members with breast cancer, Klinefelter’s syndrome, using medications containing estrogen, liver disease (which can increase estrogen in the body), obesity, and previous exposure to radiation.

SYMPTOMS
Mass in the breast, nipple discharge that is bloody or dark, thickening of the breast tissue, change in skin of the breast, flaky or peeling skin of the nipple, red coloration of skin of the breast, pitting in the skin of the breast, increasing size of the breast, change in shape of the breast, inverted nipple

DIAGNOSIS
The diagnosis of breast cancer begins with a thorough history and physical exam by your doctor. Your doctor will focus specifically on the breast and surrounding to tissue to feel for lumps, check for discharge, and check for lymph nodes. After this initial exam, your doctor will likely want to do some further imaging. A mammogram is the most common screening tool for breast cancer. Mammogram involves pressing the breast so they are slightly flatter and taking an X-ray which is then examined for abnormalities. Another imaging option is breast ultrasound, a sonogram of the tissue of the breast to looks for masses or abnormalities. Your doctor may also recommend imaging with breast magnetic resonance imaging (MRI) which involves lying in a small tube while a machine that surrounds you takes pictures. If an abnormality is found on one of these imaging tests, your will likely see a surgeon for a biopsy. Fine needle aspiration is a type of biopsy that involves placing a long, thin needle into the mass found on imaging and taking out some of the cells in that area. These cells are then sent to a pathologist who looks at the cells under a microscope with special stains to determine if they look abnormal. If needed, a surgery may be done to get a bigger biopsy sample. If you have nipple discharge, your doctor may collect a sample to send to the pathologist as well. If you are found to have cancer, your oncologist (cancer doctor) and surgeon will want to do “staging” to determine how severe the cancer is and where it has spread. In order to do staging, your doctor may use blood tests, mammogram, chest x-ray, breast MRI, bone scan, CT scan, or PET scan.

TREATMENT
The treatment for male breast cancer depends on the type of cancer as well as the stage of the cancer. Generally, treatment for breast cancer involves a combination of surgery with at least one other treatment like radiation, chemotherapy, or hormone therapy. It is very important to talk to your doctor and other men who have undergone treatment to see what options are best for you. Surgery to remove breast cancer can be done in a number of ways including lumpectomy (which removes the tumor and a little of the surrounding normal tissue), mastectomy (which involves removing the entire breast and the lymph nodes in the armpit), sentinel lymph node biopsy (which involves removing a single lymph node that is near the cancer to see if the cancer has spread to that closest node), and axillary lymph node dissection (which involves removing many lymph nodes from the armpit to determine to how many of the nodes the cancer has spread). Every surgery carries a risk of bleeding and infection, but some breast cancer surgeries can also increase the chances of having swelling in the arm (lymphedema). In combination with surgery, radiation therapy is one option. Radiation therapy is the use of beams of energy focused on a certain area to prevent those cells from growing. Radiation can cause local reddening and pain of the skin as well as other, more rare problems. Chemotherapy is another treatment option for breast cancer. Chemotherapy is the set of medications that are given to decrease the growth rate of rapidly growing cells, like the cells in cancer. Chemotherapy can be given before surgery to shrink the size of the tumor, with surgery, or after surgery to decrease the risk of recurrence. For people with disease that has spread, chemotherapy may help decrease some of the symptoms from that spread. Because chemotherapy decreases the rate of growth for rapidly dividing cells, other parts of the body including the blood may be affected. Common side effects are feeling fatigue, hair loss, low blood counts, and nausea. Certain types of breast cancer are susceptible to hormone therapy. Hormone sensitive breast cancers are very common in men. Hormone therapy blocks hormones that these cancers need to grow and thrive. These medications include those that decrease production of hormones in the body (aromatase inhibitors) and those that block hormones from getting to the cancer cells (selective estrogen receptor modulators). Surgery can also be done on the ovaries to stop the production of hormones. Blocking hormones can have side effects that are similar to the symptoms of menopause like vaginal dryness, hot flashes, mood swings and decreased sex drive as well as increased risk of osteoporosis. Some types of breast cancer are susceptible to targeted drugs like trastuzumab (Herceptin), bevacizumab (Avastin), and lapatinib (Tykerb). These medications can be quite expensive and may not be covered by your health insurance. You should discuss all of your treatment options with your doctor to help determine the best treatment plan for you. No alternative treatments are known to help cure breast cancer, but many alternative treatments can help for the side effects of breast cancer treatment. To help combat fatigue, you might try light exercise, managing stress with relaxation techniques, and other types of relaxing activities like reading or taking a warm bath. It is very important to communicate with your family and friends and seek out a strong support network in order to cope with your diagnosis and treatment. You should consider educating yourself on your disease and share that information with others. You may find that joining a support group of other people with your disease is helpful including places like the Breast Cancer Network and Cancer Care. Make sure to keep your partner close as they may be the biggest support you have through your illness. Most importantly, make sure to take care of yourself and your body which means continuing to do things you enjoy, resting when you need to, and eating well. To prevent breast cancer, you should do regular self breast exams and have screening done regularly. You should avoid alcohol or limit yourself to one drink per day. Exercise and maintaining a healthy weight can also help decrease the chances of getting breast cancer. If you are at high risk for breast cancer, you should see a doctor about possible treatments such as medications and surgeries to prevent breast cancer in the future. You should make sure to have an open discussion about your concerns with your doctor.