Breast Cancer – Male

Breast Cancer – Male

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Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
Breast cancer may occur in men. Men at any age may develop breast cancer, but it is usually detected (found) in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer.

The following types of breast cancer are found in men:

Infiltrating ductal carcinoma: Cancer that has spread beyond the cells lining ducts in the breast. Most men with breast cancer have this type of cancer.

Ductal carcinoma in situ: Abnormal cells that are found in the lining of a duct; also called intraductal carcinoma.

Inflammatory breast cancer: A type of cancer in which the breast looks red and swollen and feels warm.

Paget’s disease of the nipple: A tumor that has grown from ducts beneath the nipple onto the surface of the nipple.

Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast), which sometimes occurs in women, has not been seen in men.

Radiation exposure, high levels of estrogen, and a family history of breast cancer can affect a man’s risk of developing breast cancer.

Risk factors for breast cancer in men may include the following:
Exposure to radiation.

Having a disease related to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter’s syndrome (a genetic disorder).

Having several female relatives who have had breast cancer, especially relatives who have an alteration of the BRCA2 gene.

Male breast cancer is sometimes caused by inherited gene mutations (changes).

Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men.

A doctor should be seen if changes in the breasts are noticed. Typically, men with breast cancer have lumps that can be felt. A biopsy can be done to check for cancer. The following are different types of biopsies:

Needle biopsy or fine-needle aspiration biopsy: The removal of fluid or tissue with a very thin needle for examination under a microscope.

Core biopsy: The removal of a tissue sample with a wide needle for examination under a microscope.
Excisional biopsy: A surgical procedure in which an entire lump or suspicious area is removed for diagnosis; the tissue is then examined under a microscope.

Survival for men with breast cancer is similar to survival for women with breast cancer.

Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, whether the cancer is found in the other breast, and the patient’s age and general health.

Stages of Male Breast Cancer
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. Breast cancer in men is staged the same as it is in women. (Refer to the PDQ summary on Breast Cancer Treatment for more information.) The spread of cancer from the breast to lymph nodes and other parts of the body appears to be similar in men and women. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Recurrent Male Breast Cancer

Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.

There are different types of treatment for men with breast cancer.

Four types of standard treatment are used to treat men with breast cancer:

Surgery for men with breast cancer is usually a modified radical mastectomy (removal of the breast, the lining over the chest muscles, and sometimes part of the chest wall muscles). Some of the lymph nodes under the arm may also be removed and examined under a microscope.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Hormone therapy
Hormones are chemicals produced by glands in the body and are circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way a cancer grows. If tests show that the cancer cells have estrogen and progesterone receptors (proteins found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way hormones work or by surgically removing organs that make hormones, such as the testicles. Although estrogen is commonly thought of as a female hormone, it does occur in small amounts in males. Patients with early stages of breast cancer often receive hormone therapy with tamoxifen (an anticancer drug that blocks the effects of estrogen in the body).

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found.

Treatment Options
Breast cancer in men is treated the same as breast cancer in women.

Initial Surgery
Most men diagnosed with breast cancer will receive a modified radical mastectomy (removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles).

Adjuvant Therapy
Therapy given after an operation when cancer cells can no longer be seen is called adjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, and/or hormone therapy after surgery to try to kill any cancer cells that may be left.

Node-negative: For men whose cancer is node-negative (cancer has not spread to the lymph nodes), adjuvant therapy should be considered on the same basis as for a woman with breast cancer because there is no evidence that response to therapy is different for men and women.
Node-positive: For men whose cancer is node-positive (cancer has spread to the lymph nodes), adjuvant therapy may include the following:

Chemotherapy plus tamoxifen (to block the effect of estrogen).

Other hormone therapy.
These treatments appear to increase survival in men as they do in women. The patient’s response to hormone therapy depends on the presence of hormone receptors (proteins) in the tumor. Most breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, including hot flushes and impotence (the inability to have an erection adequate for sexual intercourse).

Distant Metastases
For men with distant metastases (cancer that has spread to other parts of the body), hormone therapy, chemotherapy, or a combination of both has shown some success. Hormone therapy may include the following:

Orchiectomy (the removal of the testicles to decrease hormone production).
Luteinizing hormone-releasing hormone agonist with or without total androgen blockade (to decrease the production of sex hormones).

Tamoxifen for cancer that is estrogen-receptor positive.

Progesterone (a female hormone).

Aminoglutethimide (to lessen the amount of estrogen produced).

Hormone therapies may be used in sequence (one after the other). Standard chemotherapy regimens may be used if hormone therapy does not work. Men usually respond to therapy in the same way as women who have breast cancer.


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