Male Breast Cancer

On this page:

• General Information about Male Breast Cancer
• Stages of Male Breast Cancer
• Recurrent Male Breast Cancer
• Treatment Option Overview
• Treatment Options
• Treatment Options for Locally Recurrent Disease

General Information about Male Breast Cancer

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�fs 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�fs 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�fs 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: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle aspiration biopsy.

• Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.

• Excisional biopsy: The removal of an entire lump or suspicious tissue.

After the tissue or fluid has been removed, a pathologist views it under a microscope to check for cancer cells.

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 prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• 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.

• The patient�fs age and general health.

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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 treatment. Breast cancer in men is staged the same as it is in women. The spread of cancer from the breast to lymph nodes and other parts of the body appears to be similar in men and women.

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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.

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Treatment Option Overview

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

Different types of treatment are available for men with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the �gstandard�h treatment, the new treatment may become the standard treatment

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

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

Surgery

Surgery for men with breast cancer is usually 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). Some of the lymph nodes under the arm may also be removed and examined under a microscope.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials.

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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�fs 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 flashes 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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Treatment Options for Locally Recurrent Disease

For men with locally recurrent disease (cancer that has come back in a limited area after treatment), treatment is usually either:

• Surgery combined with chemotherapy; or
• Radiation therapy combined with chemotherapy.

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