Male breast cancer

Men possess a small amount of nonfunctioning breast tissue (breast tissue that cannot produce milk) that is concentrated in the area directly behind the nipple on the chest wall. Like breast cancer in women, cancer of the male breast results from the uncontrolled growth of cells within this breast tissue.

What are risk factors for breast cancer in men?

Risk factors may include the following:

Radiation exposure

Estrogen administration

Diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter's syndrome

Also, there are definite familial tendencies for developing breast cancer:

An increased incidence is seen in men who have a number of female relatives with breast cancer.

An increased risk of male breast cancer has been reported in families in which a BRCA2 mutation has been identified.

What is the most common type of breast cancer in men?

Infiltrating ductal cancer is the most common tumor type, but intraductal cancer, inflammatory carcinoma, and Paget's disease of the nipple have been described as well.

Symptoms

The commonest symptom for men with breast cancer is a lump in the breast area. This is nearly always painless. Other symptoms can include Oozing from the nipple (a discharge) that may be blood stained

Swelling of the breast

A sore (ulcer) in the skin of the breast

A nipple that is pulled into the breast (called nipple retraction)

Lumps under the arm

How is male breast cancer treated?

Like breast cancer in women, treatment depends upon the stage of the cancer and the overall physical condition of the patient. Treatments are the same as for breast cancer in women.

Most men diagnosed with breast cancer are initially treated by surgery. A modified radical mastectomy (removal of the breast, lining over the chest muscles, and portions of the axillary lymph nodes) is the most common surgical treatment of male breast cancer. Sometimes portions of the muscles of the chest wall are also removed.

After surgery, adjuvant therapies are often prescribed. These are recommended especially if the cancer has spread to the lymph nodes (node-positive cancer). Adjuvant therapies include chemotherapy, radiation therapy, and hormone therapy. In cases of metastatic cancer, chemotherapy, hormone therapy, or a combination of both, are generally recommended.

Chemotherapy refers to the administration of toxic drugs that stop the growth of cancer cells. Chemotherapy may be given as pills, as an injection, or via an intravenous infusion, depending upon the types of drugs chosen. Combinations of different drugs are usually given, and treatment is administered in cycles with a recovery period following each treatment. Some of the most common chemotherapeutic agents for treating breast cancer are cyclophosphamide, methotrexate, fluorouracil, and doxorubicin (Adriamycin). In most cases chemotherapy is administered on an outpatient basis. Chemotherapy may be associated with unpleasant side effects including hair loss, nausea and vomiting, and diarrhea. For more, please read the Chemotherapy article.

Radiation therapy uses high-energy radiation to kill tumor cells. Radiation therapy may be delivered either externally (using a machine to send radiation toward the tumor) or internally (radioactive substances placed in needles or catheters and inserted into the body). For more, please read the Radiation Therapy article.

Hormonal therapy prevents hormones from stimulating growth of cancer cells and is useful when the cancer cells have binding sites (receptors) for hormones. Male breast cancers usually have estrogen receptors and are most commonly treated with the drug tamoxifen, which blocks the action of estrogen on the cancer cells. Side effects of tamoxifen treatment can include hot flashes, weight gain, mood changes, and impotence.

While estrogen is the most common target of hormonal therapy, studies have also shown that treatments directed against the actions of male hormones (anti-androgens) can also reduce the size of male breast cancer metastases. The reasons why anti-androgens are effective in widespread disease are not fully understood. Orchiectomy (removal of the testes) was formerly performed to lower androgen levels, but newer nonsurgical methods are currently favored. Drugs known as luteinizing hormone-releasing hormone (LHRH) analogs affect the pituitary gland and result in lowered production of male hormones by the testes.

If a cancer that has been surgically removed regrows at the original site, this is referred to as local recurrence. Locally recurrent cancers are usually treated by surgery along with chemotherapy, or radiation therapy combined with chemotherapy.