Breast Cancer in Men

It is a common fallacy to think that breast cancer can only affect women, but it can also affect men too. Men also have a small amount of breast tissue behind the nipple area, which contains small ducts (tubes) and is where breast cancer can potentially develop. So men can also develop the disease.

According to Cancer Research UK, there are more than 200 different types of cancer and 1 in 2 people in the UK will get cancer in their lifetime. Cancer starts in our cells; it is when abnormal cells divide in an uncontrolled way. Cancer starts when gene changes make one cell or a few cells begin to grow and multiply too much. This may cause a growth called a tumour.

Cancers are divided into groups according to the type of cell they start from.

They include:

• Carcinomas.
• Lymphomas.
• Leukaemias.
• Brain tumours.
• Sarcomas.

Nearly all male breast cancer is ductal carcinoma in situ, a condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast area. In some cases, ductal carcinoma in situ may become invasive breast cancer and spread to other tissues. Invasive cancer cells can also spread, or metastasise, to other parts of the body.

Another less common type of carcinoma found in male breast cancer is invasive lobular carcinoma. Cancer cells begin in the lobules and then spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread or metastasise to other parts of the body.

How common is male breast cancer?

Breast cancer is the most common cancer in the UK, accounting for 15% of all new cancer cases. About 1 in 100 (about 1%) breast cancer cases in the UK are in males. Every year around 350 men are diagnosed with breast cancer in the UK, that’s almost one man diagnosed every day, compared with over 55,100 women each year, so breast cancer in men is rare, but 1 in 1,000 men will develop breast cancer in their lifetime.

In males, prostate cancer is the most common cancer in the UK, accounting for more than a quarter (27%) of male cancer cases. The next most common cancers in UK males are lung cancer (13%) and bowel cancer (12%). Prostate, lung and bowel cancers together account for more than half (53%) of all new cases in males in the UK. (Office for National Statistics (ONS))

What are the signs and symptoms of breast cancer in men?

Most men don’t realise that they need to be chest aware. However, it is important to check yourself regularly, as 70% of breast cancer cases in men are primarily detected by self-examination. This is how you can do a male breast self-examination:

• Look at your breasts in a mirror. Look at the size and shape of each breast and nipple. Check for swelling, lumps, dimpling, scaly skin, or other skin changes. Look for nipple changes, such as a nipple that is painful or beginning to pull inward. Gently squeeze both nipples and check to see if fluid comes out of them. If you find any of these or other breast changes, contact your GP.
  Check your breasts while you sit or stand in the following three positions:
  – Hang your arms down at your sides.
  – Raise your hands and join them behind your head.
  – Put firm pressure with your hands on your hips. Bend slightly forward while you look at your breasts in the mirror.
• Lie down and feel your breasts. When you lie down, your breast tissue spreads out evenly over your chest. This makes it easier for you to feel for lumps and anything that may not be normal for your breasts.
  Examine one breast at a time:
  – Place a small pillow or towel under your left shoulder. Put your left arm behind your head.
  – Use the three middle fingers of your right hand. Use your fingertip pads, on the top of your fingers. Your fingertip pad is the most sensitive part of your finger.
  – Use small circles to feel your breast tissue. Use your fingertip pads to make 10p coin sized overlapping circles on your breast and armpits. First, press lightly. Second, press with medium pressure to feel a little deeper into the breast. Last, use firm pressure to feel deep within your breast.
  – Examine your entire breast area. Examine the breast area from above the breast to below the breast where you feel only ribs. Make small circles with your fingertips, starting in the middle of your armpit. Make circles going up and down the breast area. Continue toward your breast and all the way across it. Examine the area from your armpit all the way over to the middle of your chest (breastbone). Stop at the middle of your chest.
  – Move the pillow or towel to your right shoulder, and put your right arm behind your head. Use the three fingertip pads of your left hand. Repeat the above steps to do a breast self-examination on your right breast.

Regular breast self-examinations can help you know how your breasts normally look and feel. Most breast lumps or changes are not cancer, but you should always have them checked by your GP.

Symptoms of breast cancer in men may include:

• A lump or swelling in the chest area or armpit.
• Discharge from the nipple, which may be blood stained.
• An inverted nipple.
• Ulcers or sores on the chest or around the nipple.
• A rash on or around the nipple.
• Changes in the shape or size of the breast.

Sometimes breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumour in the breast is large enough to be felt. Should you notice anything unusual or are worried, make an appointment to see your GP as soon as possible. A lump in your breast may be a sign of breast cancer; however, more commonly, a lump may be a sign of a condition that can be treated, such as a hormone problem.

What risk factors can increase a man’s chance of getting breast cancer?

The exact cause of male breast cancer is unknown; however, there are certain factors that can increase a man’s chances of developing it.

These risk factors include:

• Age – The risk of breast cancer in men increases with age. It is most common in men over 60 years old. Breast cancer in young men is very rare.
• High oestrogen levels – All men produce small amounts of the hormone called oestrogen; this is perfectly normal. But high oestrogen levels have been linked to a higher breast cancer risk.
  High oestrogen levels can occur in:
  – Men who are very overweight (obese) with a body mass index (BMI) over 30.
  – Men with chronic liver conditions, such as cirrhosis.
  – Some genetic conditions. About 1 in 5 men with breast cancer (20%) have a close relative who has also had breast cancer. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. Men in families with the BRCA2 gene are more likely to develop breast cancer than men in families with the BRCA1 gene. It is thought that the BRCA2 gene may cause up to 1 in 10 breast cancers in men (10%).
• Klinefelter’s syndrome – This is a rare syndrome that only affects men. Normally, males are born with one X chromosome and one Y chromosome (XY), and females have two X chromosomes (XX). Men with Klinefelter syndrome have one Y chromosome and two or more X chromosomes (XXY or XXXY).
• Radiation – Being exposed to radiation may increase a man’s risk of breast cancer. Men who have had radiotherapy to their chest at a young age, for example to treat lymphoma, may have an increased risk.
• Testicular effects – Conditions that affect or damage the testicles may also increase the risk of breast cancer. These include:
  – Having undescended testicles.
  – Having surgery to remove one or both testicles.
  – Having mumps as an adult.
• Occupations – Men who work in hot environments, such as blast furnaces, steel works and rolling mills, may have a slightly increased risk. This is probably related to heat damage to the testicles. Some studies have also linked long-term exposure to petrol and exhaust fumes with breast cancer in men.

However, because breast cancer in men is rare, most men who have these risk factors will never develop breast cancer.

What can men do to reduce the risks of breast cancer?

From the things that you eat to the chemicals you expose yourself to, all of these can help determine whether you are at a higher or lower risk of the disease. All men can lower their risk of developing breast cancer by keeping a healthy weight and exercising regularly. Although there is no single ideal weight for all individuals, Body Mass Index (BMI) is a common tool that measures a person’s weight in relation to their height. Age is not a factor in BMI for adults. BMI can offer a rough idea of whether or not a person is at a moderate weight.

To calculate BMI kg the metric formula is your weight in kilograms divided by your height in metres squared. For example, if you are 175cm (1.75m) in height and 75kg in weight, you can calculate your BMI as follows: 75kg / (1.75m²) = 24.49kg/m².

A BMI calculation provides a single number, which falls into the following categories:

• A BMI of less than 18.5 means a person is underweight.
• A BMI of between 18.5 and 24.9 is ideal.
• A BMI of between 25 and 29.9 is overweight.
• A BMI over 30 indicates obesity.

Choose a healthy diet – Foods may contain compounds that are protective against breast cancer and others that may have a cancer-promoting effect; so, what you eat and what you don’t is important. One example of a healthy diet is the Mediterranean diet. Any healthy diet should also include a varied selection of foods that are as natural as possible, and provide the right amount of energy and nutrients. There is evidence that processed meat slightly increases breast cancer risk. Many studies indicate that a diet high in fruit and vegetables provides protection against breast cancer. By making better food choices you can reduce your risk of developing breast cancer.

Avoid or limit alcohol – Alcohol use increases the risk of breast cancer in both women and men. Even low levels of alcohol intake have been linked with an increase in risk. Alcohol use is linked with several cancers and is the third most important preventable risk factor for cancer. It is best not to drink alcohol. For men who do drink, they should have no more than two alcoholic drinks a day.

Vitamin D deficiency – Studies have found low levels of circulating vitamin D are linked to an increased breast cancer risk. Studies have not demonstrated that taking vitamin D supplements reduces breast cancer risk, although taking these can restore serum vitamin D levels to a healthy state and are recommended for those unable to achieve sufficiency through sunshine and diet.

Physical activity – By being physically active you can reduce your risk of breast cancer by around 20%. Physical activity also reduces the risk of breast cancer recurrence and mortality following a breast cancer diagnosis. It is thought that physical activity helps lower the levels of certain circulating hormones and reduces inflammation, which can help lower the likelihood of cancer developing and progressing. Physical activity, including structured exercise, lowers levels of hormones such as oestrogen, androgen, insulin and leptin (a hormone associated with hunger), and certain growth factors. Increased levels of all of these have been associated with breast cancer. Being active also generally improves the capacity of the immune system to protect you from cancer. For general health and well-being, the World Health Organization (WHO) recommends at least 150 minutes of moderate, or 75 minutes of vigorous, physical activity weekly. It also recommends doing muscle-strengthening exercises at least twice a week.

If several members of your family have had breast or ovarian cancer, or one of your family members has a known BRCA1 or BRCA2 mutation, speak to your GP about genetic testing.

How is male breast cancer diagnosed?

If you notice anything unusual in your chest area or you are worried, make an appointment to see your GP as soon as possible. Referral guidelines help GPs decide what tests you should have and how quickly you should see a specialist doctor. The guidelines include risk factors and the signs and symptoms that a cancer may cause. If your GP thinks your symptoms could be caused by cancer, they will refer you for a scan of the breast and the lymph nodes under your arm (axilla), called an ultrasound. You might also have a breast x-ray (mammogram). If these tests show an area that could be cancer, your doctor or breast cancer nurse takes a sample (biopsy) of breast tissue. This is then examined under a microscope by a specialist. If these tests show that you have breast cancer, you might have other tests to see whether the cancer has spread.

These tests include:

• An MRI scan.
• A bone scan.
• A CT scan.
• A liver scan.

The healthcare staff will explain what will happen at each test. They may also give you written information about the tests. Some tests can be uncomfortable, but the medical staff will make you feel as comfortable as possible.

The number staging system for breast cancer divides breast cancers into four stages, from 1 to 4.

Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body:

• Stage 1 breast cancer means that the cancer is small and only in the breast tissue, or it might be found in lymph nodes close to the breast.
• Stage 2 breast cancer means that the cancer is either in the breast or in the nearby lymph nodes or both. It is an early-stage breast cancer.
• Stage 3 means that the cancer has spread from the breast to lymph nodes close to the breast or to the skin of the breast or to the chest wall.
• Stage 4 breast cancer means that the cancer has spread to other parts of the body.

The NHS in all four nations is committed to making sure that people with cancer or suspected cancer are seen as quickly as possible. If you are diagnosed with cancer, you should not have to wait more than 31 days from the diagnosis and a decision to start treatment.

Treatment for male breast cancer

A team of specialists will meet to discuss the best possible treatment for you; this is called a multidisciplinary team (MDT). Your doctor will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions. For most men, the main treatment for early breast cancer is surgery to remove the cancer.

This may be:

• A mastectomy – This is when the whole breast is removed. Once treatment has finished your surgeon can make a new nipple for you if you want it. You need to wait a few months after the mastectomy to allow any swelling to go down and the wound to heal.
• Breast-conserving surgery (wide local excision) – This is where the cancer and some surrounding normal breast tissue are removed.

Your surgeon may remove some or all the lymph nodes in your armpit, or you may be offered radiotherapy to the lymph nodes instead. If you have locally advanced breast cancer or inflammatory breast cancer, you will usually be offered chemotherapy or sometimes targeted therapy before surgery. This is known as neo-adjuvant treatment.

The operation is done under a general anaesthetic, where you are asleep throughout the procedure. You will probably need to stay in hospital for 1 to 2 days. It can take several months to fully recover from surgery. The Royal College of Surgeons of England has a leaflet for people recovering from a mastectomy with detailed information and advice.

As with all medical procedures, there are risks and side effects of a mastectomy. Before having surgery, talk to your surgeon and breast care nurse about the possible risks.

These can include:

• Pain and discomfort for 1 to 2 weeks – you will be given painkillers to help with this.
• Numbness or tingling around the scar and in your upper arm – this should pass within a few weeks or months, but can occasionally be permanent.
• A wound infection, causing redness, swelling, warmth or discharge from the wound – if any of these symptoms happen, tell your nurse or doctor immediately.
• Painful swelling in your arm (lymphoedema) – this may be permanent but can be treated.

After surgery, you will have adjuvant treatment; your oncologist (cancer doctor) will usually offer you one or more of the following treatments:

• Radiotherapy – This uses high-energy rays. You may have it to the chest wall after surgery. Some men may also have radiotherapy to the lymph nodes in the armpit or the lower part of the neck.
• Chemotherapy – This uses different drugs to treat breast cancer. It is most commonly given as an injection into a vein or as tablets or capsules.
• Targeted therapies – These interfere with the way cells grow. They can reduce the risk of HER2 breast cancer coming back.
• Hormonal therapy – This can slow down or prevent breast cancer cells from growing in men who have ER positive breast cancer.

After treatment you usually have regular check-ups. At the check-ups your doctor or a breast care nurse will examine you and ask about your general health. This is your chance to ask questions and to tell them if anything is worrying you. How often you have check-ups depends on your individual situation but they might go on for at least five years.

What support is available for men with breast cancer?

There are resources available that offer practical and emotional advice and support, including online groups for men who have or who have had breast cancer. These include:

Against Breast Cancer’s men-only Moobment Facebook page group for men affected by breast cancer

The Men’s VMU: a monthly virtual meet-up group run by and for men who have/have had breast cancer. Twitter: @TheMensVMU, Email: doug.harper@themensvmu.org

• Against Breast Cancer’s men-only Moobment Facebook page group for men affected by breast cancer.
• The Men’s VMU: a monthly virtual meet-up group run by and for men who have/have had breast cancer. Twitter: @TheMensVMU, Email: doug.harper@themensvmu.org.
• Walk the Walk UK Virtual Meet–up (VMU) for men diagnosed with breast cancer.
• The British Psychological Society (BSP) supporting men with breast cancer.
• Macmillan Cancer Support 0808 808 00 00.
• Breast Cancer Now 0808 800 6000.
• Cancer Research cancer chat.