Did you know that breast cancer affects those assigned male at birth (AMAB) as well as those assigned female at birth (AFAB)?
The National Cancer Institute defines male breast cancer as a tumour that can develop in male breast tissues (‘tissues’ refers to a group of cells working collaboratively to perform a specific job). The breast tissue of those AMAB is small in quantity and is located behind the nipple. After forming in the breast cells, the cancer then continues developing in stages (which looks at how far the cancer has spread).
Breast cancer is less common in those AMAB than those AFAB, meaning it is not as well understood.1 Compared to female breast cancer, male breast cancer is typically diagnosed later in life, commonly when the disease is at more of an advanced stage.2 This is due to the rarity and lack of awareness of male breast cancer, resulting in fewer screenings and later detection of the disease.3,4
Male breast cancer constitutes less than 1% of all types of male cancer and approximately 1% of all breast tumours worldwide.5 In the UK, there are approximately 370 males diagnosed with breast cancer each year.
Risk factors for male breast cancer
Risk factors explore which lifestyle and/or genetic circumstances can make you more likely to develop cancer. Risk factors for male breasts include:6
- Ageing (though young males can also be affected)
- Family history
- Being overweight
- Black ethnicity
- Radiation exposure to the breast(s) or chest
- Heavy drinking (of alcohol)
- Carrying a genetic mutation (a characteristic passed on from parent to child)
- Use of exogenous oestrogen (oestrogen that comes from outside the body – e.g., hormonal therapy)
- Testicular conditions (e.g. undescended testicles, history of mumps, or one or both testicles have been removed)
- Conditions associated with high oestrogen levels (e.g., Klinefelter’s syndrome & gynaecomastia)
- Hormonal imbalance
However, having risk factors does not guarantee you will develop breast cancer. Equally, you could have none of the above risk factors and still develop the condition.
Common signs and symptoms of male breast cancer
Symptoms of male breast cancer include:
- A lump in the breast is not always indicative of cancer; however, male breast cancer often presents as a mass (much like a firm feeling or a body of shapeless matter)
- Pain (uncommon)
- Dimpled or puckered skin
- A rash in the area of the nipple
- When it appears that your nipple is pointing inward (retracted nipple)
- Swelling of the breast
- Discharge oozing from the nipple
- A lump under the arm
- Swelling under the arm
- A sore or ulcer in the skin of the breast
The presence of any of the above symptoms does not mean you have cancer; however, if you notice any change(s) to your breasts, you should consult a healthcare professional.
In terms of clinical features, including signs and symptoms, male breast cancer is generally similar to female breast cancer.7 However, there can be some differences in male breast cancer due to the physiological differences in male and female breast tissue.8
Diagnostic tests and procedures:
There are some tests involved when diagnosing male breast cancer. These include:
- Medical history: The doctor assesses risk factors, family history, and signs and symptoms.
- A physical examination: The doctor will examine the breast tissue, nipples, and lymph nodes.
- Mammogram: This is an X-ray that is useful for detecting breast abnormalities (especially when a lump is involved).
- Ultrasound (often used alongside a mammogram): This test can identify further details about the lump
- Biopsy: This is a surgical procedure in which a needle will withdraw fluid from a lump that is suspected to be cancerous for further investigation.
Breast cancer can be hereditary; speak to your GP if cancer runs in your family and you’re concerned. There are genetic blood tests you could undergo to discover if you carry a cancer-risk gene.
Types and stages of male breast cancer
The most common type of male breast cancer is infiltrating ductal carcinoma (IDC). IDC begins in the lining of the milk ducts (the thin tubes that carry milk to the nipples from the breast’s lobules) and spreads to the tissue surrounding it. IDC is also known as INVASIVE ductal carcinoma; it can spread to other parts of the body via the blood and lymph systems.
Below is a list of other types of male breast cancer:
- Invasive lobular carcinoma: This type begins in the milk-producing glands of the breast and spreads to the tissue around it.
- Ductal carcinoma in situ (DCIS): This type of non-invasive cancer is where abnormal cells exist in the lining of the duct but have not spread beyond to other tissue in the breast. It can also be referred to as intraductal breast carcinoma.
- Inflammatory breast cancer: This type is where the breast is red, looks swollen and feels warm to the touch.
- Paget’s disease of the nipple (also known as Paget’s disease of the breast): This type involves a tumour that has grown in the ducts beneath the nipple and spread to the nipple’s surface. It typically causes dryness to the nipple and the areola (the darker, circular area of skin surrounding the nipple).
Stages of male breast cancer:
The staging system in male breast cancer is similar to the system used for breast cancer in those AFAB. Male breast cancer in the UK is typically classified using the TNM staging system, which stands for tumour (how big the main lump is), node (whether local lymph nodes are affected), and metastasis (whether it has spread to more distant sites).
Doctors may also utilise a numbered staging system such as the one below:
|Stage 0||The cancer is in its beginning stage.|
|Stage I||The cancer has begun spreading to fatty breast tissues and lymph nodes (Stages IA & IB).|
|Stage II||The tumour is either large or it has spread to lymph nodes, or both (Stages IIA & IIB).|
|Stage III||The cancer has spread to lymph nodes but not to the bones or organs (Stages IIIA, IIIB & IIIC).|
|Stage IV||The cancer has spread to lymph nodes and organs.|
Management and treatment for male breast cancer
Due to the rarity of male breast cancer, there is limited research on clinical trials and experimental treatments for it. Some of the treatment methods and clinical trial approaches for male breast cancer are similar to those used for female breast cancer.1
Many have surgery followed by one or more other treatments - this helps reduce the risk of relapse (the event of cancer returning in future). An example of such a surgery is a mastectomy, which involves removing the entirety or part of the breast.
Another possible surgery is a lumpectomy (breast-conserving surgery). This surgery does not remove the breast itself but rather removes the cancer or abnormal tissue from the breast, as well as some surrounding normal tissue. This method is used more often for those AFAB - male breast cancer can require more intensive surgery due to growing behind/into the nipple(s).
People AMAB with breast cancer are likely to undergo radiation therapy - a technique in which radiation is used to exterminate cancer cells. Radiation therapy may be used to treat cancer in its early stages or after it has metastasised. Radiation therapy can be utilised alongside other treatments (e.g., chemotherapy).
Chemotherapy is a medicine, usually injected through the veins or prescribed as tablets, which kills cancer cells and aims to prevent them from multiplying and spreading throughout the body. Chemotherapy is typically used as treatment if the cancer has spread or there is a possibility that it will. A course of chemotherapy will normally be given in separate doses across a span of several months.
Another type of treatment is hormone therapy, especially if the cancer is hormone-receptor positive (HR+). HR+ specifies a ‘quality’ of certain cancer cells that have receptors (a cell protein) which can bind to specific hormones in the body. In people AMAB with breast cancer, hormone therapy usually entails the use of drugs that either block the effects of oestrogen or lower the body’s oestrogen levels. Hormone therapy reduces the level of oestrogen and progesterone hormone levels in the body. The type of hormone therapy that a person undergoes would depend on the stage and grade of their cancer.
There are also targeted therapies, which are a class of medicines that aim to stop the spread of cancer by changing the way that cells work.
Prognosis and survival rates of male breast cancer
People AMAB with breast cancer have poorer overall survival in comparison to those AFAB, and have an increased risk of developing secondary non-breast related cancers. There are several factors that can influence the prognosis of a male with breast cancer. These include:
- Early detection of the cancer
- The stage of the cancer
- The cancer’s size and grade
- Overall health
- Response to treatment
Even so, survival rates are approximations of large groups and do not reflect each individual person’s prognosis. Maintaining a healthy weight, being physically active, and lower alcohol consumption are all part of excellent health promotion. This will help all people AMAB to minimise their risk of developing breast cancer.
Emotional support for male breast cancer
Going through a cancer diagnosis can be scary, uncertain, and lonely. Further complications caused by male breast cancer include depression and poor body image following treatment.10 Some people AMAB might feel too embarrassed by their breast cancer diagnosis to reach out, as it is a disease that is mostly considered a “female issue”.11
Some people find it easier to open up to someone who isn’t a relative or friend. If this applies to you, there are organisations that offer emotional support, such as Breast Cancer Now, Macmillan Cancer Support, and Cancer Research UK. They offer information on cancer, counselling, and helplines to support people AMAB in coping with their diagnosis. Through these organisations, you can find wider online communities of people who are in a similar position to yourself. This support extends to caregivers too, as it can be mentally and physically demanding to undertake care responsibilities and witness a loved one suffering.9
Further monitoring of male breast cancer
Male breast cancer patients will have regular follow-up appointments (including breast exams) with their doctor after finishing treatment to ensure all is well. However, they can contact their doctor or specialist nurse in between appointments with any queries or concerns. The frequency of these check-ups is dependent on each person’s individual situation.
If you notice a change in the presentation of your breast(s), contact your GP to discuss this further. After all, early detection of cancer can improve prognosis, and it is always better to be safe than sorry.
How can I prevent male breast cancer?
General tips provided by healthcare professionals to minimise your risk of developing breast cancer are to maintain physical activity, a healthy diet, and not to drink alcohol heavily.
How common is male breast cancer?
Male breast cancer is comparatively lower than female breast cancer. Male breast cancer makes up an estimated 1% of all breast cancer cases. This low incidence of male breast cancer is attributed to the differences in male breast tissue and hormonal factors.
What can I expect if I have male breast cancer?
It’s good practice to carry out self-examinations. You know your body better than anybody else. Keep an eye out for the signs and symptoms of male breast cancer, which include a lump or swelling in the breast, dimpled/puckered skin, redness or flaky skin in the breast, rash on or around the nipple, nipple discharge, or a retracted nipple.
When should I see a doctor?
Seek medical advice for evaluation if you notice any changes or abnormalities in your breast tissue, including the presence of typical symptoms of male breast cancer as described above. Despite the rarity of male breast cancer, it is vital not to dismiss any signs of a potential underlying cause.
Male breast cancer is relatively rare in incidence and is defined by the growth of cancer cells in male breast tissues. Male breast cancer can affect young as well as older people, and sadly, is most often detected later in life when it has developed to advanced stages. Awareness and understanding of male breast cancer help enable early detection and faster treatment.
If you have any concerns that you could have breast cancer, speak to your GP. Regular self-examinations and seeking medical attention if any concerning symptoms emerge can make a marked difference in the outcome and prognosis of male breast cancer cases.
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- Johansson I, Nilsson C, Berglund P, Lauss M, Ringnér M, Olsson H, et al. Gene expression profiling of primary male breast cancers reveals two unique subgroups and identifies N-acetyltransferase-1 (Nat1) as a novel prognostic biomarker. Breast Cancer Research [Internet]. 2012 Feb 14 [cited 2023 Jul 20];14(1):R31. Available from: https://doi.org/10.1186/bcr3116
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