Male Breast Cancer: Clinical Signs [2022]
What Are the Signs of Male Breast Cancer? And why do they go undetected?
I think one thing that people don’t realize is that guys can actually get breast cancer. It is a relatively rare diagnosis, but that being said, we still see it. I think in the United States, there are about 2 to 3000 cases reported every year in men that develop breast cancer. When it comes to symptoms of breast cancer, most men have a breast lump that can be felt right under the nipple.
I would say occasionally a man will present with nipple discharge, but because men are not regularly getting mammograms, usually there’s some physical or some film that men present with.
What Is The Current Standard Of Care For Male Breast Cancer?
If men develop breast mass, we do like to work it up through imaging. We usually start with mammography. And the main thing is we’re trying to differentiate it: is this mass (breast) cancer or is it gynecomastia?
Once we work it up, we may want to do a needle biopsy. And if that confirms breast cancer in men, we then proceed with the management of the breast cancer itself, which usually mirrors the management of female breast cancer. I think one notable thing that I notice with male breast cancer is that it’s almost always ER-positive or affected by estrogen.
And that’s a good thing, because it gives us more weapons to attack the breast cancer with. Another notable thing about male breast cancer is that it can present at a more advanced stage because you’re not getting cancer screenings (mammograms). I think what I read recently said that more than 40% of males have positive lymph nodes when they first show up.
So I think that should be something all clinicians are aware of when they’re evaluating breast cancer in men. This is a higher percentage than we see in females.
Why Is It Critical To Look For These Signs In Male Breast Cancer?
I think it’s critical because I think this goes with any medical diagnosis. The earlier you catch things, the easier it is to treat them and the less the patient has to go through (Eg. radiation treatment). And I’ve seen time and again that a lot of people don’t even realize that there is breast cancer in men.
So as a result, they can present at a later stage, and that creates challenges down the road. And especially with guys getting chemotherapy, you’re trying to avoid doing a nodal dissection and giving them lymphedema. You’re trying to avoid chemotherapy, and you’re trying to avoid radiation therapy.
We’re trying to get the patient through as little as possible, and when tumors get more advanced, they have to go through so much and make it invasive breast cancer treatment.
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What Are The Common Signs Of Male Breast Cancer?
I think the most common symptom a man will present with is a mass underneath the nipple, and I think a lot of guys can blow that off and just say, “Oh, it’s a cyst.” It’s just some granular (male breast) tissue. And clinicians can actually blow this off as well. Or they can just assume it’s gynecomastia. And obviously, I’m a firm believer that the patient is the best doctor.
The patient can notice changes to their body faster than anyone else. And especially in medicine, which is so hard, you need as much help as you can get. If a patient feels something, they really need to be educated to step forward and say, “Hey, this is a little different.” Maybe I should have it checked out.”
Is Diagnosis Of Breast Cancer In Men Dependent On Their PCP?
By the time the patient sees us, the diagnosis has already been made. And really, this is why I go back to educating the patient about knowing their body. And this goes for not just a lump in your breast; it goes for moles on your arm, how you digest food, really any symptom. I think it’s important to know these.
Why Don’t They Have Similar Set Standards For Men With Breast Cancer? And Why Should We Focus on Family History Of Breast Cancers?
This is a very rare diagnosis and male breast cancer treatment. So I don’t feel that all men have to run off and get mammograms, right? That doesn’t really hand it out appropriately. Because of this, we pay more attention to the physical exam, especially if the patient is young and has a family history of breast cancer. A lot of my male patients will actually tell me that their mother and their sister had breast cancer at a very young age, so family history is very relevant and they should pay attention to these breast cancer risk factors. And so that’s a clue to say, “Hey, maybe this patient’s that have an increase breast cancer risk factors, and be aware of your body.”
And so, if you know your mother or sister had a gene abnormality for breast cancer, I think it’s worthwhile to test it.
That being said, even if they have the gene, their lifetime risk factor is actually fairly low. The lifetime risk for developing male breast cancer in a gene carrier is about 5 to 10%, which is a very interesting number because that’s less than the average female’s (higher) risk of breast cancer increases. But that being said, obviously that’s an area where we could target these patients to have closer follow-up with a clinician.
Final Thoughts On Male Breast Cancer
I think the biggest thing is to be aware of this diagnosis. The earlier we catch this, the better it is for the patient. The management very much mirrors the management of women who develop female cancer of the breast.
Because the tumors are ER-positive, we can always treat them with hormonal therapy (targeted therapy). Usually, that’s a nice weapon. I think it’s also important to think about genetics (genetic testing) with males who present with breast cancer (in men). Cancer (tissue) is often linked to a change in the genes, most notably the BRCA2 mutation. And so any male who presents with breast cancer (in men) should be tested for the gene.
John Kiluk, MD – About The Author, Credentials, and Affiliations
Dr. John Kiluk is a breast cancer specialist and surgical oncologist at Moffitt Cancer Center’s Center for Women’s Oncology. In 2011, he was chosen by both patients and colleagues as Moffitt’s Physician of the Year. Dr. Kiluk learned early on the value of helping people in need by shadowing his physician father around the hospital. Now, as a breast surgeon at Moffitt, he takes great pride in being there for his patients every step of the way, from diagnosis to rehabilitation. Dr. Kiluk says that the Moffitt breast program is special because all of the doctors on the team are dedicated to helping people with breast cancer risk. This method of treating patients leads to a busy clinic that is both a professional and personal success for its doctors and nurses because of the satisfying atmosphere of teamwork and patient satisfaction it fosters. Dr. Kiluk has a special interest in treating male patients with breast cancer. Even though breast cancer occurs in men, patients make up less than one percent of Dr. Kiluk’s patient load, they are critically important to the care he provides. When it comes to this health issue, he recognizes the unique anxieties that men face.