Like female breast cancer, male breast cancer often is related to estrogen hormonal levels. In men, the risk increases when estrogen levels are abnormally high. Testicular abnormalities in development (e.g., undescended testes, congenital inguinal hernia, or testicular injury) may change the estrogen-level balance. Infertility and Klinefelter’s syndrome (the XXY condition) also seem to increase a man’s risk of getting breast cancer. Like women, if a man has a history of breast cancer in his family, or if he was treated with radiation for lymphoma to the chest area, his chances of developing this disease increase.2,3
Another factor that increases a man’s chances of getting breast cancer includes advanced age. The median age for diagnosis is age 67 for men and age 62 for women.4 Alcohol abuse and liver disease are also associated with increased risk for male breast cancer. Various causes of liver damage affect the liver’s ability to metabolize steroid hormones, which is why obesity is also a known risk factor. “Just because a man has an increased risk does not mean he will get cancer,” Zarka notes.
Diagnosis
While breast cancer in women is often detected before a palpable mass is noticeable during a breast-screening mammogram, radiographic screening is not in place for men due to the rarity of male breast cancer. In men, breast cancer normally is detected during self-examination or during a physical exam by a physician. The lesions are then further characterized by radiographic imaging.
For both sexes, either a fine-needle aspiration (FNA) biopsy or core biopsy of the mass is often performed to obtain a pathologic diagnosis. The process by which a biopsy specimen is handled depends upon the chosen biopsy technique. FNA biopsies are often performed by pathologists, radiologists, or surgeons. Cytological smears from the FNA procedure are prepared, taken to the cytology laboratory for staining, and, subsequently, evaluated. Diagnosis is rendered by a pathologist. A surgeon or radiologist typically performs a core biopsy and submits the tissue biopsy specimen to the histology laboratory, where the specimen is processed and slides prepared by histotechnologists. The biopsy slides are then delivered to the pathologist who examines the slides and makes a diagnosis.
When diagnosing breast cancer in a man or woman, hormone-receptor status is determined on the tumor tissue. Ninety percent of men have estrogen-receptor- (ER-) positive tumors, versus 76% ER-receptor-positive tumors in women4; 81% of men with invasive cancers have progesterone-receptor- (PR-) positive tumors versus 66.7% PR-receptor-positive tumors in women.4
Regarding the types of breast cancer, approximately 90% of men present with invasive cancer.3 Due to standardized radiographic screening in women, a significantly higher proportion of women present with non-invasive (in situ) cancer. Some subtypes of invasive carcinoma are also different in men as compared to women. For example, statistics show that 1.5% of invasive male breast cancers are invasive lobular carcinoma versus 11.8% of invasive cancers in women.5 “This is probably due to the male anatomy of the breast,” Zarka explains. “Male breasts have the same ducts as women, but men do not have developed breast lobules where milk is produced in adult women and where lobular breast carcinoma arises.”
Some differences also exist regarding genetics. Although, most women with breast cancer do not possess the BRCA-1 mutation, women who are BRCA-1 positive definitely have an increased risk of breast cancer, in addition to the risk of ovarian carcinoma. The BRCA-1 mutation occasionally occurs in men, but BRCA-1 positivity in men is not associated with the same breast-cancer risk as in women. Conversely, BRCA-2 gene positivity in men and women is associated with an increase in breast-cancer development in both sexes.5
Treatment
Although chemotherapy and radiation treatments for breast-cancer treatments are similar for men and women, there are some differences regarding surgical treatment at presentation. Most men diagnosed with breast cancer, whether it is an in situ or invasive carcinoma, undergo a mastectomy.3 Today, many women are offered a lumpectomy instead of a mastectomy for in situ invasive cancer, depending on the size and extent of disease. This is because men have less breast tissue and, therefore, less tissue to reconstruct after tumor removal. “It is often easier to get good margins by performing a mastectomy in a male up front,” Zarka says.
Years ago, mastectomy prevailed as the surgical treatment for female breast cancer. But since female breast cancer is now often detected when the mass is smaller and since better reconstruction techniques exist, lumpectomy is becoming a more appropriate option. Mastectomy or lumpectomy is typically followed by chemotherapy for both sexes, as are follow-up screenings.
Prognosis
Says Zarka, “It looks to be that, stage for stage and age for age, the prognosis is very similar for men and women. Since men present with larger tumor sizes because their tumors are detected by palpation, they will typically have a higher stage at presentation as compared to women.”
Online:
Visit www.parade.com to read “Real men do wear pink,” an article about a father and daughter who both survived breast cancer.
Karen Lynn, is a freelance medical writer.
References
- Malani AK. Male breast cancer: A different disease than female breast cancer? South Med J. 2007;100:197.
- Tischkowitz MD, Hodgson SV, Fentiman IS. 19. Male breast cancer: Aetiology, genetics and clinical management. Int J Clin Pract. 2002;56:750-754.
- Fentiman IS, Fourquet A, Hortobagya GN. Male breast cancer. Lancet. 2006:367:595-604.
- Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: A population-based study. Cancer. 2004:101:51-57.
- Giordano SH, Buzdar AU, Hortobagyi GN. Breast cancer in men. Ann Intern Med. 2002;137:678-687.
