Breaking the silence: Understanding male breast cancer risks

Dear Dr G,

I understand that October is dedicated to Breast Cancer Awareness, commonly known as Pink October. However, I'm curious if the general public is aware that breast cancer can also affect men.

I’m a 37-year-old man who discovered a lump in my breast about six months ago. Initially, I wasn't too concerned, as I've always had a bit of gynecomastia (enlargement of breasts in males). But when the lump started to hurt, I was shocked to learn that doctors wanted to perform tests to rule out breast cancer. After undergoing several uncomfortable tests and a biopsy, I was diagnosed with breast cancer.

I felt embarrassed and scared, but I proceeded with a modified mastectomy. Thankfully, all the cancer was removed, and I am now recovering well. I hope my story can serve as a platform to highlight the issue of male breast cancer.

Could you provide information on how common breast cancer is in men? What are the risk factors? Is it true that men tend to be diagnosed at a later stage?

Thank you, and Happy Pink October to you and your readers.

Sincerely,

Pinky Paul

 

October is widely recognised as Breast Cancer Awareness Month, symbolised by the pink ribbon. This movement began with Charlotte Haley, whose family members were diagnosed with breast cancer. She initially distributed peach-coloured ribbons to raise funds for research. In 1991, the Susan G. Komen Foundation began using pink ribbons at a charity race in New York City for breast cancer survivors. This practice evolved into an international campaign, uniting various charities to raise awareness and funding for breast cancer research, diagnosis, treatment, and cure.

Male breast cancer is rare, accounting for about 1% of all breast cancer cases. In the US, approximately 2,140 men are diagnosed annually, resulting in about 450 deaths. The incidence is increasing, typically affecting men in their sixties and seventies. Globally, male breast cancer results in around 20,000 deaths each year. Due to its rarity, large-scale studies often exclude males, leaving our understanding based on smaller studies.

The most well-known risk factor for male breast cancer is a genetic mutation in the BRCA gene. Other factors include alcohol abuse, ionizing radiation, and exposure to female hormones. High estrogen levels can occur due to medications, obesity, and liver diseases. Klinefelter Syndrome, a genetic condition where a man inherits an extra X chromosome, significantly increases the risk of developing breast cancer.

Treatment for breast cancer in men is similar to that in women, primarily involving mastectomy. Due to the smaller amount of breast tissue in men, a modified mastectomy is often performed. Post-surgery treatments may include radiotherapy and hormonal therapies, depending on factors such as genetic mutations and HER-receptor status.

Historically, male breast cancer was thought to have worse outcomes than female breast cancer. This belief was due to a lack of awareness leading to late diagnoses and increased metastasis risks. However, a National Institutes of Health study found that 63.1% of male cases present with localised disease, compared to 45.4% in females. The rates of local lymph node spread were 29.1% in males and 43.6% in females, with distant metastases at 5.7% in males and 8.1% in females.

Despite its rarity, male breast cancer advocacy has grown. The Brandon Greening Foundation for Breast Cancer in Men, established in 2009, encourages both men and women to wear pink, celebrating survivors and remembering those lost. The campaign supports those affected by breast cancer and advocates for advanced research.