Are 'man boobs' linked to a risk of cancer?

Dear Dr G,

I have always associated breast cancer with women. However, I recently came across an article suggesting that it can also afflict men.

I am a 55-year-old man and have noticed that my chest has become noticeably larger over the past few years.

My wife jokingly calls them my "man boobs", and I have always assumed this is simply part of getting older and putting on weight.

However, I am beginning to wonder if this increases my risk of developing breast cancer.

I would like to put Dr G on the spot for some clarification.

How common is breast cancer in men, and what are the risk factors? Is there any association between man boobs and breast cancer?

What are the warning signs I should look out for, and how would doctors diagnose the condition?

Finally, if a man develops breast cancer, are the treatments similar to those for women? Is the prognosis good, or is breast cancer more dangerous in men?

Yours sincerely,

Bob With Breasts

 

According to the American Cancer Society, fewer than 1% of all breast cancers occur in men.

In the United States, approximately 2,670 men are expected to be diagnosed with invasive breast cancer in 2026, with around 530 deaths.

The lifetime risk of developing breast cancer for an average American man is approximately one in 755, compared with roughly one in eight for women.

Although these figures may seem reassuring, the danger lies in the fact that many men are completely unaware that they can develop breast cancer.

Consequently, suspicious symptoms may be ignored until the disease has progressed.

Male breast cancer is primarily a disease of older men, with most diagnoses occurring between 60 and 70.

The medical term for enlarged male breast tissue is gynaecomastia, derived from the Greek words for "woman" and "breast".

Gynaecomastia occurs when there is an imbalance between the effects of oestrogen and testosterone on breast tissue.

Although testosterone is the dominant male sex hormone, men naturally produce small amounts of oestrogen. When the balance shifts towards greater oestrogen activity, breast tissue can enlarge.

This is particularly common during puberty and in older age, when hormonal fluctuations are more pronounced.

Certain medications, including some treatments for prostate enlargement, prostate cancer and heart disease, may contribute to gynaecomastia.

Liver disease, testicular disorders and other hormonal abnormalities can also be responsible.

The reassuring news is that gynaecomastia itself is a benign condition and is not considered a precancerous lesion. It does not ordinarily transform into breast cancer.

One particularly important risk factor is inherited genetic susceptibility.

Mutations in the BRCA2 gene, more commonly associated with hereditary breast and ovarian cancer in women, substantially increase the risk of breast cancer in men.

Those with a strong family history of breast cancer, particularly with affected male relatives or known BRCA mutations, should consider genetic counselling.

Breast cancer often presents as a painless, hard lump, usually on one side of the chest. The lump may feel irregular, become fixed to surrounding tissue or cause changes in the overlying skin.

Other warning signs include nipple retraction, nipple discharge (take particular notice if it is bloody), skin dimpling, ulceration or a persistent rash around the nipple.

Enlarged lymph nodes in the armpit may indicate that the disease has spread beyond the breast.

The diagnosis of male breast cancer generally follows the same principles used in women.

A doctor begins with a careful clinical examination, followed by imaging such as mammography or ultrasound when appropriate.

If a suspicious abnormality is identified, a core needle biopsy is performed to obtain tissue for examination under a microscope. Surgery remains an important treatment for early-stage disease.

Because men have relatively little breast tissue, mastectomy, which involves removing the affected breast tissue, is commonly performed.

Following surgery, additional treatment may include radiotherapy, chemotherapy, hormonal therapy, or targeted medications.

The prognosis depends largely on how early the cancer is detected.

According to American Cancer Society survival statistics, men whose breast cancer remains confined to the breast have a five-year relative survival rate of approximately 97%.

When the disease has spread to nearby lymph nodes or surrounding structures, the figure is approximately 86%.

Unfortunately, when cancer has spread to distant organs, the five-year relative survival rate falls to approximately 31%.

An important concern is that breast cancer in men is sometimes diagnosed later than in women. This is not necessarily because the cancer is biologically more aggressive, but because men are less likely to recognise warning signs and seek medical attention promptly.

Unlike women, men at average risk are not routinely advised to undergo screening mammography.

However, men with substantial inherited risk may require specialised assessment and individualised surveillance.

All men should become familiar with the normal appearance and feel of their chest and seek medical attention for any new or persistent lump, nipple change or unexplained swelling.

Maintaining a healthy body weight, limiting alcohol consumption, remaining physically active and reviewing medications that may affect hormonal balance are sensible measures for general health.

Ultimately, October as Breast Cancer Awareness Month should remind us that the disease does not discriminate between men and women.

Pink ribbons may symbolise a campaign traditionally centred on women, but the message of early detection belongs to everyone.

After all, masculinity should never be measured by the size of a man’s chest, nor should embarrassment prevent him from seeking medical advice.

When put on the spot, Dr G is often reminded of the timeless wisdom of Benjamin Franklin: "An ounce of prevention is worth a pound of cure." For gentlemen everywhere, perhaps it is time to take that advice to heart, and occasionally, to the breast as well.