Regional Health November 07, 2017

While rare, this cancer that affects men still needs awareness.

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth, or tumor. Breast cancer is a disease in which cancer cells grow in the breast tissue. Although male breasts do not fully develop, they do contain most of the same basic breast structures as women. Male breasts include small glands called lobules, ducts, and the nipple. These structures also are surrounded by fatty tissue and all are susceptible to developing breast cancer.

Breast cancer in men is rare, comprising less than 1% of all breast cancers, about 2,000 cases per year in the United States.1 This makes awareness of the disease uncommon. Types of breast cancer found in men are:

  1. Infiltrating ductal carcinoma—Cancer starts in the ducts of the breast and spreads into surrounding tissues. This is the most common type of breast cancer in men.
  2. Ductal carcinoma in situ—Early stage cancer confined to the ducts. This type has the highest cure rate.
  3. Infiltrating lobular carcinoma—A rare cancer that starts in the lobules of the breast and spreads into surrounding tissues.
  4. Paget’s disease—A rare cancer that starts in the ducts and spreads to the nipple and areola.
  5. Inflammatory—A rare, but aggressive cancer that occurs with visible changes in the skin around the breast and nipple.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Breast cancer is more common in men aged 65 years and older. Factors that may increase the risk of men developing breast cancer include:

  • Being 65 or older.
  • Family history of breast cancer.
  • Genetic gene mutations, such as BRCA1, BRCA2, and others.
  • Exposure to radiation, especially in the chest.
  • Exposure to increased levels of estrogen, which may occur with2:
    • Diseases linked to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder).
    • Liver diseases.
    • Alcohol use disorder.
    • Testicular disorders, such as an undescended testicle.
    • Obesity.
    • Gynecomastia—breast tissue growth in men unrelated to excess fat in the chest.
    • Prostate cancer treatment.
    • Certain occupations, such as exposure to high heat or gasoline fumes.

Symptoms

When breast cancer first develops, there may be no symptoms at all. As the cancer grows, it can cause:

  • One or more lumps in the breast, which may or may not be painful.
  • One or more lumps in lymph nodes near the breast, under your arm, or collarbone that which may or may not be painful.
  • Changes in the skin or nipple, such as dimpling, puckering, or an inverted nipple.
  • Redness, irritation, or ulceration of the skin in the breast area.
  • Discharge from the nipple, which may be clear or bloody.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done, including a thorough manual breast exam and blood tests. Diagnosis is confirmed with a biopsy, a procedure that takes a tissue sample from the affected area that is examined under a microscope for the presence of cancer cells.

Imaging tests can help with diagnosis and determine the extent of cancer. These may include:

  • Mammogram
  • Ultrasound
  • Chest x-ray
  • Bone scan
  • MRI scan
  • PET scan

The physical exam, combined with all of your test results, will help determine the type and stage of cancer you have. Staging is used to guide your treatment plan. Breast cancer in men is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body. Cancer cells also may be graded by how fast they grow and spread.

Treatment

Cancer treatment varies depending on the stage and type of cancer. A combination of therapies is most effective. For example, radiation may be used before surgery to shrink the tumor, or after to make sure all the cancer has been removed. Treatment options include:

  1. Surgery—The goal of surgery is to remove the tumors and any affected tissue. Surgical procedures include:
    • Modified radical mastectomy—Removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles. This is the most common procedure.
    • Radical mastectomy—Removal of the whole breast, the lymph nodes under the arm, and the chest wall muscles under the breast. This is only done when the tumor is large and growing into the chest muscles.
    • Axillary lymph node dissection—Removal of the lymph nodes under the arm. This is done to help determine whether cancer cells have entered the lymphatic system.
    • Sentinel node biopsy—A small amount of blue dye and/or a radioactive tracer is placed in the area where the tumor was located. The lymph nodes that pick up the substance are removed. Those remaining lymph nodes should be removed if any sentinel nodes contain cancer.
  2. Radiation Therapy—Radiation therapy is the use of radiation to kill cancer cells and shrink remaining tumors. Radiation therapy can be:
    • External—Radiation directed at the breast or area of spread from a source outside the body.
    • Internal—Radioactive materials are placed into the breast or area of spread in or near the cancer cells.
  3. Chemotherapy—Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, or IV. The drugs enter the bloodstream and travel through the body, killing mostly cancer cells. Some healthy cells are killed as well, contributing to common side effects.
  4. Medications—The following therapies may be used in conjunction with chemotherapy to help treat or to prevent cancer from coming back:
    • Targeted therapy—Some breast cancer express HER2 receptors. Targeted therapy against HER2 receptor can be used in conjunction with chemotherapy in this setting.
    • Hormone blocking therapy—Designed to take advantage of the fact that many breast cancers are estrogen sensitive. Estrogen binds to the estrogen-sensitive cells and stimulates them to grow and divide. Anti-estrogen drugs prevent the binding of estrogen. This stops the cells from growing and prevents or delays breast cancer from returning. Tamoxifen is the most common hormonal agent used.
  5. Other Medications—Cancer treatments can cause some side effects like loss of appetite, nausea, anemia, increased risk for infection, or pain. Other medications or treatments may be needed to minimize these problems throughout your cancer treatment.

Prevention and Prognosis

There are no current guidelines to screen for breast cancer in men. According to the National Cancer Institute, a division of the National Institutes of Health (NIH), “Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured.”

Diagnosing breast cancer early and treating it promptly is the best way to prevent death. Since breast cancer does not cause symptoms in the early stages, be aware of any changes in your body and do not delay in talking to your doctor about them. Dr. Shailja Shah, with Regional Health Group, is available to review symptoms, diagnose, and discuss treatment options. To schedule an appointment, call the office at (812) 234-0098 or click the button to schedule an appointment online.

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