If in women it is the most diagnosed cancer, in men it is a rather unusual event, although not very rare. It is breast cancer, diagnosed in about one in 100,000 men: “It is prevalently observed in adulthood, after the age of sixty. Although with a lower incidence, a diagnosis of breast cancer may appear below the age of 45,” adds Dr. Andrea Sagona, breast surgeon at Humanitas Cancer Center.
According to a recent research published in Scientific Reports, which analyzed data for 446 male breast cancer patients, the most diagnosed type of tumor is ductal cancer, in more than eight out of ten cases. This is the case where the disease originates mainly from the cells of galactophoric ducts, which in men are developed in a rudimentary form; while in women they have the function of bringing milk from the lobules to the nipple. Due to the anatomy of the male breast, the lobular tumor is very rare due to the presence of a few lobules.
The factors predisposing to male breast cancer are different: they are mainly conditions of altered hormonal metabolism with an imbalance of the relationship between estrogen and progesterone that may arise as a result of testicular diseases, cirrhosis of the liver, obesity, overexposure to substances containing or having estrogenic activity, gynecomastia secondary to drugs, such as those for prostatic pathologies, or a previous radiotherapy for treatment of lymphoma in the breast area.
A particular case is that of Klinefelter syndrome, in which the presence of a supernumerary X chromosome causes excessive production of estrogen with important development of the mammary gland, which becomes more susceptible to the development of breast cancer.
An increase in risk is associated with family history: “Men’s cancer is often linked to genetic changes in BRCA1 and BRCA2, which are correlated with an increased risk of breast and ovarian cancer. For this reason, male patients who fall ill with this disease must be tested to detect any variations in the genetic kit, in order to also make the information available for their families and allow them to carry out appropriate prevention programs “.
The picture of symptoms that may give rise to concern differs between men and women: “In men, as in women, nodules, swelling or bleeding and ulceration may occur. Unlike the female sex, however, signs such as orange peeled skin are rarely seen. It is precisely because of the anatomy of the male breast, with a smaller volume of breast tissue, that it is easier to notice the presence of a nodule.
In the initial forms, however, breast cancer is often silent, so “patients often arrive at the first clinical examinations already with pathological lymph nodes, to which the tumor will have already spread”, recalls Dr. Sagona. The diagnostic pathway is the same as for female breast cancer, with examinations such as mammography, ultrasound and biopsy.
Hormones and genes
The most frequent type of tumor is infiltrating ductal carcinoma: the tumor overcomes the duct barrier, in which it originates, and spreads in the connective tissue of the breast. In this case it may also invade the lymph nodes. As there is less tissue, the tumor grows very close to the nipple. This part of the breast may also be affected by Paget’s disease: the tumor spreads to the areola, causing visible changes in the skin around the nipple (redness, burning, bleeding). The prevalence of this form of cancer is greater in men than in women.
The prognosis for this neoplasia is however generally favorable: “In the past it was thought to be worse than that associated with female breast cancer but today it is super-imposable to the latter”.
On the basis of diagnostic tests, more specifically a biopsy, the most appropriate treatment for neoplasia will be defined: “Male breast tumors are predominantly endocrine-responsive (80-90%), i.e. formed by cells with receptors for estrogen and progesterone hormones. Hormone therapy is therefore a good option in combination with chemotherapy and mastectomy surgery.
On the prevention front, there are some points in common with female breast cancer. Two lifestyle factors that seem to be associated with a higher risk of cancer also in humans are obesity and excessive consumption of alcoholic beverages. The correlation with alcohol abuse could be explained in the light of the role played by the liver in hormone metabolism.