Breast cancer is the most diagnosed cancer in women but it can also affect men. Although it is unusual, it should not be considered uncommon, it is in fact diagnosed in approximately one out of 100,000 cases in men.

As Dr. Andrea Sagona, breast surgeon at the Humanitas Cancer Center, explains, this tumor “occurs especially in adulthood, after 60 years. Although the incidence of breast cancer is lower, it can be diagnosed under the age of 45”.

Recent research published in Scientific Reports has shown that the most diagnosed tumor (in more than eight out of ten cases) is that of the ductile type. The research analyzed data from 446 male patients with breast cancer. In this type of cancer, the disease originates mostly from the cells of the galactophor ducts, which in men are developed in rudimentary form and which in women have the function of bringing milk from the lobules to the nipple.


What are the risk factors for male breast cancer?

The factors predisposing to this type of cancer are different; in particular, the conditions of altered hormonal metabolism play a role, with an imbalance in the relationship between estrogen and progesterone that can occur as a result of testicular diseases, cirrhosis of the liver, obesity, overexposure to substances containing estrogen or with estrogenic activity, gynecomastia secondary to drugs (such as those for prostatic diseases) or a previous radiotherapy treatment in the breast area, as in the case of lymphomas.

Then there is the case of patients with Klinefelter syndrome, in whom the presence of a supernumerary X chromosome leads to an excessive production of estrogen with consequent important development of the mammary gland, which thus becomes more susceptible to the onset of breast cancer.

The risk also increases in relation to family history: “Often male cancer is linked to genetic alterations BRCA1 and BRCA2, to which an increased risk of onset of breast cancer and ovarian cancer are correlated. For this reason, men who fall ill with this disease must be tested for any changes in their genetic make-up, so as to make the information available to family members and to enable them to carry out appropriate prevention programs,” said Dr. Sagona.


What are the symptoms?

“In men, as in women, nodules and swelling may be felt, or bleeding and ulceration may occur. Unlike women, however, signs such as orange peel skin rarely appear in the male sex. The lower volume of male breast tissue, however, makes it easier to observe the presence of a nodule.

Initially, breast cancer is often silent, which means that “in many cases patients reach the first clinical visits with the pathological lymph nodes, to which the tumor will already have spread. The diagnostic pathway is the same as for female breast cancer, with examinations such as mammography, ultrasound and biopsy,” the specialist specified.


Definition of the most appropriate treatment

Infiltrating ductal carcinoma is the most frequent: the tumor originates in the ducts and then crosses the barrier, to develop in the connective tissue of the breast. In this case it may also invade the lymph nodes. Because there is less tissue, the tumor tends to grow very close to the nipple. This part of the breast may be affected by Paget’s disease, with the spread of areola cancer and the presence of visible changes in the skin around the nipple (redness, burning, bleeding). This form of cancer is more common in men than in women.

The prognosis tends to be favorable: “In the past it was thought to be worse than that associated with female breast cancer, but today it can be superimposed on the latter,” added Dr. Sagona.

In the light of the results of the diagnostic tests, in particular the biopsy, the most appropriate treatment will be defined: “Male breast tumors are predominantly endocrine-responsive (80-90%), i.e. formed by cells with receptors for the estrogen and progesterone hormones. Therefore, hormone therapy is a good option in combination with chemotherapy and mastectomy surgery,” concluded Dr. Sagona.