Male breast cancer, while less prevalent, represents a notable medical issue, impacting roughly one in every 100,000 men. Its relative rarity should not diminish its significance, as it constitutes approximately 0.5-1% of all breast cancer cases, resulting in an estimated annual occurrence of roughly 500 cases of male breast cancer.
Incidence of Male Breast Cancer
Male breast cancer typically emerges in adulthood, primarily between 60-70. Nevertheless, there are instances of diagnosis among men under 45, often linked to genetic mutations. Studies reveal that male breast cancer predominantly originates in the mammary ducts, responsible for milk transportation from the lobules (milk production area) to the nipple. These ducts, albeit rudimentary, are indeed present in men.
Risk Factors for Male Breast Cancer
Several factors contribute to male breast cancer, with disruptions in hormone metabolism playing a pivotal role. Elevated estrogen levels, typically associated with female hormones, can result from the following conditions:
- Testicular pathologies
- Liver cirrhosis
- Obesity
- Overexposure to estrogen-containing substances
- Gynecomastia induced by drugs, such as those used for prostatic conditions
- Previous thoracic radiotherapy is common in lymphoma treatment, particularly during youth.
A unique scenario arises in patients with Klinefelter’s syndrome, characterized by an extra X chromosome in their chromosomal composition (XXY instead of the usual XY). This genetic makeup prompts excessive estrogen production, leading to significant mammary gland development and heightened susceptibility to breast cancer.
Research indicates that a family history of the disease elevates the risk. Genetic mutations in the BRCA1 and BRCA2 genes, linked to increased breast, pancreatic, prostate, and colon cancer risks, are often associated with male breast cancer. Given its relative rarity among males, genetic testing is advisable for those affected to provide crucial information to their family members and enable the implementation of appropriate prevention programs.
Symptoms of Male Breast Cancer
Male breast cancer presents symptoms similar to those seen in women. These include palpable lumps, typically localized around the retroareolar region, and redness, bleeding, and nipple ulceration. Axillary lymph node involvement is common, either due to the proximity of the lymphatic plexus to the retroareolar site or late diagnosis, as men are not typically screened with mammography, unlike women. Less frequently observed symptoms, such as “orange peel” skin, are rarely seen in males.
However, the limited volume of male breast tissue makes lump detection easier. Pain in the breast area is a less common symptom. The diagnostic process closely mirrors that of female breast cancer and encompasses clinical examination, mammography, ultrasound, and biopsy.
Diagnosis and Treatment of Male Breast Cancer
A qnewly acknowledged factor is that the prognosis of male breast cancer is on par with women’s breast cancer when matched for stage.
A specialist can determine the most appropriate treatment course by following diagnostic tests and evaluation of biopsy and staging results, which may include abdominal ultrasound, chest X-ray, PET or CT scans, and bone scintigraphy. Owing to the limited male breast tissue, surgical intervention usually necessitates a total gland removal (mastectomy), including the areola-nipple complex, and removal of affected sentinel or axillary lymph nodes. In select cases, nipple-sparing mastectomy procedures are considered, preserving the areola and nipple to reduce disfigurement. Most male breast cancers (80-90%) are hormone-responsive, featuring cells with estrogen and progesterone receptors. Thus, hormone therapy alone or in combination with chemotherapy can effectively reduce circulating estrogen levels.
