Male Breast Cancer

Chris Vi, PhD Candidate (Medicine), B.H&MedSci(Hons), B.BioMedSci

Deeya Mahadooa, MSc Mental Health Psychology, BA(Hons) Psychology 

 

Men do have breast tissue which has the potential to become cancerous, as with women. However, occurrence rates in men are rare – accounting for 1% of all breast cancers, as a ratio, occurrence is 1 male for every 100 females. (Khattab et al., 2020).

• The average age of diagnosis in 71 years, as there are often no identifiable risks (Khattab et al., 2020).
• Most cases, 85%, of MBC are invasive ductal carcinomas (Perkins, 2003).

 

PDQ Adult Treatment Editorial Board (2020).

This image is the property of Terese Winslow LLC, 2020, obtained through PDQ Adult Treatment Editorial Board (2020).

 

Genetic risk factors

• Has first- or second-degree relative with BC: affected sibling/parent, male or female.
• Males with BRCA gene mutation also have increased risk – BRCA1 = 4% increase. BRCA2 = 6% increase risk (Khattab et al., 2020).
• Certain syndromes can increase risk – Klinefelter’s syndrome (males with XXY chromosomes) have 20 to 50-fold increased risk.
• Excess estrogen stimulation, obesity, thyroid disease, medications containing estrogen, or certain conditions have been identified as potential triggers (Fentiman, 2009).

Environmental risk factors

• Working in hot environments (blast furnaces, steel works etc.) (Basham et al., 2002).
• Occupations with soap, perfumes, exhaust fumes/emissions, petrol (Hansen, 2000)
• Smokers
• Radiation exposure

 

MBC tumours have been found to express estrogen receptor (ER) and progesterone receptor (PR) at higher levels than in female breast cancer tumours. Additionally, the different cellular origins in male and female breast cancer tumours are affected differently by environmental risk factors (Uslukaya et al., 2016).

 

Study Review – Sanguinetti et al., 2016

• 47 patients
• Average age of 67 years
• Average time from diagnosis to onset of symptoms, 16 months
• Main symptom/complaint was sub areolar swelling – 76% of sample = 36 patients.
• Treatments/management included mastectomy, radiotherapy, hormone therapy with/without chemotherapy.
• Follow up at 38-months (average)
  • Local recurrence in 8 patients = 17%
  • Metastases (cancer spread) in 15 patients = 32%
    • Bone = 8
    • Lung = 4
    • Liver = 1
    • Liver + skin = 1
    • Pleura + skin = 1

 

Clinical Features – PDQ Adult Treatment Editorial Board (2020).

Signs of breast cancer in men may include the following:

• A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast.
• An inverted nipple.
• Fluid from the nipple, especially if it is bloody.
• Scaly, red, or swollen skin on the breast, nipple, or areola.
• Peau d’orange (skin of an orange-similar in texture)
  • Accompanied by swelling, redness, tenderness, scales/dry flaky skin, wounds with black scabs (Connor, 2018).

 

Although the treatment protocols are the same for men and women’s breast cancer, further study and awareness into MBC are needed as the cancer is detected at an older age, when the cancer is already at a later stage, with early metastasis occurring (Uslukaya et al., 2016). This implies a poorer prognosis, with potentially worse outcomes with reported lower overall-survival rates (Anderson et al., 2004).

 

Subject to copyright Rehab Plus, 2020

 

References

Anderson, W. F., Althuis, M. D., Brinton, L. A., & Devesa, S. S. (2004). Is male breast cancer similar or different than female breast cancer? Breast Cancer Research and Treatment, 83, 77– 86. http://dx.doi.org/10.1023/B:BREA.0000010701.08825.2d.

Basham, V. M., Lipscombe, J. M., Ward, J. M., Gayther, S. A., Ponder, B. A., Easton, D. F., & Pharoah, P. D. (2002). BRCA1 and BRCA2 mutations in a population-based study of male breast cancer. Breast Cancer Research, 4(1), R2. doi: https://doi.org/10.1186/bcr419

Connor, E. (2018). What causes Peau D’Orange? Retrieved from https://www.healthline.com/health/breast-cancer/peau-d-orange

Fentiman, I. (2009). Male breast cancer: A review. Ecancermedicalscience, 3, 140. doi: 10.3332/ecancer.2009.140

Hansen, J. (2000). Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000 Apr; 37(4), 349-352. doi: 10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l

Khattab, A., Kashyap, S., & Monga, D. K. (2020). Cancer, Male Breast Cancer. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526036/

Perkins, G. H., & Middleton, L. P. (2003). Breast cancer in men. BMJ (Clinical research ed.), 327(7409), 239–240. https://doi.org/10.1136/bmj.327.7409.239

PDQ Adult Treatment Editorial Board. (2020). Male breast cancer treatment (PDQ®): Health professional version. In PDQ Cancer Information Summaries. Bethesda, MD: National Cancer Institute (US). https://www.ncbi.nlm.nih.gov/books/NBK65792/

Sanguinetti, A., Polistena, A., Lucchini, R., Monacelli, M., Galasse, S., Avenia, S., Triola, R., Bugiantella, W., Cirocchi, R., Rondelli, F., & Avenia, N. (2016). Male breast cancer, clinical presentation, diagnosis and treatment: Twenty years of experience in our Breast Unit. International Journal of Surgery Case Reports, 20S(Suppl), 8–11. https://doi.org/10.1016/j.ijscr.2016.02.004

Uslukaya, Ö., Gümüş, M., Gümüş, H., Bozdağ, Z., & Türkoğlu, A. (2016). The management and outcomes of male breast cancer. The Journal of Breast Health, 12(4), 165–170. https://doi.org/10.5152/tjbh.2016.3073