Breast Cancer in Men Rose Marie Francis SCI/163 September 27, 2011 Dr. Leroy Isaacs ? Breast Cancer in Men Less than 1% of all breast cancer occurs in men, and although the disease is rare, the incidence appears to be increasing. Because men usually do not suspect breast cancer when they feel a lump in the breast, diagnosis frequently is delayed. Although screening for breast cancer is not recommended for men, radiographic imaging plays an important role in distinguishing benign conditions from malignant disease, and mammography usually is recommended as the first radiographic assessment.
Ultrasonography is useful in differentiating between noncancerous cysts and solid malignant tumors, especially if coexisting gynecomastia masks a cancerous lesion on mammography. Sonography also is useful to guide breast biopsy (Anne Mattarella, BS, ELS 2010). Breast cancer in men is rare, with an incidence of 1% of all breast cancer cases (centers for Disease Control and Prevention). One case of male breast cancer occurs for every 150 cases of female breast cancer (Hill TD, Khamis HJ, 2005), and 0. % of all male cancers are breast cancers (Breast Cancer Res Treat 2004). Of the 188,467 individuals who were diagnosed with breast cancer in 2005, 1764 were men, and 375 men died from the disease (Cancers for Disease Control and Prevention). In 2009, 1910 new cases of male breast cancer were expected to be diagnosed and 440 men were projected to die from the disease (CA Cancer J Clin 2009). The lifetime risk of developing male breast cancer is about 1 in 1000 (American Cancer Society 2009).
The rate of breast cancer in men has been increasing (Hill TD, Giordano SH, Perkins G, et. 2004-2005). Benign Breast conditions Most breast masses in men are caused by gynecomastia, which is an increase in fibroglandular breast tissue in 1 or both breasts (Egan RL, WB Saunders 1988). Men rarely develop benign breast tumors, such as papillomas, subcutaneous leiomyomas, sebaceous cysts, hematomas, fat necrosis, subareolar abscesses, lipomas and epidermal inclusion cysts (Hines SL, Tan W, Conant EF Breast Imaging Series 2006).
Gynecomastia is more prevalent in pubescent boys and in older men experiencing declining levels of testosterone (Appelbaum ATL, Evans GF, Levy, et. 1999). The condition also may occur as a result of excess estrogen levels, such as in obesity or disease of the endocrine glands or liver (American Cancer Society 2009). The diagnosis of gynecomastia usually can be made based on a physical examination and medical history, especially in men with palpable breast enlargement who are on long-term antihypertensive (Kopans DB, Lippincott Williams & Wilkins 2007).
Risk Factors The causes of male breast cancer have not been studied as thoroughly as have those of female breast cancer (Weiss JR, Moysich KB, Swede H 2005), and the small number of cases makes it difficult to determine risk factors (Lanitis S, Rice AJ, Vaughan A, et. 2008). Many of the same factors that increase the risk of breast cancer in women are believed to increase the risk in men, including: I. Age. As with female breast cancer, the risk of developing male breast cancer increases with age.
The median age at diagnosis is 67 years (Giordano SH, Cohen DS, Buzdar A, Perkins G 2004). II. Family History. Fifteen percent to 20% of men with breast cancer have a close relative with the disease (Weiss JR, Moysich KB, Swede H 2005). If a first-degree relative had either female or male breast cancer, a man’s risk of developing the disease increases 2 to 3 times (Weiss JR 2005). III. Genetics. Approximately 4% to 40% of men have a genetic risk resulting from mutated BRCA1 or BRCA2 genes (Fentiman IS, Fourquet A,et 2006). IV. Exposure to Radiation.
Men who received radiation to the chest, such as for the treatment of lymphoma, have a greater risk of developing breast cancer (American Cancer Society, Giordano SH, Lanitis S, Rice AJ, Mathew J, Perkins GH 2008). V. Excess Estrogen Levels. In men, increased estrogen levels may result from older age, hypogonadism, genetics, Klinefeller syndrome, liver disease, a hormone imbalance or hormonal treatment for prostate cancer (American Cancer Society 2009). VI. Klinefelter syndrome. Men who are born with Klinefelter syndrome carry an extra X chromosome, or XXY, instead of the normal XY (American Cancer Society).
The risk of developing breast cancer for men with Klinefelter syndrome is up to 50 times greater than for men without the disorder (Giordano SH, Buzdar AU 2002). VII. Liver Disease. Liver disease may increase a man’s risk of developing breast cancer. Men with cirrhosis appear to have 9 to 13 times the risk of developing the disease (Lanitis S, Rice AJ, Vaughan A 2008). VIII. Excessive alcohol use. Men who drink heavily have a greater risk of developing breast cancer possibly because of alcohol’s effect on the liver (American Cancer Society 2009). Conclusion
Although male breast cancer is rare, the incidence is increasing. Few, if any, randomized controlled trials have been conducted among male breast cancer patients. As a result, diagnosis and treatment strategies are based on protocols that have been established among women. Any mass found in a male breast should be thoroughly evaluated for malignant disease. Risk factors for male breast cancer include age, a family history of the disease, BRCA gene mutations, exposure to radiation, excess estrogen levels, testicular problems, excessive alcohol use.
The most common type of breast cancer in men is infiltrating ductal carcinoma. References Cancer for Disease Control and Prevention. Breast cancer statistics. www. cdc. gov/cancer/breast/statistics/. Updated January 28, 2009. Accessed May 21, 2009. Lanitis S, Rice AJ, Vaughan A, et al. Diagnosis and management of male breast cancer. World J Surg. 2008;32(11):2471-2476. Giordano SH. A review of the diagnosis and management of male breast cancer. Oncologist. 2005:10(7):471-479 ? ?