Breast cancer dominated media airwaves last month following the news of Angelina Jolie’s double mastectomy due to the discovery of a gene mutation that significantly increased her risk of developing breast cancer. Shining a spotlight on breast cancer is a good thing; the deadly disease impacted the lives of almost 227,000 U.S. women in 2012 and took the lives of almost 40,000,according to the American Cancer Society.
But in all that headline news, very little, if any, attention was given to the issue of breast cancer in men. That might be appropriate given the much smaller numbers of men who develop breast cancer, but it is worth noting that breast cancer isn’t exclusively a woman’s disease.
Men at any age may develop breast cancer, but it is usually found in men between 60 and 70 years of age.It makes up less than 1 percent of all cases of breast cancer; about 2,200 U.S. men were diagnosed in 2012 and about 400 died of the disease, according to the American Cancer Society. The number of breast cancer cases in men relative to the population has been fairly stable over the last 30 years.
The prognosis for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar prognosis according to the American Cancer Society.
Breast enlargement in males is actually quite common. Everyone is born with a small amount of breast tissue. Breast tissue is made up of milk-producing glands, and ducts that carry milk to the nipples. Women begin developing more breast tissue during puberty because of the effect of estrogen, but men do not.
Gynecomastia is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels. For the first several weeks after birth, for example, infant boys can experience breast enlargement from the high levels of estrogen circulating in the mother. Also, some medications can cause breast enlargement such as aldactone (diuretic) and digoxin (cardiac medicine). Marijuana and alcohol are also associated with male breast enlargement.
Male breast cancer generally takes the form of a painless, firm mass that is usually under the nipple.
Signs to look for include:
- A firm mass under the nipple or breast tissue
- Ulceration of the nipple
- Inversion or retraction of the nipple
- Drainage from the nipple
- Swelling in the armpit (indicating lymph node involvement
Elevated risk factors for male breast cancer include:
- Obesity, which is associated with decreased testosterone and increased estrogen. Obesity may be a risk factor for breast cancer in men because it increases the number of fat cells in the body. Fat cells convert androgens into estrogen, which may increase the amount of estrogen in your body and, therefore, your risk of breast cancer.
- Cirrhosis of the liver, which is associated with elevated estrogen and male breast cancer.
- Family history of female breast cancer, especially if there is an abnormality of the BRCA2 gene. (The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes or mutations in either one of the two breast cancer susceptibility genes, BRCA1 and BRCA2.
Survival rates for men are similar to female breast cancer, but unfortunately male breast cancer is often diagnosed at a late stage. Mammograms, ultrasounds, and breast biopsy can all be used to diagnose breast cancer in men, but barriers to diagnosis still exist such as embarrassment and lack of awareness.
Breast self-examination, for example, is not often discussed in men’s health. For obese males who are at risk for breast cancer, a mass could be easily missed. Breast exams are not usually performed during men’s routine physical exams. Treatment for male breast cancer is similar to female breast cancer and may consist of radiation, surgery, chemotherapy, or hormonal therapy. It is important to be aware of male breast cancer. I encourage all men to be alert for any abnormalities of their breasts and bring it to the attention of their physicians.
Dr. Helen Goldberg is founder of the Blue Sage Center for Integrative Oncology in San Antonio. She is a board-certified medical oncologist who recently completed a two-year fellowship at the University of Arizona Center for Integrative Medicine under Dr. Andrew Weil. For more information, visit www.BlueSageIntegrativeOncology.com.