Male Breast Cancer

Male breast cancer is a rare form of cancer that grows in the breast tissue in your chest. When most people think of breast cancer, they typically think of women.

But males also have breast tissue that can become cancerous. One out of every 100 breast cancer diagnoses affects males. About 2,800 males in the U.S. receive this diagnosis each year.

Because it’s so rare, it can be easy to dismiss a lump in your breast as no big deal if you’re male. But it’s important to get all suspicious lumps checked by a healthcare provider.

Types of male breast cancer

Cancer is most likely to form in your breast ducts. Ducts are tubes that connect glands called lobules to your nipple. The types of male breast cancer are:

• Ductal carcinoma. Up to 9 out of 10 male breast cancers are invasive ductal carcinoma. Cancer starts in your breast ducts and spreads to other parts of your breast. Ductal carcinoma in situ is less common. With this type, the cancer starts in your breast ducts but doesn’t spread beyond them.
• Lobular carcinoma. With invasive lobular carcinoma, cancer forms in the lobules of your breast. Like invasive ductal carcinoma, lobular breast cancer can spread. This type is uncommon, though, because males have few, if any, lobules.

Breast cancer cells can have receptors on them that cause them to grow in response to specific hormones. Think of a receptor as a lock that fits a specific key (hormone). When the hormone attaches to the receptor, cancer cells divide and multiply. Most male breast cancers have receptors that cause cancer cells to grow in response to progesterone and estrogen.

The most common form of breast cancer in males is estrogen receptor-positive (ER+) invasive ductal carcinoma.

Symptoms of male breast cancer

The first sign of male breast cancer is often a firm, painless lump in one of your breasts. Usually, it’s behind a nipple. Other signs and symptoms include:

• A lump in your armpit
• Skin on your chest that looks dimpled or pitted, like the skin of an orange
• Red, flaky or scaly skin on your chest or near your nipple
• Pain or tenderness in your chest or underarm
• Clear or bloody nipple discharge or an inverted nipple (a nipple that’s sunken inward)

Male breast cancer causes

Male breast cancer happens when the DNA inside breast cells changes, or mutates. The mutated cells start multiplying rapidly and don’t die. Eventually, the cancer cells form masses called tumors. Parts of the tumor may break off and spread to other body parts through your lymphatic system or bloodstream. Cancer that’s spread is called metastatic cancer.

Scientists continue to research what causes healthy cells to transform into cancer cells in the first place.

Risk factors

Several risk factors may increase your breast cancer risk, including:

• Age. Most people diagnosed are in their 60s.
• Biological family history. You’re at greater risk if you have a parent, sibling or child with breast or ovarian cancer. This is because certain breast cancer genes run in families.
• Genes. Genetic mutations increase your breast cancer risk. These include BRCA1 and (especially) BRCA2 mutations. Less common mutations occur in Cowden syndrome (PTEN gene), Li-Fraumeni syndrome (TP53) and Lynch syndrome (MMR gene).
• High estrogen levels. Conditions that raise your estrogen include cirrhosis of the liver, obesity and a genetic disorder called Klinefelter syndrome. Alcohol use can also raise your levels.
• Testicular issues. Your risk increases if you’ve had surgery to remove a testicle (orchiectomy), an injury or a condition involving your testicles. These include having inflamed testicles (orchitis) or undescended testicles.
• Radiation therapy. You’re more likely to develop breast cancer if you’ve had prior radiation therapy directed at your chest.

How to lower your risk

Get genetic testing if you likely have a gene mutation that increases your cancer risk. A family history of breast or ovarian cancer is a clue that the BRCA2 mutation may be in your genes. Not only does it cause breast cancer, but this mutation can also lead to melanoma, pancreatic cancer and prostate cancer.

A healthcare provider can help you decide if you’d benefit from genetic testing.

How doctors diagnose this condition

A healthcare provider will ask about your symptoms and risk factors. Providers perform various tests to diagnose male breast cancer, including:

• Breast exam. Your provider will examine your breast tissue. They’ll check for skin changes, lumps or other abnormalities.
• Imaging tests. Mammograms can find most male breast cancers. Your provider may also perform an ultrasound before or after the mammogram to give more information about the tumor.
• Biopsy. Your provider will perform a biopsy to look for cancer cells in your breast tissue. This involves removing tissue from the tumor and sending it to a lab for testing.

If the cells are cancerous, pathologists in the lab will check for hormone receptors and the HER2 receptor. (HER2 is a protein that fuels cancer growth.) The results will help your provider plan treatment.

Stages of male breast cancer

After diagnosing breast cancer, healthcare providers stage it. Staging uses information like tumor size and location to figure out how advanced the disease is. At this point, you may need more imaging tests and a sentinel node biopsy. For this procedure, your provider removes one or more lymph nodes near a tumor and tests them for cancer cells.

The stages of male breast cancer are:

• Stage 0. Cancer cells are only in your breast ducts. Stage 0 breast cancer is another name for ductal carcinoma in situ.
• Stage I. The tumor is small and hasn’t spread to your lymph nodes.
• Stage II. The tumor is larger than in stage I. It may have spread to a few of the lymph nodes in your armpit (axillary lymph nodes).
• Stage III. Cancer has spread to several lymph nodes, and the tumor may be larger. Cancer cells may also be in your chest wall or skin.
• Stage IV. Cancer cells have spread to other parts of your body. In male breast cancer, the most common locations for cancer spread are your bones, lungs and liver.

How is male breast cancer treated?

Your treatment depends on the cancer type and stage. You’ll likely need a combination of treatments that follow a timeline that your provider will explain to you.

Surgery

Breast cancer surgery is the most common treatment for early-stage male breast cancer. Surgery to remove your entire breast (mastectomy) is more common than surgery to remove the lump only (lumpectomy).

A radical mastectomy removes all of your breast tissue. It removes the lymph nodes in your armpit and some chest muscle, too. But it’s more common to get a modified radical mastectomy. This procedure doesn’t remove muscle tissue or as many lymph nodes.

Radiation

Radiation for breast cancer uses X-rays or other energy sources to kill cancer cells. Radiation usually follows a lumpectomy to kill any remaining cancer cells. It’s possible for surgery to miss small tumor cells close to your chest wall or skin. But radiation can destroy what’s left, so tumors don’t grow back.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout your body. For local tumors (those that haven’t spread), you may get chemo before surgery to shrink tumors. Or you may need radiation and chemo after surgery to reduce the chance that a tumor will grow back or come back somewhere else in the body. You won’t receive treatments at the same time, but rather one after the other.

Hormone therapy

Providers use hormone therapy to lower estrogen levels or block their effects. You’ll likely get this treatment if the cancer cells use hormones, like estrogen, to grow. Tamoxifen is a common medication used to treat male breast cancer. Other medicines that keep hormones from fueling cancer growth in males are aromatase inhibitors combined with gonadotropin-releasing hormone (GnRH) agonists.

Targeted therapy

Targeted therapy treatments interfere with processes that allow cancer cells to grow. Targeted treatments only work on specific types of cancer cells. For example, some treatments only work on breast cancers with hormone receptors. Others, like PARP inhibitors, work on cancer cells with BRCA gene mutations.

When should I see my healthcare provider?

See a provider if you have an unexplained lump in your chest that doesn’t go away within two weeks. Follow your healthcare provider’s advice about how often you need cancer screenings.

What can I expect if I have male breast cancer?

The biggest factors that affect your prognosis (outlook) are the cancer type and stage. The survival rate is higher for early-stage cancers.

A recent study tracked the mortality (death) rate of males diagnosed with breast cancer based on cancer stage. All had hormone receptor-positive (HR+) breast cancer. Within 20 years of diagnosis, researchers found that:

• Stage I: 12.4% had died of breast cancer.
• Stage II: 26.2% had died of breast cancer.
• Stage III: 46% had died of breast cancer.

Unfortunately, many men delay seeing their provider. So, most aren’t diagnosed until the cancer has already advanced. At this point, it’s much harder to treat.

This is why it’s important to seek care if you notice an unexplained breast lump.