Male Breast Cancer: Myths and Facts

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1) Men don’t have to worry about getting breast cancer.
False. But, most men will not get breast cancer. Male breast cancer is a very rare disease. The ratio of male-to-female breast cancer diagnosis is 1 man to every 120 women.

2) If breast cancer doesn’t run in a man’s family then he is definitely not at risk for getting the disease.
False. There are factors other than family history that make men prone to breast cancer. These include:

  • Klinefelter Syndrome — A genetic abnormality where a man has two female chromosomes and one male chromosome. Usually, a man has only one of each.
  • Chronic liver disease such as cirrhosis or chronic alcohol injury — These conditions lead to incomplete breakdown of estrogen. Abnormally high levels of estrogen are linked to increased breast cancer risk.
  • Gallstones — Black men with gallstones are at increased risk for breast cancer.
  • Gynecomastia — When excess growth of breast tissue in men is due to abnormally high levels of estrogen, there is increased risk of breast cancer.
  • Testicular diseases — Inflammation (orchitis), undescended testicles (cryptorchidism) and testicular injury are associated with increased breast cancer risk.

There are other conditions that increase breast cancer risk in both men and women:

  • Genetics – Mutations such as BRCA1, BRCA2, PTEN and TP53
  • Diabetes
  • Obesity
  • Sedentary Lifestyle
  • Exposure to cancer causing chemicals or radiation

3) Male breast cancer is very similar to female breast cancer.
True.  As with females, most cases are estrogen receptor (ER) positive and HER2 negative. As in women, most cases are infiltrating ductal type. The number of male breast cancer cases is very small, and studies have not yet shown that the disease is any different from that in females.

4) There are differences in breast cancer outcomes among ethnic groups.
True. Black men, like black women, tend to be diagnosed at younger ages and have lower breast cancer-specific survival than their white counterparts.

One study compared white, black and Hispanic men with breast cancer. It found that black men had the lowest levels of ER-positive disease, the highest levels of HER2-positive disease and the highest levels of triple-negative disease.

Another study found that black and Asian males had more poorly differentiated cancers compared to white males, and that this difference led to worse survival.

5) All men should have annual screening mammograms.
False. The disease is so rare, even in men with genetic mutations, that screening mammography plays no role in breast cancer detection in men. Physical examination by a doctor and breast self examinations are sufficient for men.

6) Breast cancer is usually easy to diagnose in men.
True. Most cases of male breast cancer will present with an obvious breast mass, which is often behind the nipple. Sometimes, it will present as a mass in the upper outer portion of the breast or with nipple changes (ulceration, discharge, inversion).

When a breast mass is found, it is evaluated just like in a woman. Mammogram and ultrasound are used to determine if its features are benign or malignant. Image-guided biopsy is performed to make a diagnosis.

7) Men can easily have a lumpectomy for breast cancer treatment.
False. Most breast cancers are behind the nipple, so the nipple and central portion of the breast must be removed. This is where the majority of the breast tissue is. A total mastectomy often has a better cosmetic outcome and does not compromise getting clean margins around the disease. Men with large amounts of breast tissue may have successful lumpectomies followed by radiation therapy.

8) All axillary lymph nodes must be removed in surgery for male breast cancer.
False. Men can have axillary sentinel lymph node biopsies. It is important to note that the American College of Surgeons Oncology Group Z0011 clinical trial (a study that supports avoiding full axillary lymph node dissections if 2 or fewer sentinel nodes are positive) did not include men. Therefore, it is unclear if men with 1 or 2 positive sentinel lymph nodes can avoid a full axillary lymph node dissection.

9) Men can’t have postoperative hormone therapy.
False. Tamoxifen is the treatment of choice for men with ER-positive breast cancer. Studies show that taking the medication for five years improves survival, just as it does for women with ER-positive breast cancer.

The side effects of tamoxifen in men include weight gain and sexual dysfunction. Unfortunately, these conditions lead many men to stop the drug prematurely.

Aromatase inhibitors cannot be used in male breast cancer. They don’t appear to suppress estrogen as effectively as they do in women, and are associated with lower survival compared to tamoxifen.

10) Chemotherapy agents for women can be used for men.
True. All of the same chemotherapeutic agents given to female patients are given with success to male patients. However, because male breast cancer is rare, there have been far fewer studies to show the effectiveness of the regimens.

11) Because the disease is so rare, a man with breast cancer has no risk of developing breast cancer on the other side.
False. Contralateral breast cancer (CBC) is more frequent in men than in women. So, men with history of breast cancer need continued surveillance with physical examination.

12) Men with breast cancer should undergo genetic testing.
True. Male breast cancer is closely associated with BRCA1, BRCA2, PTEN and TP53 genetic mutations. These genetics defects are also linked to other cancers, like prostate cancer. Male patients diagnosed with breast cancer should be counseled about genetic testing for their own health and for the health of their families, especially their female family members who may have inherited a genetic defect.