unmanly diagnosis

The National Cancer Institute defines breast cancer as a disease in which a tumorous growth occurs in breast tissue. In the public mind it is associated almost solely with women. This association is even celebrated in the breast cancer awareness signature color of pink, which is traditionally seen as a uniquely feminine color. Despite these typical assumptions, men are able to contract breast cancer – and occasionally do.

Dr. Gary Burton is a board-certified internist and oncologist at Feist-Weiller Cancer Center in Shreveport. Burton said, “There will be approximately 190,000 individuals diagnosed with breast cancer in the U.S. in 2013. While rare, 1,500 of these individuals will be men.” According to the National Institutes of Health, male breast cancer has a peak age of onset at 71 years.

With a 1-in-1,000 chance of developing breast cancer – compared to odds of 1-in-8 for women –male cases usually fall within four main types listed by the National Cancer Institute:

• Infiltrating ductal carcinoma – the most common invasive breast cancer, also known as invasive ductal carcinoma, it starts in the milk ducts and invades surrounding breast tissue;

• Ductal carcinoma in situ – a noninvasive cancer in the milk ducts which, if untreated, may become invasive later and therefore requires treatment; • Inflammatory breast cancer – a rare, aggressive disease in which cancer cells block lymph vessels of the breast and skin, causing the tissues to become red and inflamed; • Paget disease of the nipple – a rare type of skin cancer involving the skin of the nipple and areola and which may indicate tumors within the breast, as well.

The NIH lists the following common symptoms of breast cancer in men, which closely follow the same symptoms of breast cancer in women:

• A lump or swelling (noting that a lump is usually not cancer, but breast cancer will usually create a lump), • Skin dimpling/puckering, • Inverted nipple, • Redness or scaling of the nipple or breast skin and • Fluid discharge from nipple. According to the NIH, data suggests that delays in diagnosis often occur due to the shock and stigma associated with breast cancer in males, believed to occur because of its image as a femaleonly disease. Embarrassment and fear of ridicule may be sufficient to cause patients to conceal and/or evade diagnosis until the disease has reached a dangerous late stage, feeling that such a diagnosis challenges their masculinity. Burton said, “Men with breast cancer tend to present with a more advanced disease than women, which reflects the idea that men do not get breast cancer. Adolescents often develop gynecomastia (a small breast bud), which is of no concern for breast cancer. Adult men with a new breast lump, however, are far more likely to have breast cancer (5 percent) than an adult women with a new breast lump (less than 10 percent).

“Management of men with breast cancer follows the same guidelines as for women with breast cancer, although men were excluded from participation in breast cancer trials until after 2000. In fact, the Feist-Weiller Cancer Center here in Shreveport entered one of the first male patients on a national clinical trial,” Burton said.

“Treatment follows the general principle of breast cancer management with local control with removal of the tumor and sampling or dissection of the lymph nodes under the arm. Patients with a high risk of recurrence on the chest wall receive radiation. Because of the risk of microscopic spread to other regions of the body such as bone, liver and lung, many patients receive either chemotherapy, hormone blocking therapy or both to reduce the risk of tumor recurrence at these sites.

“The risk factors for female breast cancer are well defined and including reduced risk with early and multiple pregnancies, protracted breast feeding and early menopause, all of which would have no implication in men,” Burton said. “Other risk factors, which include smoking, alcohol use and estrogen replacement certainly could play a role in male breast cancer; however, no studies have been reported to confirm these risks play a significant role. We do, however, see an increased incidence of breast cancer in men transitioning to female with the use of estrogen to develop female characteristics and in men receiving estrogen suppression therapy for prostate cancer. Men with breast cancer also tend to have an increased blood level of estrogen. Inherited risk factors do play a significant role.

“Men with breast cancer are far more likely to have an inherited mutation, and all male breast cancer patients should have genetic testing.”