Is The Information The Same For Men?

Most of the information that men with breast cancer need is the same as for women. The symptoms, diagnosis and treatment are all very similar to women with breast cancer.

As with women, the single biggest risk factor for male breast cancer is increasing age. Most cases are diagnosed in men between the ages of 60 and 70.
Other risk factors are:

  • High oestrogen levels
  • Exposure to radiation
  • family history
  • Klinefelters syndrome
A diagnosis of breast cancer can be particularly difficult for men. You may feel confused and isolated. It is very common to hear about breast cancer in women but not at all common to hear about it in men. Your consultant may know other men with breast cancer that you could talk to. Or you could contact us.
The most common symptom for men with breast cancer is a lump in the breast area. This is nearly always painless.

Other symptoms can include:

  • Oozing from the nipple (a discharge) that may be blood stained
  • Swelling of the breast
  • A sore (ulcer) in the skin of the breast
  • A nipple that is pulled into the breast (called nipple retraction)
  • Lumps under the arm
The tests for breast cancer in men are much the same as for women. You may have a painless scan using sound waves, called an ultrasound. Or you may have a breast X-ray (mammogram). If your scan shows up an area that could be cancer, your specialist will take a sample (biopsy) of breast tissue for examination under a microscope. If these tests show that you have breast cancer, you will probably have other tests to make sure the cancer has not spread.

There are different types of breast cancer. The most common type in both women and men is invasive ductal carcinoma. The early, pre-cancerous condition called ductal carcinoma in situ (DCIS) is diagnosed in men quite rarely. DCIS means that there are cancer cells in the breast. But they are all still contained inside the ducts of the breast and cannot spread. Inflammatory breast cancer and Paget’s disease and other types of breast cancer are also found very rarely in men.

The same treatments are used for breast cancer in men as for women. Treatment is decided by the stage of your cancer. This means the size of the cancer and whether it has spread when it is diagnosed. The staging is the same for men’s breast cancer as for female breast cancer.

To treat your cancer, you may have one or more of the following treatments:

  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Hormone therapy
  • Biological therapy
The most common operation for men with breast cancer is removal of the whole breast (mastectomy) including the nipple. There is not very much breast tissue in men, so it isn’t usually possible to leave any behind. Sometimes the surgeon also removes part of the underlying muscle if it is close to the cancer. For men diagnosed with invasive breast cancer the surgeon removes some or all of the lymph nodes in the armpit. The lymph nodes are checked to see whether they contain cancer cells.

For men, implants currently available don’t recreate the correct shape of a man’s breast so it is not usual to have breast reconstruction. But sometimes your surgeon may be able to improve the appearance of the chest with more surgery after mastectomy. Once treatment has finished you could have a new nipple created. You need to wait a few months after the mastectomy to allow swelling to go down and the wound to heal. Although the shape can be created, the new nipple won’t respond to touch or temperature. Other options include tattooing a new nipple and areola on to the chest. Or stick on nipples – your breast care nurse can tell you where to get them.

As the cancer is always close to the muscle of the chest wall in men (because there is so little breast tissue) your specialist is likely to suggest radiotherapy after surgery. This reduces the risk of the cancer cells growing back in the chest wall in the future. You usually have radiotherapy for a few minutes daily from Monday to Friday, from 3 to 6 weeks. Some hospitals give radiotherapy on alternate days, rather than every day.
Chemotherapy is sometimes used to shrink a large cancer before surgery but this is not common. Chemotherapy is most often given after surgery and before radiotherapy. Your doctor will take various factors into account to see whether chemotherapy is needed to help reduce the chance of the cancer coming back. Your doctor will usually recommend chemotherapy if cancer cells were found in the lymph nodes under the arm. Of if the tumour is larger than 2 cm. You may also be advised to have chemotherapy if you are young or if the cancer is high grade.
Breast cancer cells can have oestrogen receptors or progesterone receptors. Most male breast cancer cells do have hormone receptors. This is known as being hormone receptor positive. About 9 out of 10 male breast cancers (90%) are oestrogen receptor positive, which means that they need oestrogen in order to grow. Your specialist will arrange tests on your cancer cells when you are first diagnosed. This shows if the cancer cells have hormone receptors. Men have small amounts of oestrogen in their body. Hormone therapies block oestrogen from making cancer cells grow. So they can reduce the chance of the cancer coming back.

The most common hormone therapy for male breast cancer is tamoxifen. The side effects are much the same as in women. Tamoxifen can make you feel sick when you first start taking it, but this usually wears off quite quickly. The most common side effect for men and women is hot flushes. Tamoxifen may also cause weight gain, difficulty sleeping, low mood and depression. In men, tamoxifen may also cause a loss of sex drive. This has been reported in up to 3 out of 10 men taking tamoxifen.

Other hormone therapies are used to treat breast cancer, including aromatase inhibitors. Large studies have shown that aromatase inhibitors reduce the chance of breast cancer coming back in women who have had their menopause, but we need more research before we know how well aromatase inhibitors work in men.

Your cancer cells will also be checked for receptors called HER2 receptors. If your cancer cells have a lot of these receptors, you may be prescribed a biological therapy.