Lifting the shirt off male breast cancer


The incidence of male breast cancer varies throughout the world. In the United Kingdom it counts for about 0.7% of all breast cancers. There seems to be an increasing incidence in the USA, especially amongst black males, with about a thousand cases being diagnosed per year. The mean age of breast cancer in the USA is about sixty years of age. If you look at Africa particularly sub-Saharan Africa the incidence of male breast cancer varies from 3% to 10% of all breast cancers
Risk factors for male breast cancer are interesting; it is definitely not associated with benign male breast lumps (gynaecomastia). There does however appear to be an inherited component. The lifetime risk of a male to get breast cancer if his mother and his sister had breast cancer is about 2.5%.
Male breast cancer is increased in families who have the BRACA2 gene mutation. It increases in males who have Kleinefelters Syndrome (which is the chromosomal abnormality XXY. It seems to be increasing in men who work on electrical lines and factors such as ionising radiation and electromagnetic fields have been implicated in male breast cancer.
A male breast cancer is almost always a ductal carcinoma. Very rarely a lobular carcinoma is seen and that is usually in association with Kleinerfelters Syndrome. Any variation of ductal carcinoma can be seen in male breast cancers including Paget’s disease. 80% to 90% of male breast cancers are oestrogen receptor positive. Less than 10%, are progesterone receptor positive, 50% of them also contain androgen receptors.
The disease parallels female breast cancer but tends to present in an older age group It also usually presents at a more advanced stage and this is due to the decreased amount of breast tissue found in men. So it is more frequent to see skin and chest fixation.
90% of all male breast cancers present as a breast lump and it is usually a painless mass.14% present with a nipple discharge, about 20% with nipple changes, 4% present with breast pain and 3% as metastic disease, (the breast cancer spreads to other organs)
Breast cancers usually present as an asymmetrical eccentric firmness either with fixation or ulceration of the breast. Any of the following presentations should raise suspicion in a man - any unilateral breast mass which is firm, fixed or ulcerated. The investigations that should be done are a mammogram and sonar. SENSitivity in mammograms is the same in males as it is in females. An ultrasound is also of benefit to obtain the diagnosis. A needle biopsy will provide the diagnosis.
Treatment for male breast cancer, as for female breast cancer, is multi-disciplinary .In other words it involves surgery, oncology (chemotherapy and hormone therapy) and radiation therapy. The usual treatment is a modified radical mastectomy with a lymph node dissection, followed by adjuvant chemotherapy if necessary. Radiation treatment to the chest wall is used if necessary and endocrine therapy to improve the survival (if the cancer is hormone sensitive). The principles of management are identical to that for female breast cancer
There is a higher incidence for local reccurrence so clear surgical margins and radiation treatment (should the tumour be greater than 2 cm) play an important part of loco-regional control. These tumours are mainly oestrogen receptor positive so endocrine therapy ( Tamoxifen) is part of systemic treatment.
Adjuvant therapy (chemotherapy) is used for node positive tumours or biological aggressive tumours. . Tumours that are greater than 2cm have twice the risk of relapse than those where the lesions are less than 1cm.
So the prognosis is believed to be worse than in females but it is actually identical to female breast cancer, stage for stage. Because men are diagnosed at a later stage relative to the size of breast tissue they have, it gives the impression of a worse prognosis. It is important for men with unilateral breast masses, which are firm, to seek medical attention.
Source: (25/01/2012)

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