Frequently asked questions about breast cancer in men - risk factors, symptoms, self-diagnosis and more

October is observed as the Breast Cancer Awareness Month, all around the world. Breast cancer is one of the leading causes of death among women and is also the most common type of cancer that affects women. However, we often associate breast cancer only with women. In fact, some people are not even aware that breast cancer can also affect men. The fact is that men do have a small amount of breast tissue in their body. 

It is important to know and be aware of breast cancer in men. A medical expert answers some frequently asked questions about breast cancer in men.

How is breast cancer in men different from that in women? What causes breast cancer in men? 

 

Breast cancer in men is a rare type of cancer that forms inside the breast tissue. While every individual is born with a small amount of breast tissue, women begin developing more breast tissue during puberty as compared to men. Therefore, the occurrence of breast cancer is higher in women. According to a study titled ‘Male Breast Cancer in India: Series from a Cancer Research Centre’ out of 1,752 cases of breast cancer in the country, between 2005 to 2014, only 18 cases were identified to be among men. 

Types of breast cancer in men include: 1) Ductal carcinoma: This cancer begins in the milk ducts. Majority of all male breast cancer is ductal carcinoma.  2) Lobular carcinoma: This type of cancer is rare because men have few lobules (a gland in the breast that makes milk) in their breast tissue.

Other rare types of breast cancer that can occur in men include Paget's disease (a type of cancer with skin changes involving the nipple of the breast) and inflammatory breast cancer (a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast)

What are the early warning signs of breast cancer in men that one should look out for? 
Breast cancer does not produce symptoms when the tumour is small and most treatable, making it difficult to detect.
The warning signs include a painless lump or thickening in the breast tissue, changes to the skin covering the breast such as dimpling, puckering, redness or scaling. It can also be identified through changes to the nipple such as redness, scaling, nipple discharge or a nipple that begins to turn inward.

How can you do a self-examination of breasts?

To perform a self-examination, stand in front of a mirror, placing your arms on your hips. Look closely at your chest area for noting any changes to your nipples such as swelling or inversion. Then, raise your arms above your head and inspect the areas around your chest and armpits. The next step is to feel your chest for any potential lumps, which can be done by moving your fingertips in a circular motion around the breast area. Additionally, the nipple area needs to be checked for any discharge.

Who is at risk of breast cancer?

The most common risk factor for male breast cancer is old age. It is most often diagnosed in men who are in their 60s. Other risk factors include:

• Family history: Some men inherit abnormal genes from their parents that increase the risk of breast cancer
• Liver disease: Certain conditions such as cirrhosis of the liver (late stage of scarring of the liver caused by many forms of liver diseases such as hepatitis and chronic alcoholism), can reduce male hormones and increase female hormones which can lead to increased risk of breast cancer
• Exposure to estrogen: The risk tends to increase if one takes estrogen-related drugs such as those used for hormone replacement therapy for prostate cancer. High estrogen level can be a result of excess alcohol and tobacco consumption, inadequate physical activity and obesity.

How can breast cancer be diagnosed?

Apart from self-examination, mammogram, ultrasound and biopsy require identifying cancer cells in tissue specimens.
A mammogram is a process of using low-energy X-rays to examine the human breast for diagnosis and screening. Ultrasound is most often done to confirm if a lump found by a mammogram or physical exam is a cyst filled with fluid or a solid tumour. A biopsy is a test in which tissue or fluid from the suspicious area is extracted and examined under a microscope and further tested to check for the presence of breast cancer. 

What are the treatment options available?
Treatment depends on the stage of cancer, overall health and individual treatment preferences. It can be a combination of surgery, radiation and medical therapy. 

The aim of the surgery is to remove the tumour and surrounding breast tissue. Common surgical procedures include:

Mastectomy: This involves the removal of entire breast tissue, including the nipple and areola.
Sentinel lymph node biopsy: This involves identification of the lymph nodes where the cancer cells are likely to start spreading from. If cancer is found, additional lymph nodes are removed for testing. If no cancer cells are found here, then there is a good chance that breast cancer hasn't spread beyond the breast tissue. 

Apart from the surgical procedure, one can opt for radiation or systemic therapy. Radiation therapy is used to destroy cancer cells remaining in the breast, chest wall, or underarm area after surgery, or to reduce the size of a tumour before surgery. In systemic therapy, anti-cancer drugs are injected into a vein or given by mouth. It includes biologic therapy, chemotherapy, and hormone therapy.

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