Men may not realize that, for them too, any changes in the area of the breasts, including lumps felt on the chest or in the underarm area, could be a sign of breast cancer and should be immediately checked out by a doctor. Although breast cancer is far more prevalent in women—1 in 8 women will be diagnosed with breast cancer in their lifetime—about 1 in 800 men are also diagnosed with the disease. And since men are less familiar with signs and symptoms, the unfortunate truth is that their breast cancer is often not diagnosed until it’s in a later stage.
Male breast cancer can arise at any age but is more likely to occur in older men, between ages 60 and 70. A man’s risk for breast cancer increases if he has a family history of breast cancer or other genetic risk factors. Breast cancer is diagnosed and treated the same way for both men and women, and the survival rates are similar as well.
“If diagnosed early, male breast cancer is very treatable and generally has a good prognosis,” says Liva Andrejeva-Wright, MD, a radiologist in the Department of Radiology & Biomedical Imaging. “Just as for breast cancers found in women, breast cancers in men have a better prognosis when detected while they are small in size. If a man feels a breast lump, a lump in the armpit, or experiences suspicious nipple discharge, he should contact his provider and not feel strange or embarrassed about doing so. At the Breast Center, we frequently see men for breast-related complaints. While many breast lumps in men turn out to be benign, some will be cancerous.”
What is male breast cancer?
Cancer begins at a cellular level. Normally new, healthy cells are generated to replace old, dying ones. But sometimes there can be a disruption in the DNA as new cells are generated. The result of this abnormal growth of new cells can be the formation of a tumor that is either benign (not cancerous) or malignant (cancerous).
Just as with female breast cancer, a diagnosis of male breast cancer means that malignant (cancerous) cells have been found within breast tissues.
What are the symptoms of male breast cancer?
Men with breast cancer usually first notice a lump in their chest or underarm. If any of the changes in the breast area listed below occur, you should discuss them with a physician, says Dr. Andrejeva-Wright:
- A lump or thickened skin in the breast or underarm
- Changes to the size or shape of your breast/chest area
- Puckering or dimpling (peau d’orange) skin in the breast area
- An inverted nipple
- Fluid or bloody leakage from the nipple
- Swelling, scales, or redness on any part of the breast, including the nipple and areola.
How is a male breast cancer diagnosis made?
If a doctor has reason to suspect cancer, the following tests and procedures may be used to arrive at a diagnosis:
- Clinical breast exam. Usually a first step, this is performed in the office. The doctor feels the breast and underarm area for palpable lumps and examines the skin and nipple for any breast changes.
- Imaging tests. Next, the doctor may order such tests as a mammogram (a special low-dose X-ray of the breasts) with a breast ultrasound (sonogram) and, occasionally, a magnetic resonance imaging (MRI) of the breasts. A radiologist will examine these imaging tests to look for malignant tumors.
- Breast biopsy. A breast biopsy is a procedure in which a small piece of tissue is removed and sent to a pathology lab, where it is evaluated to determine if it is malignant or benign. The four main kinds of breast biopsies are the core needle biopsy, excisional biopsy, fine need aspiration, and punch skin biopsy. Hormone-sensitivity tests. If cancer is found, an estrogen and progesterone receptor test (immunohistochemistry) is performed to determine whether the tumor contains receptors for estrogen and progesterone. If it does, the patient can also be treated with medications that suppress estrogen and progesterone in the body, depriving cancer cells of those hormones. This is done in addition to surgical therapy.
- HER2 test. This test measures the amount of the growth-factor protein known as HER2, found in the breast tissue. This information helps a medical oncologist choose the right therapy for treatment.
What are the risk factors for breast cancer in men?
What is the prognosis for men with breast cancer?
It depends on the kind, stage, and type of breast cancer. In general, when male breast cancer is detected at an early stage, men have a similar chance of recovery as women with breast cancer.
“However, breast cancer is often diagnosed in men at a later stage because many may not routinely examine their breasts, aren’t aware that breast cancer can occur in men, or are embarrassed about having a breast-related complaint,” says Dr. Andrejeva-Wright.
Later detection of breast cancer means the cancer is harder to cure and may have spread (metastasized) to other areas of the body, such as the lymph nodes.
Should men at higher risk for breast cancer get screening mammograms?
Men have less breast tissue than women and fewer than 1 percent of men develop breast cancer, so national cancer screening guidelines do not recommend regular screening mammograms for men. However, if a doctor suspects breast cancer, a diagnostic mammogram may be needed to look for malignant tumors.
However, when a man is determined to be at higher risk for breast cancer, it is recommended that he have an annual clinical breast exam to check for breast changes that could indicate breast cancer.
What is Yale Medicine’s approach to detecting and treating breast cancer in men?
Our radiologists are uniquely qualified to diagnose even the rarest forms of breast cancer, including male breast cancer—early and accurately. Our radiologists who subspecialize in breast imaging are among the most highly skilled leaders in the field. They are nationally and internationally recognized for their skill in diagnosing breast cancer. Additionally, our radiologists conduct research on 3D mammography and dense breast imaging, which is advancing the field of radiology.
“A man with a breast-related complaint will be scheduled for a diagnostic mammogram and ultrasound within a few days,” Dr. Andrejeva-Wright says. “If a suspicious mass is seen, then a needle biopsy is scheduled soon after. If a diagnosis of breast cancer is made, our intake specialists coordinate all necessary appointments with the patient as soon as possible, so that treatment can begin quickly.”