Dr Peter Schoub outlines breast cancer in men and explains that male breast screening includes mammograms.
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Breast cancer in men
Breast cancer in men is an uncommon but potentially deadly disease. Whereas women have a one in eight lifetime chance of developing breast cancer, in men it’s closer to one in eight hundred.
In men, breast cancer tends to develop at a later age than in women. Almost all male breast cancers occur after the age of 50.The most common symptoms are a palpable lump, redness and flaking of the skin or nipple, retraction of the nipple or nipple discharge.
The type of breast cancer seen in males is usually ductal (as opposed to lobular), and almost always hormonal (oestrogen and progesterone receptor positive). Triple-negative and HER2 breast cancers are extremely rare in men. Men can also get ductal carcinoma in situ (DCIS) which implies precancerous disease.
On average, breast cancer is diagnosed at a later stage in men than women. This means there is a higher chance of lymph node metastases at the time of diagnosis. The result is that men with breast cancer generally have a worse prognosis than women. The main reason that it’s identified late in men, is that men generally don’t do regular screening mammograms.Consequently, cancers are only identified when they are large enough to be felt as a lump. In addition, many men don’t realise that they can get breast cancer and may delay investigation of breast symptoms.
Mammograms and ultrasound are valuable investigations for screening and diagnosis of breast cancer in men. Both cranial caudal (top to bottom) and mediolateral oblique (from the side) mammogram views can be obtained in most men.
The job of the radiologist is to differentiate potential cancers from benign conditions, such as gynaecomastia (benign swelling of the breast tissue in men on one or both breasts). Gynaecomastia is a relatively common condition and may be related to hormonal disease, medication, alcohol abuse, steroid or other supplement usage. Gynaecomastia can almost always be identified on mammogram and ultrasound, meaning that biopsy is unnecessary. However, if there is a suspicious lesion seen on imaging, the next step is an ultrasound-guided core biopsy. This is a small procedure performed in the outpatient department under local anaesthetic. Specimens are obtained with a needle and sent to the pathology lab for definitive diagnosis.
The treatment for breast cancer in males is similar to women. The treatment depends on the stage of breast cancer, usually determined by the size of the lump and whether there is spread to lymph nodes or other parts of the body.
In the lower-stage cancers, the lump is excised and radiotherapy is given. Hormone-blocking drugs like tamoxifen may also be prescribed. In high-stage cancers, chemotherapy may be given in addition to the other treatments. These days chemotherapy generally is given prior to surgery.
- Since male breast cancer occurs infrequently, regular mammogram screening is not advised for most men.
- Some males are at a higher risk of developing breast cancer. The risk factors are similar to those found in women. For example: BRCA mutation carriers (or certain other genetic conditions); strong family history; hormone therapy; and previous radiotherapy to the chest. Men considered to be at high risk are advised to undergo routine screening. This entails an annual mammogram and ultrasound from the age of 50. If there is a strong family history of breast cancer or known BRCA carriers in the family, genetic testing is strongly advised for the male members of the family.
- Breast MRI can also be performed in men, although it’s usually reserved for pre-treatment staging of a diagnosed cancer, rather than a screening tool.
- Even though regular screening isn’t recommended for most men, it’s extremely important for all men to know that male breast cancer does occur, and that a palpable lump or skin/nipple changes need prompt medical investigation.
MEET THE EXPERT – Dr Peter Schoub
Dr Peter Schoub is a radiologist at Parklane Women’s Imaging Centre. He obtained the European Diploma of Breast Imaging in 2018 and is an honorary lecturer in the Department of Radiology at the University of the Witwatersrand.
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