The last few decades have brought much-needed attention and research dollars to aid in the prevention, early detection, and treatment of women’s cancers; however, breast cancer, in particular, has another, often overlooked patient population—men.
Approximately 2,240 new cases of invasive breast cancer are diagnosed annually in men; although this is much fewer than the 232,340 women who are diagnosed each year, this number is significant because men may not realize that they can also be carriers of a gene mutation that causes breast cancer.1-2
Men who have the inherited BRCA1 and BRCA2 gene mutations are at an increased risk for breast cancer as well as other cancers, including pancreatic, testicular, and prostate cancer.3 Heavy alcohol use, liver disease, obesity, radiation exposure, hormonal therapy from prostate cancer treatment, or having Klinefelter syndrome (men who have the Y chromosome plus at least two X chromosomes) are also risk factors for male breast cancer.
Public Service Announcements in college dorms and on television commercials instruct women to conduct monthly exams and to look for unusual changes in their breasts, while men may not be as aware of some of the tell-tale symptoms—dimpled or puckered skin; a red, scaly nipple or skin; or fluid discharge4—that can be indicative of breast cancer. Men should also be on alert for these symptoms, and health care professionals need to share this information with all patients who may be at risk, including their male patients.
Survival Rates between Black and White Patients Varies
Race accounts for a noteworthy difference in survival, according to a research study conducted across medical centers in Michigan. This study showed that black male patients fared worse than other patients in terms of 5-year-overall survival and 5-year disease-specific survival compared with white males, black females, and white females (P=0.0001).5
The study noted that the majority of male breast cancer diagnoses, compared to female breast cancer diagnoses, were made at later stages (49.2% vs. 35.3%, respectively), with greater number of positive lymph nodes (44% vs. 33.5, respectively). In addition, a higher percentage of estrogen receptor/progesterone receptor–positive breast cancers were found in males compared with females (95% vs.79%, respectively).
HER2 Status Differences, Treatment Similarities
In another study, preliminary results showed that male breast cancer has biological differences from female breast cancer, including HER2 status. Seventy six men (median age, 64 years) who were diagnosed with the disease were shown to have higher hormone receptor status and much lower HER2 expression, as well as higher Ki-67 (a molecular marker) values.6 This study highlights the importance of including men in breast cancer studies so that the research can accurately reflect data from both male and female patients, thus allowing clinicians to make appropriate treatment decisions.
The types of breast cancer that are typically diagnosed in men include infiltrating ductal carcinoma, ductal carcinoma in situ, inflammatory breast cancer, and Paget disease of the nipple, according to the National Cancer Institute.7 Although the types of cancer, biological differences, and diagnoses may vary between men and women, the treatments are similar and can include surgery, radiation and adjuvant therapy.
With all breast cancers, prevention and early detection are the keys to best outcomes. It is important for both females and males at high risk to find out through genetic tests and counseling whether they carry the BRCA1 and BRCA2 gene mutations. Outside of that, being aware of the signs and symptoms of breast cancer is important for both men and women, beginning at young adulthood.
Further public education efforts and frank discussion by health care professionals may help men, in particular, to learn the symptoms so that diagnosis can happen at an earlier stage. The American Society of Clinical Oncology’s patient site, Cancer.Net, includes helpful resources that clinicians can share with male patients about prevention, monthly exams, tests, and treatment options. In addition, Men for a Cause and The John W. Nick Foundation also provide resources that discuss this rare cancer in men.
1. National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA. Accessed August 20, 2013.
2. Cancer.net. Breast Cancer. http://www.cancer.net/cancer-types/breast-cancer/statistics. Accessed August 20, 2013.
3. American Cancer Society. What are the key statistics about breast cancer in men? http://www.cancer.org/cancer/breastcancerinmen/detailedguide/breast-cancer-in-men-key-statistics. Accessed August 20, 2013.
4. Medline Plus: Male Breast Cancer. http://www.nlm.nih.gov/medlineplus/malebreastcancer.html. Accessed August 20, 2013.
5. Mushtaq R, Shaik M, Mistry S, et al. Survival rates of male breast cancer compared to female: A Surveillance, Epidemiology, and End Results (SEER) database analysis. J Clin Oncol. 2013 (suppl; abstr 6567).
6. Masci G, Caruso M, Losurdo A, et al. HER2 assessment and Ki-67 labeling index in a cohort of male breast cases: The Ich Network on Cancer Research (INCaRe) experience. J Clin Oncol. 2012 (suppl; abstr 623).
7. National Cancer Institute. General Information About Male Breast Cancer. http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/Patient. Accessed August 21, 2013.