Breast Cancer In Men
San Francisco Medical Society Online
About 1,300 men were diagnosed with breast cancer last year, according to
the American Cancer Society.
Researchers once believed that the disease was
more aggressive in men than in women, but, as it turns out, men are
generally diagnosed later than women, at which point their cases may be
more advanced. A study of 217 men with breast cancer who were treated at 18
different U.S. hospitals showed that the men waited an average of ten
months after symptoms appeared before consulting a doctor.(1)
(According to another study, at least two thirds of all women who discover
breast cancer symptoms themselves seek a physician evaluation within three
"If a man notices a lump or swelling in his breast, there's no excuse not
to evaluate it," says oncologist Hope S. Rugo, M.D., associate clinical
professor of medicine at UCSF's Carol Frank Buck Breast Care Center.
a man presenting to his primary care physician with a suspicious lump in
his breast could be referred for testing with a fine needle aspiration or a
Symptoms in Men
Although men of all ages can develop breast cancer, statistically, most men
are diagnosed between the ages or 60 and 70. Male breast cancer often first
appears as a small, hard, painless lump in the nipple area; researchers
believe it tends to occur there because most men have small, undeveloped
vestiges of milk ducts beneath the areola and nipple. (Women have these
ducts throughout their breasts.) Some men notice changes in the appearance
of the nipple or the skin around the nipple; the nipple may be retracted,
for example. Discharge or bleeding from the nipple is another warning sign.
Rugo describes one patient, a man who noticed a swelling in his breast, but
was told by his doctor that he had gynecomastia-a relatively more common
benign swelling of breast tissue.
In fact, the patient did have breast
cancer, but years went by before he was tested for it. But by the time the
diagnosis was made at UCSF, the cancer had spread and he was diagnosed with
One Man's Story
Boris Subbotin, a retired electrical engineer living in California's San
Fernando Valley, was diagnosed far earlier. In 1991 he noticed a small lump
near his left nipple. He says that he didn't suspect that it might be
breast cancer-- even though his mother had died of the disease in 1947 at
age 53. Still, Subbotin, now 71, decided that the lump probably didn't
belong there. His physician suggested a biopsy, which revealed cancerous
Following a total mastectomy on the left side, including lymph node
removal, Subbotin learned that he had Stage 1 breast cancer with no muscle
wall involvement. His tumor turned out to be eight-tenths of a centimeter
in diameter; his cancer was caught at an early stage.
"At the time, my surgeon, Frank Candela, had done two prior breast cancer
surgeries on men at Sloan-Kettering," says Subbotin. "Not a lot was known
about the management of breast cancer in men, and then, as now, it was not
likely for men to join support groups for this."
Most breast cancers found in men (including Subbotin's) are
estrogen-receptor (ER) positive, meaning the tumors are sensitive to
hormones and associated with a better prognosis than ER-negative tumors.
Researchers are still trying to figure out why that might be and to
determine optimal drug therapies for men with breast cancer. Today, most
recommendations are based on what women's clinical trials have shown.
(Because most men undergo mastectomies, few if any undergo radiation
After his mastectomy in 1991, Subbotin went on a tamoxifen regimen for four
and a half years.
Subbotin's cancer was caught at an early stage, but hormonal drug therapies
such as tamoxifen have also been found to lengthen the survival times of
men with hormone-receptive tumors who have metastatic disease.
Family History an Issue
According to the National Cancer Institute, a family history of male or
female breast cancer is one risk factor for the disease in men. In fact, an
increased risk of male breast cancer has been reported in families in
whicmutations of the BRCA-2 gene on chromosome 13q has been identified (3).
In one study of men with breast cancer in Iceland, a BRCA-2 mutation
appeared in 40 percent of reported cases. (4)
Another study of 142 male breast cancer patients treated between 1973 and
1994 at either the Memorial Sloan-Kettering Cancer in New York or the
Ochsner Clinic in New Orleans showed that 15 percent of the men had a
first-degree relative with the disease. More significantly, the study
suggested that the presence of a family history did not affect the age at
diagnosis, the duration of symptoms, the stage of disease at diagnosis, nor
the overall survival.
Instead, the most powerful predictor for outcome for all of the men was the
status of the axillary lymph nodes (5). The study, published in the journal
Cancer last year, concluded that "BRCA-2 testing in males with breast
carcinoma is not warranted, as it would not change therapeutic approaches,
and treatment should not be changed based on family history."
Dr. Rugo notes that axillary lymph node status is the most powerful
predictor in how well women do, as well.
Still, she believes that when
there is a strong family history of breast cancer, men with breast cancer
might wish to consult a genetic counselor and/or undergo genetic testing.
This suggestion makes sense in light of a Danish study of 551 male breast
cancer patients that found that daughters of men with breast cancer might
be at higher risk of developing the disease. Researchers began tracking
their subjects in 1968; over the next 30 years the men had a total of 119
daughters. Three cases of breast cancer were identified in these women, at
ages 26, 34, and 36 (which may not seem like a particularly dramatic
finding but is considered statistically significant). None of the women had
mothers with breast cancer. (6)
Studies have shown that men who take estrogen-based medications (to treat
prostate cancer, for example) might also be at greater risk of subsequently
developing breast cancer. A 1988 study in the Journal of the American
Medical Association, meanwhile, reported on a case of breast cancer in a
male-to-female transsexual who had taken estrogen to promote female sexual
Men who have a rare chromosomal disorder called Klinefelter's syndrome
(characterized by two X chromosomes and one Y chromosome) may also be at
greater risk for the disease. And because liver disease has been associated
with relatively high estrogen levels, men with cirrhosis of the liver may
be at greater risk as well.
This may explain why breast cancer rates are
higher in parts of Africa and Egypt, where liver disease is more common,
than they are in the United States or in European countries.
Another risk factor for breast cancer is exposure to radiation.
Several studies have examined, with conflicting results, whether
occupational exposure to electromagnetic fields is linked to male breast
cancer. One study looked at the occupations of 227 men who were diagnosed
with breast cancer between 1983 and 1987. The results, published in the
American Journal of Epidemiology in 1991, showed elevated risk among men
who held any job with exposure to electromagnetic fields, with higher risks
found in electricians, telephone linemen, electric power workers, and radio
and communications workers.
The risk was highest among subjects who were first employed in jobs with
exposure before age 30 and who were initially exposed 30 years prior to
diagnosis. Researchers at the University of Washington in Seattle, who led
the study, concluded, "the hypothesis warrants evaluation in women." (8)
A later study, meanwhile, published in 1994 by the Department of Social and
Preventive Medicine at the State University of New York at Buffalo, showed
that there was no increase in disease risk for males believed to have
occupational exposure to electromagnetic fields. The study compared 71 men
diagnosed with breast cancer between 1979 and 1988 with 256 healthy male
Interestingly, the Buffalo study showed that men with occupations involving
heat exposure were more likely to get the disease. Researchers theorize
that exposure to heat on the job could influence testicular function, which
in turn would influence hormone levels affecting breast tissue. (9)
Further Information and Support
There are a number of support and information resources available for men
with breast cancer. One good medical resource is the Male Breast Cancer
Information Center (http://interact.withus.com/interact/mbc/), a website
designed by the late Bob Stafford, an Indiana man who was diagnosed with
breast cancer at age 37 and lived with the disease for more than ten years
before he died in 1998.
The National Alliance of Breast Cancer
Organizations, meanwhile, runs an information service; you can send
questions via e-mail to NABCOinfo@aol.com. You can also call (888) 80-NABCO
Mon-Fri (9:30 to 5:30 EST) address: 9 East 37th Street 10th floor NY NY 10016.
Several cancer organizations-including Y-Me (http://www.y-me.org), the
Community Breast Health Center in Palo Alto, California (650/326-6686), and
the American Cancer Society-try to help men with breast cancer connect with
each other across the United States.
Some male breast cancer patients
seeking emotional support also say prostate cancer support groups have
Winchester, David J. "Male Breast Carcinoma: A Multi-Institutional
Challenge," Cancer, August 1, 1998, vol. 83, no. 3. pp 399-400
Facione, N.C. et al., "Helpseeking for Self-Discovered Breast Symptoms,"
Cancer Practice, July/August 1997, vol. 5, no. 4, pp. 220-27.
Thorlacius S. et al., "Linkage to BRCA-2 Region in Hereditary Male Breast
Cancer," Lancet, 1995, vol. 346, no. 8974 pp. 544-545.
Thoriacius, S. et al., "Study of a Single BRCA-2 Mutation With High Carrier
Frequency in a Small Population," American Journal of Human Genetics, 1997,
vol. 60 pp. 1079-84.
Hill, Arnold et.al. "Localized Male Breast Carcinoma and Family History: An
Analysis of 142 patients," Cancer, September 1, 1999, vol. 86, no. 5 pp
Storm, Han H. and Olsen, Jorn, Risk of Breast Cancer in Offspring of Male
Breast Cancer Patients. Lancet, January 16, 1999, vol. 353(9148):209
Pritchard, T. et al., "Breast cancer in a Male-to-Female Transsexual,"
Journal of the American Medical Association, 1988, vol. 259 p. 2278
Demers, P.A. et.al. "Occupational Exposure to Electromagnetic Fields and
Breast Cancer in Men." American Journal of Epidemiology, August 15, 1991,
vol. 134, no. 4, pp. 340-347
Rosenbaum, P.F., "Occupational Exposures Associated With Male Breast
Cancer," American Journal of Epidemiology, January 1, 1994, vol. 139, no.1,
Lauren John is a free lance medical and science writer in the Bay Area.
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