Within the framework of Pink October, the Breast Cancer Awareness Month, attention often centers on women’s health. However, men also have breast tissue and can develop this disease. Although it occurs far less frequently, it has a key peculiarity: it is usually diagnosed later.
In most cases, men receive the diagnosis after noticing a lump themselves in the chest area. Since routine ultrasound or mammography studies are not typically recommended for the male population, early detection relies almost exclusively on self-observation and timely medical consultation. Dr. Kathryn Ruddy, an oncologist at the Mayo Clinic Comprehensive Cancer Center, outlines everything there is to know about this condition.
Symptoms and Risk Factors
The most common symptom is the presence of a lump in the breast, which tends to feel firmer than the surrounding tissue and may have irregular borders. Because men have less breast tissue, these lesions are often located near the nipple. Other signs can include nipple discharge or pain in the area. As with women, the most common variant is ductal carcinoma.
“Given that the breast cancer screening tests, such as mammograms and breast exams, are not usually recommended for men, they are generally the ones who find the lump,” notes Dr. Ruddy. “If you notice an unusual lump, nipple discharge, or discomfort in the chest or breast, it is essential to seek medical attention promptly to determine the cause.”
The risk of developing male breast cancer increases with age and is more common among those with a family history, especially of the same condition in men. Among the known risk factors are:
- Specific genetic mutations, such as those in the BRCA1 and BRCA2 genes.
- Klinefelter syndrome, a rare condition in which a man is born with an extra X chromosome.
- History of medical treatments with prior exposure to radiation therapy to the chest wall (as used to treat lymphoma).
- Testicular or liver disorders that alter hormonal levels.
How Diagnosis and Staging Are Performed
When symptoms or a suspicious finding appear, the first clinical step is to perform imaging studies, such as breast ultrasound and mammography, sometimes complemented by magnetic resonance imaging (MRI). If physical exams and imaging show abnormalities, a biopsy is performed to analyze a tissue sample.
Male breast cancer is staged from 0 to 4, in the same way as in women:
- Stage 0: if detected at this stage, before it becomes invasive, virtually all patients are curable.
- Stages 2, 3, and 4: these are the stages where a larger proportion of men are diagnosed, unlike female cases that are more often found at stages 0 and 1.
- Stage 4: indicates that the disease has spread to other parts of the body; at this stage it can be treated but not completely eradicated.
“When detected at the same stage, the prognosis of breast cancer in a man is not worse than that of a woman,” explains Dr. Ruddy. “However, male cases are diagnosed more often when the tumor has already grown substantially, or has spread to the axillary lymph nodes or other organs.”
Treatment Options and Emotional Support
The therapeutic approach depends on the extent of the disease. For stages 0 to 3, surgery is a central part of the plan, while in stage 4 treatment is primarily based on systemic medications to fight the disease throughout the body.
In the surgical realm, mastectomy (complete removal of breast tissue) is a common option, although some patients may opt for a lumpectomy (partial removal). Decisions about chemotherapy, endocrine therapy, and radiotherapy in men are largely based on evidence gathered from women. Nevertheless, the Translational Breast Cancer Research Consortium is conducting the ETHAN trial, focused exclusively on men recently diagnosed at stages 1 to 3. In this study, various antiestrogenic drugs and targeted therapies are evaluated to shrink the tumor before surgery and provide evidence specific to the male population.
Beyond the medical aspect, the emotional impact requires special attention. “Since breast cancer is less common in men, some patients may feel isolated or even uncomfortable or ashamed to have a disease typically associated with women,” warns Dr. Ruddy. “That is why it is important for men to speak openly with their medical team about how they feel and, if possible, connect with other survivors either in person or through support groups.”
To achieve earlier diagnoses and improve prognoses, the specialist emphasizes the need to seek medical advice at any perceived change in the chest wall, nipples, armpits, or neck. She also encourages participation in available clinical trials to optimize future treatments and attain higher cure rates.
