The etiology, diagnosis, and treatment of breast cancer in males is similar to that in females. Unlike breast cancer in females, breast cancer in men is rare. Less than 1% of all breast cancers occur in men.

Men with breast cancer often face unique challenges. This diagnosis can be shocking, and may bring about feelings of isolation, shame, and emasculation. A lack of awareness of male breast cancer, along with responses from others, contribute to these emotions.

 
Stigma is commonly expressed as one of the most stressful barriers to receiving care and support for men with breast cancer. This stigma can be experienced in many settings, including within the cancer care system and in existing social surroundings. Studies have shown that breast cancer care focuses on female patients, leading men to feel dismissed. Men report being mistakenly called by female names and prefixes in waiting rooms and will most often be the only male breast cancer patient in the room. This brings about feelings of embarrassment and of being an outsider.In social settings, men often hesitate to disclose their diagnosis due to fear of how others will react. Many times, close family and friends are the only trusted sources of emotional support, and these chosen few are often equally as shocked by the diagnosis as the patient.

Other times, people do not know how to deal with the diagnosis and will retreat from the patient. Men will often feel isolated and have few outlets for support, which leads to social exclusion and ongoing shame. In order to reduce the impact of these stressful events, studies have shown there are solutions to provide a more comprehensive approach in the health care setting. When breast cancer is not seen as only a woman’s disease, negative outlooks decrease.

What are environmental and genetic risk factors for male breast cancer?

• Marital status (never married are higher risk)
• Previous breast pathology
• Gynecomastia
• History of testicular pathology
• Family history of breast cancer
• Men who inherit BRCA2 have about a 6% lifetime risk of breast cancer
• Overall, male breast cancer shares risk factors associated with female breast cancers, especially high estrogen levels. A few transsexual (male to female) patients have been reported with breast cancer 5-10 years after initiation of estrogen therapy

Diagnosis

Male breast cancer usually presents as a painless lump. In 75% of cases, the lump is a hard and fixed nodule in the subareolar region, with nipple involvement more common than in women.Often, the disease is not detected until late in its course: more than 40% of patients have stage III or IV disease at diagnosis.Lack of awareness that men develop breast cancer may possibly contribute to diagnosis of breast cancer in men at more advanced stages than in women. however, mammography can be useful in diagnosis and fine-needle aspiration biopsy can confirm the diagnosis.

What is the role of surgery in the treatment of male breast cancer?

The general principles of surgical management of male breast cancer are similar to those of breast cancer in women. Simple mastectomy remains the usual choice for stage 1 and stage 2 breast tumors. Nipple and skin-sparing mastectomy are common in women, but generally not practiced in male breast cancer. Cosmetic outcomes are of secondary concern, but where feasible, surgeries with better cosmetic outcomes can be considered in men as well.

Retrospective studies indicate that breast-conserving surgery can be performed in carefully selected patients.Male breast cancer patients who present with locally advanced tumors (ie, stage 3, stage 4) can be offered therapy similar to that for locally advanced breast cancer in women, with neoadjuvant chemotherapy followed by surgical resection.

References

Breast Cancer in Men: Overview of Male Breast Cancer, Etiology, Diagnosis. (2019). eMedicine. [online] Available at: https://emedicine.medscape.com/article/1954174-overview#a1.

‌ Breastcancer.org. (2020). Male Breast Cancer. [online] Available at: https://www.breastcancer.org/symptoms/types/male_bc#:~:text=Breast%20cancer%20in%20men%20is [Accessed 20 Aug. 2020].