Breast cancer awareness month tends to focus on women since most patients are women, but many people don’t know men can also get the disease.
This is because all humans are born with breast tissue and the small amount men retain throughout life makes it possible for them to develop the condition. Unfortunately, research shows that many men are not aware that they are at any risk. In fact, 1 out of every 100 people diagnosed with breast cancer is a man and about 500 American men will die of the disease in 2019.
How is it possible for men to get breast cancer?
All humans are born with a small amount of breast tissue, which includes glands, ducts and fat. Puberty causes women to develop more breast tissue, but the small amount of breast tissue men have makes it possible for them to develop breast cancer. Research shows many men are not aware that they are at any risk. There are also social and cultural factors that can hinder diagnosis and make treatment and recovery even more difficult for men. Hopefully greater awareness that breast cancer can happen to people of any gender will help reduce stigma and promote earlier diagnosis, when the disease is most treatable.
What are the unique concerns for men diagnosed with breast cancer?
Since breast cancer awareness month is strongly associated with women and “pink ribbon culture,” men diagnosed with this disease may feel marginalized and have social and psychological struggles along with the medical implications of the condition. These stereotypes may deter men from seeking medical attention, professional and social support and put them at increased risk for body image and identity concerns. Men diagnosed with breast cancer have reported concealing their conditions in order to avoid stigma, being afraid that disclosing their condition would exclude them from certain social groups and fear that treatments—such as mastectomy—would be emasculating. Almost all literature and support for breast cancer patients is geared toward women, which may leave many men feeling excluded and alienated. High-risk men being screened for breast cancer report feeling awkward and alienated in waiting rooms full of women. Men who successfully dealt with the challenges of a breast cancer screenings or diagnosis reported various coping mechanisms including using humor, reframing their masculine identities on their own terms and engaging in breast cancer awareness, advocacy and support.
What are the risk factors for breast cancer in men?
Research shows that unlike women, most male breast cancers are not genetically linked. More than half of women with breast cancer have a related gene—45-65%—while less than 1% of men do. Though younger men can get the disease, age is a significant risk factor. The average man is 67 years old when diagnosed, compared to 62 years old for women. Since the majority of breast cancers in men are hormone-responsive, elevated levels of estrogen are thought to predispose men to breast cancer. Studies show that men with the highest levels of estrogen were over twice as likely to be diagnosed with breast cancer. Conditions that can lead to elevated estrogen levels in men include gynecomastia, liver disease, testicular abnormalities and obesity. A recent study showed that adolescent obesity—independent of adult weight—can increase rates of breast cancer for men. African American men are also diagnosed at higher rates than whites. Men with BRCA gene mutations are also at elevated risk and may benefit from regular self examinations and medical screenings. The lifetime risk for male breast cancer in BRCA2 carriers ranges from 2.8% to 6.9% by ages 70 to 80 respectively.
How is breast cancer diagnosed and treated in men?
The most common symptom of breast cancer in men is a lump or unusual thickening in the breast or chest tissue. Other signs can include nipple retraction, bleeding or discharge from the nipple, chest skin ulceration and swelling of underarm glands. Breast cancer in men is often diagnosed at a later stage and on average tumors are larger than when they are found in women. Experts speculate this occurs because men are less likely to know that they are at risk for breast cancer—unlike women who are encouraged to perform regular self-examinations—and may be less likely to visit the doctor, especially for this problem.
Currently there are not separate protocols for treating breast cancer in men, so doctors usually base treatment on what has worked best for post-menopausal women. The most common treatment is mastectomy. Radiation, chemotherapy and endocrine/hormone therapy may also be used. Though more research is needed, breast/chest-preserving strategies that reduce surgical disfigurement and have better cosmetic outcomes may be just as effective as more aggressive interventions. Due to their small numbers, men have traditionally been excluded from breast cancer studies and male breast cancer is very understudied, which means there is very little direct research for male-specific treatment options. Some studies are beginning to accept both genders or are focused exclusively on men, which could help develop male-specific treatment protocols.
Take our quiz on breast cancer and nutrition to learn more about how to manage risk.