How breast cancer in men is a rare but real concern

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Breast cancer is commonly associated with women, but it's essential to acknowledge that this disease can also affect men. Male breast cancer, though relatively rare, is a pressing issue. Accounting for only about 1 percent of all breast cancer cases, it is often overlooked. In this article, we will shed light on the prevalence, risk factors, signs, and the crucial importance of early detection for male breast cancer.

Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in the USA reveals that between 2005 and 2010, out of 289,673 cases of breast cancer, only 2,054 were diagnosed in men, constituting just 0.7 percent of all breast cancer cases. Internationally, a meta-analysis study reported varying incidences of male breast cancer, with the highest rates found in Brazil (3.4 cases per 100,000 man-years) and the lowest in Japan and Singapore (0.1 per 100,000 man-years).

In India, institution-based studies indicate that male breast cancer comprises less than 1 percent of all breast cancer cases, and it primarily affects elderly men, typically in their 6th or 7th decade of life. The risk of male breast cancer rises with age. It's important to understand the risk factors for male breast cancer - particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

Risk factors:

Growing older: This is the biggest factor. Just as is the case for women, the risk increases as age increases. The average age of men diagnosed with breast cancer is about 68. In India, this age is younger as compared to the West.

High estrogen levels: Breast cell growth - both normal and abnormal - is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:

Taking hormonal medicines: Being overweight, increases the production of estrogen. Having been exposed to estrogens in the environment (such as estrogen and other hormones in meat, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body). Being heavy users of alcohol can limit the liver's ability to regulate blood estrogen levels. Having liver disease usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer. Certain conditions like Klinefelter syndrome; Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer

Men with Klinefelter syndrome have more than one X chromosome and one female chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).

A strong family history of breast cancer or genetic mutations: Family history can increase the risk of breast cancer in men - particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for Cancer) have an increased risk of male breast cancer. There is a strong association between male breast cancer and an abnormal BRCA2 gene, the history demonstrates a strong presence of male breast cancer and prostate cancer in the males of the family.

Radiation exposure: If a man has been treated with radiation to the chest for any condition such as lymphoma, bone tumor, or even hypertrophic scar or keloid has an increased risk of developing breast cancer.

Following are the signs which if present help should be immediately sorted:

A lump felt in the breast
Nipple pain
An inverted nipple
Nipple discharge (clear or bloody)Enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Breast enlargement can be idiopathic or due to certain medications, heavy alcohol use or weight gain. Gynecomastia itself does not cause cancer, the high estrogen state which causes cancer also causes gynecomastia.

A small study about male breast cancer found that the average time between first symptom and diagnosis is over a year and a half. This long time between the symptom and diagnosis is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. if more public awareness is created men will learn that just like women, they need to go to their doctor right away if they detect any persistent changes to their breasts.

Diagnosis is made by evaluation of the signs and symptoms by

MammogramUltrasound of BreastCytology of Nipple discharge if presentBiopsy(core needle) of the Breast LumpImaging by PET CT/ MRI/ CT scan/ Bone scan. etc for evaluating distant spread.

Treatment

Male Breast cancer is generally a hormone-positive disease. If detected early, it can be treated by surgery followed by hormonal therapy. Chemotherapy and radiation are needed if the disease presents in an advanced stage.

In Males, the loss of breast and body disfigurement is not as impactful as in a female. Although, the loss of a nipple does have a psychological impact on males. Therefore, the need for early detection is as important in male breast cancer:

To improve survival
De-escalation of treatment
Minimising body disfigurement

Male breast cancer is a rare but significant health concern that should not be ignored. Awareness of risk factors and the importance of early detection can save lives and improve the outcomes for men facing this disease. It's essential to empower men to be proactive about their breast health and seek medical attention if they notice any warning signs.

(Dr Mandeep Singh Malhotra is a Director of Surgical Oncology at CK Birla Hospital, Delhi)

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