Contrary to normal belief, men can get breast cancer too. One percent of breast cancers around the world (including in Malaysia) belong to the male population. Because of widespread ignorance about the disease, too many men are seeking help too late.

Both men and women have breast tissue. Until puberty, girls and boys have a small amount of breast tissue with a few ducts under the nipple and areola (the pigmented region surrounding the nipple). When a girl reaches puberty, her ovaries produce hormones that cause breast ducts to grow, cause lobules (milk-producing glands) to form at the ends of the ducts, and increase the amount of stroma (fatty and connective tissues surrounding the ducts and lobules).

When a boy reaches puberty, his testicles produce hormones that prevent further breast tissue growth. Because men usually have much less breast tissue than women, breast lumps and other abnormalities are often easier to find on men than on women. However, because breast cancer is far less common in men and many men believe that only women get breast cancer, men often ignore the early signs of breast cancer, attributing the symptoms to infection or another cause. Some men are embarrassed to find a breast lump and delay making an appointment with their physician. Since men usually have less breast tissue than women, male breast cancer does not need to grow far to intrude into the skin and the muscles underneath the breast. Men who experience signs of breast cancer should see a physician.

Signs of Male Breast Cancer

Abnormal lumps or swelling in either the breast, nipple, or chest muscle Skin dimpling or puckering Nipple retraction (turning inward) Redness or scaling of the nipple or breast skin Nipple discharge

The most common breast abnormality in men is a benign (non-cancerous) condition called gynecomastia. Gynecomastia is an increase in the amount of breast tissue. Gynecomastia is most common in teenage boys and is related to changes in the hormone balance during adolescence. A man with gynecomastia may have a button-like or disk-like growth under the nipple and areola (the pigmented region surrounding the nipple) that can be felt and often seen. Older men may also develop gynecomastia due to changes in their hormone balances. While gynecomastia is usually symmetrical (similar in both breasts), in some cases it may develop asymmetrically (one breast is more affected) or even unilaterally (only one breast is affected).

Less commonly, gynecomastia may be caused by tumors or diseases of certain endocrine (hormone-producing) glands that cause a man’s body to produce more estrogen (a main female hormone). While some estrogen is normally produced in males, the amount is usually too small to cause breast growth. Because the liver aids in hormone metabolism, liver diseases may change a man’s hormone balance and cause gynecomastia or breast cancer.

Some medications, such as certain drugs used to treat ulcers, heartburn, high blood pressure or heart failure, may also cause gynecomastia. A few studies have suggested that some cases of gynecomastia may be caused by the use of recreational drugs such as marijuana, though researchers have not conclusively linked gynecomastia to recreational drugs.

Risk Factors for Male Breast Cancer
While only approximately 1% of all breast cancer cases occur in men, several risk factors have been identified that make some men more likely to develop breast cancer than others. These risk factors include:

Advancing age: The average age of men diagnosed with breast cancer is between 60 and 70 years old.

Family history: Approximately 20% of men with breast cancer have close female relatives who have (or have had) breast cancer.

Radiation exposure: Prior exposure to radiation (usually for treatment of a cancer inside the chest such as Hodgkin's or non-Hodgkin's lymphoma) is a risk factor for male breast cancer.

Liver disease: The liver helps with hormone metabolism by binding proteins that carry hormones in the blood. Men with severe liver diseases such as cirrhosis tend to have lower levels of androgens (male hormones) and higher estrogen levels (female hormones), which puts them at an increased risk of developing gynecomastia (non-cancerous tissue growth) and breast cancer.

Treatment with estrogen: Estrogen may feed some types of cancerous breast tumors, and therefore, men who have been treated with estrogen may be at an increased risk for breast cancer. However, according to the American Cancer Society, the risk of breast cancer due to estrogen treatment appears to be small. The benefit of slowing the growth of prostate cancer with estrogen, for example, often outweighs the risk of developing breast cancer. Also, men who take high doses of estrogen as part of a gender-changing procedure may be at a higher risk for breast cancer.

BRCA2 gene mutations: When functioning normally, the BRCA2 or breast cancer gene 2 helps repair damage to DNA (a process that also prevents tumor development). However, some men and women have genetic mutations of the BRCA2 gene, which can lead to an increased risk of breast cancer. Breast cancer gene 1 (BRCA 1) mutations also increase the risk for breast cancer in women. Men who carry mutations of the BRCA1 gene may pass the gene along to their daughters, who would be at an increased risk of developing breast cancer.

Klinefelter's syndrome: Normally, men are born with one X chromosome and one Y chromosome (the chromosomes which determine gender). Klinefelter’s syndrome is a genetic condition that occurs when a man is born with two or more X (female) chromosomes. Approximately 1 in 850 men have Klinefelter’s syndrome. Symptoms of Klinefelter’s syndrome include longer legs, a higher voice, a thinner beard than average men, smaller than normal testicles, and the inability to produce sperm (infertility). Men with Klinefelter’s syndrome also have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, men with Klinefelter’s syndrome are at a higher risk of developing gynecomastia (non-cancerous tissue growth) and breast cancer.

Diagnosis
If a physician is concerned about his or her findings during a clinical breast exam, he or she may order a mammogram to further investigate the breast abnormality. If testing reveals the possibility of cancer, a breast biopsy may be performed. A biopsy involves taking samples of breast tissue for pathological examination under a microscope. A biopsy is the only definitive way to determine whether breast cancer is present.

Treating Male Breast Cancer
Depending on the type and stage of breast cancer, one of the following treatment will most likely be used:

Surgery: usually a modified radical mastectomyis performed to remove the breast, the lining over the chest muscles, and part of the chest wall muscles. Some or all of the axillary (underarm) lymph nodesmay also be removed and sent to the laboratory for pathological examination to determine whether breast cancer has spread past the breast.

Radiation therapy involves using high-energy rays to stop cancer cells from growing.

Chemotherapy is treatment with anticancer drugs.

Hormone therapy: often used if the breast cancer cells have estrogen and progesterone receptors. Over 80% of male breast cancers have estrogen receptors. Hormone therapies used to treat male breast cancer include drugs like tamoxifen and megace. Tamoxifen is an antiestrogen and works by blocking estrogen in the breast, thereby slowing the growth and reproduction of breast cancer cells that depend on estrogen for survival. Megace is an anti-androgen and blocks the effect of androgen (a male hormone) on breast cancer cells. Researchers are not certain why blocking androgen in the breast helps treat male breast cancer.

Survival rates after five years range from around 50 per cent among those diagnosed at an advanced stage, to 85 and 90 percent among malignancies caught early. The survival rates among men and women with breast cancer are about the same but that the average length of symptoms before a man goes to see his doctor is about 18 months in men, while for a woman it is one to two months.

For those who catch the disease at an early stage the outlook is good. The greatest danger for men is that they don't realise it could happen to them. If men don't realise that they could get breast cancer they will ignore the symptoms. The longer you leave it, the worse it can be.

Men need to be aware that when they get a breast lump it needs to be checked and they must not think they can't get breast cancer. People should not die of ignorance.