Can men get breast cancer too? (Male Breast Cancer) Let's talk about this!

When we think of breast cancer, we think of women, right? Many people think that this is a disease that only affects women. But did you know that men can also get breast cancer (Male Breast Cancer). True, it is a bit rare. Only about one in 100 breast cancer patients is a man. But, we cannot ignore it just because it is rare. If you find a lump or a tumor in your chest, don't just dismiss it as "Oh, this doesn't happen to men." It is very important to show any suspicious lump to a doctor and have it checked.

What is Male Breast Cancer?

Simply put, male breast cancer is when the cells in the breast tissue in your chest start to grow abnormally and out of control. Men also have breast tissue, just like women, but in smaller amounts. It is in this tissue that cancer can develop.

It is very important to be aware of this situation in Sri Lanka as well. Because, sometimes due to shame or the wrong attitude of "what kind of breast cancer is it for men?", many people delay seeing a doctor even when they have symptoms. This increases the chances of the disease worsening.

What are the types of male breast cancer?

This cancer starts in the breast tissue in your chest. Men's breasts, like women's, have small milk-producing glands (lobules) and small tubes (ducts) that carry milk (if any) to the nipple. However, in men, these are not as large, because they don't need to breastfeed. So, most of the time, this cancer starts in the ducts. There are two main ways:

• Ductal Carcinoma: This type of cancer accounts for about 9 out of 10 cases of male breast cancer. In this type, the cancer starts in the milk-carrying ducts and then spreads to other parts of the breast. There are two types of this type:
• Invasive Ductal Carcinoma: This is the most common type. The cancer starts in the ducts and spreads to the surrounding breast tissue.
• Ductal Carcinoma In Situ (DCIS): This is a little less common. Here, the cancer is contained within the ducts and has not spread outside of them.

• Lobular Carcinoma: This is a type of cancer that starts in the milk-producing glands (lobules). Invasive Lobular Carcinoma means that it has spread to surrounding tissue. However, this type is very rare in men, because men have very few or no lobules.

Importantly, cancer cells sometimes have special 'antennas' called receptors. When certain hormones bind to these antennas, the cancer cells start to divide and grow rapidly. Think of it like a key finding a lock. Most male breast cancers have receptors that respond to the hormones estrogen and progesterone. The most common type of breast cancer in men is estrogen receptor-positive (ER+) invasive ductal carcinoma.

What are the symptoms of male breast cancer?

Often the first sign is a painless, hard lump in the breast, often under the nipple . Other symptoms may include:

• A lump in the armpit.
• The skin on the chest is rough, like an orange peel, and looks like pits.
• The skin on the chest or nipple becomes red and flaky.
• Feeling pain or tightness in the chest or armpit.
• A clear liquid or something resembling blood coming from the nipple, or an inverted nipple.

If you see something like this, don't just assume, "This just happened." See a doctor immediately.

What are the causes of male breast cancer?

To be precise, breast cancer is caused by changes in the DNA, or mutations, in breast cells. These mutated cells begin to divide rapidly and uncontrollably, without dying. Eventually, these cancer cells join together to form tumors. Sometimes, pieces of these tumors can break off and spread to other parts of the body through the lymphatic system or bloodstream. When this happens, it is called metastatic cancer.

Scientists are still researching why healthy cells turn into cancer cells.

Risk Factors

Some factors may increase your risk of developing breast cancer. Let's take a look at what they are:

• Age: The risk of developing this disease increases slightly as you get older. Male breast cancer is most often diagnosed in people over the age of 60. That doesn't mean it doesn't occur in younger people, but the risk increases with age.
• Biological family history: If your mother, father, brother, sister, or child has had breast cancer or ovarian cancer, you are at increased risk. This is because some cancers can be passed down through genes.
• Genes: Certain genetic mutations increase the risk of breast cancer. The most common of these are BRCA1 and especially BRCA2. In addition, changes in the PTEN gene in Cowden syndrome, the TP53 gene in Li-Fraumeni syndrome, and the MMR gene in Lynch syndrome can also increase the risk.
• Increased estrogen levels: Some medical conditions, such as cirrhosis of the liver, obesity, or a genetic condition called Klinefelter syndrome, can increase estrogen levels in the body. Excessive alcohol consumption can also be a cause.
• Testicular issues: You are at higher risk if you have had one of your testicles surgically removed (orchiectomy), if you have had any trauma to your testicles, or if you have a condition such as orchitis, or if you have undescended testicles.
• Radiation therapy: If you have previously had radiation therapy to the chest area, your risk of developing breast cancer may increase.

How to reduce the risk?

If you think you may have a genetic mutation that increases your risk of cancer, it's a good idea to get genetic testing. If someone in your family has had breast or ovarian cancer, that's a sign that you may have the BRCA2 gene mutation. This gene mutation can cause not only breast cancer, but also skin cancer (melanoma), pancreatic cancer, and prostate cancer.

A doctor can help you decide whether genetic testing is right for you.

How do doctors diagnose this?

When you see a doctor, he or she will ask you about your symptoms and risk factors. Then they will do several tests to find out if you have male breast cancer:

• Breast exam: The doctor will feel your breast tissue and check for any skin changes, lumps, or other abnormalities.
• Imaging tests: A mammogram can detect most breast cancers in men. This takes an X-ray of the breast. Sometimes an ultrasound may be done before or after the mammogram to learn more about the lump.
• Biopsy: This is the best way to be sure . The doctor takes a small piece of tissue from the lump or suspicious area and sends it to the lab to look under a microscope for cancer cells.

In the lab, pathologists examine the tissue sample to see if it contains cancer cells, and whether it has the hormone receptors mentioned earlier, and whether it has the HER2 receptor (a protein that helps cancer grow). This information will be very helpful to your doctor in planning your treatment.

Stages of male breast cancer

Once cancer is confirmed, doctors will determine its `stage`. This means looking at the size and location of the tumor to see how far it has spread and how serious it is. At this point, you may also have other `imaging` tests, as well as a `sentinel node biopsy`. This involves removing one or more lymph nodes near the tumor to check for cancer cells.

The main stages of male breast cancer are:

• Stage 0: The cancer cells are only inside the breast ducts. This is also called Ductal Carcinoma In Situ.
• Stage I: The tumor is small and has not spread to the lymph nodes.
• Stage II: The tumor is slightly larger than stage I. It may have spread to several axillary lymph nodes.
• Stage III: The cancer has spread to several lymph nodes, the tumor may be large, and cancer cells may have spread to the chest wall or skin.
• Stage IV: Cancer cells have spread to distant parts of the body. In male breast cancer, the most common sites of spread are the bones, lungs, and liver .

How is male breast cancer treated?

The treatment you receive will depend on many factors, including the type of cancer and how far it has spread (stage). You may need to have several treatments done in a series. Your doctor will explain this to you in detail.

Surgery

The most common treatment for early-stage male breast cancer is surgery. Most often, the entire breast is removed. This is called a mastectomy . Sometimes, a lumpectomy, which removes only the tumor, is also performed, but for men, a mastectomy is the most common.

Sometimes a ``radical mastectomy`` is performed. In this, the entire breast tissue, the lymph nodes in the armpit, and part of the chest muscle are removed. But now the most common is ``modified radical mastectomy.`` In this, the muscle tissue is not removed, and a small amount of lymph nodes are also removed.

Radiation therapy

Radiation therapy for breast cancer uses X-rays or other types of high-energy rays to destroy cancer cells. This treatment is usually given after a lumpectomy to kill any remaining cancer cells. Sometimes, radiation therapy can kill small cancer cells that cannot be removed by surgery and are close to the chest wall or skin. This can help prevent tumors from growing again.

Chemotherapy

Chemotherapy is the use of special drugs to kill cancer cells throughout the body. For localized (non-malignant) tumors, chemotherapy can be given before surgery to shrink the tumor. Or, chemotherapy can be given after surgery with radiation therapy to reduce the risk of a tumor coming back or the cancer spreading to other parts of the body. These treatments are not given at the same time, but one after the other.

Hormone therapy

If cancer cells use hormones like estrogen to grow, doctors use hormone therapy to either lower estrogen levels or block its effects. Tamoxifen is a drug commonly used to treat male breast cancer. Also, drugs called aromatase inhibitors, when combined with gonadotropin-releasing hormone (GnRH) agonists, can stop the growth of cancer cells caused by hormones.

Targeted therapy

Targeted therapies work by interfering with specific processes that help cancer cells grow. These treatments only work on specific types of cancer cells. For example, some treatments only work on breast cancers that have hormone receptors. There are also treatments, such as PARP inhibitors, for cancer cells that have a BRCA gene mutation.

When should I see a doctor?

If you have an unexplained lump in your breast that doesn't go away after two weeks, be sure to see a doctor. Also, follow your doctor's instructions about how often you should have cancer screenings.

What happens if I have male breast cancer? (Prognosis)

The type of cancer and the stage it is in greatly affect the course of your disease, that is, the prognosis. If it is detected early, the cure rate is much higher.

A recent study found that the mortality rate for men with breast cancer (hormone-responsive - `HR+` type) by cancer stage was: Within 20 years of diagnosis:

• Stage I: 12.4% died from breast cancer.
• Stage II: 26.2% died from breast cancer.
• Stage III: 46% had died from breast cancer.

Unfortunately, many men delay seeing a doctor. As a result, by the time they are diagnosed, the cancer is already quite advanced, making it difficult to treat.

That's why we say, if you notice any unusual lumps in your breast, see a doctor right away. Many men don't think they have breast cancer. So they may not recognize the symptoms. But men do get breast cancer. Early detection and treatment can save your life. If someone in your family has had breast cancer, talk to a doctor about how to detect cancer early.

Finally, things to remember (Take-Home Message)

Okay, so let's summarize some of the things you need to remember from what we've talked about:

• Men can also develop breast cancer. Although it is rare, don't ignore it.
• A painless lump in the breast, especially under the nipple, can be a major symptom. Also look for lumps in the armpit, skin changes, and nipple discharge.
• The risk is higher if someone in your family has a history of breast cancer, if you are over 60 years old, or if you have certain genetic conditions (BRCA).
• If you have any doubts, don't be shy and see a doctor without delay. Tests like a mammogram and biopsy can confirm the disease.
• If caught early, the chances of a cure are much higher! There are various treatment options, such as surgery, radiation therapy, chemotherapy, and hormone therapy.

Being aware of this can make a big difference in your life and the lives of other men you know. Stay healthy!

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