Yes, Men Get Breast Cancer Too

Male breast cancer is rare, but those men who develop it often only get treatment when it’s almost too late. Dr Rika Pienaar, an oncologist at Mediclinic Panorama Cancer Care Centre, believes that’s because it’s seldom talked about, which results in men feeling isolated, embarrassed, and emasculated at the prospect of having a “women’s” disease. Here, Dr Pienaar answers all your questions about this little-known cancer.

Q: How common is breast cancer in men?

Dr Pienaar: Breast cancer in men is rare. The lifetime risk of breast cancer is much lower in men than in women – for every 100 women I see with breast cancer, I see about one man. However, stats show that the incidence in Africa is considerably higher than in the US and the UK. 

Q: Who is most at risk?

Dr Pienaar: Many of the risk factors are similar to those of postmenopausal women. They include:

Age. It’s very rare to see breast cancer in younger men. Breast cancer incidence rates rise steadily with age. The average age of a new breast cancer diagnosis in men is 67. 

Family history. In a first-degree relative (mom, dad, sibling or child). 

Genetics. As with women, the BRCA1 and BRCA2 gene mutations increase risk – in men, especially the BRCA2 gene. That said, there isn’t enough risk in men for us to recommend regular mammogram screening or prophylactic mastectomy like we would for women.

Oestrogen/testosterone imbalance. This can be as a result of hormone therapy or liver damage from liver cirrhosis, bilharziasis and Hepatitis B, obesity, marijuana use, thyroid disease, and inherited conditions such as Klinefelter syndrome.

Primary testicular conditions. Including orchitis (inflammation of the testicle), cryptorchidism (undescended testes), testicular injury and testicular cancer. 

Q: What are the signs of male breast cancer?

Dr Pienaar: The man will usually find a painless, firm lump in his breast on the one side – it’s extremely rare that both breasts are affected. Sometimes there may also be skin changes like redness, swelling, itching or, often, retraction of the nipple is seen. In rare cases, an ulcer that does not heal may be present.

Q: What precautions should men be taking?

Dr Pienaar: Due to the rarity of the disease, we don’t recommend regular mammogram screenings, but if you notice a lump under your nipple – even a small one – see your GP right away. They can arrange special investigations, such as a mammogram, ultrasound and biopsy to rule out breast cancer.  

Q: And if it is breast cancer?

Dr Pienaar: The treatment approach is the same as in women – using neoadjuvant chemotherapy or endocrine therapy. Surgery is most commonly a mastectomy – which for men means removal of the nipple – followed by radiotherapy, adjuvant endocrine- or chemotherapy or biological treatments. In very selective cases, a lumpectomy can be considered or even a nipple reconstruction. Something men need to be prepared for is that the medication can affect sexual performance – this is often a reason men stop taking their medication early, putting themselves at risk. 

Q: How dangerous is male breast cancer?

Dr Pienaar: The prognosis is worse compared with women and the five- and 10-year survival rates are lower. This is across all race and stage subgroups. So it’s very important to get diagnosed and start treatment as soon as possible.