Breast Cancer in Men: Know Your Risk

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In October 2019, Michael Knowles, music executive and the father of two well-known entertainers, publicly revealed his diagnosis of breast cancer and subsequent treatment and testing. “Weakness is when you want to keep it secret,” he told Good Morning America. “I need men to speak out if they’ve had breast cancer. I need them to let people know they have the disease, so we can get correct numbers and better research. The occurrence in men is 1 in 1,000 only because we have no research.”

Estimates by the American Cancer Society are that in 2020, around 2,620 cases of men’s breast cancer will be diagnosed, and about 520 men will die from the disease. The lifetime risk for men of developing breast cancer is around 1 in 833.

What symptoms should men look for? Primary symptoms include a lump or swelling, which is often, but not always, painless; skin dimpling or puckering; nipple retraction, which is the nipple turning inward; redness or scaling of the nipple or breast skin; and discharge from the nipple. It could spread and cause swelling under the arm and around the clavicle before the tumor in the breast is not large enough to be felt.

Since men don’t have the same amount of breast tissue as women, a tumor may be a little easier to detect. Also, since routine screens for men don’t exist, knowing the symptoms can make the difference. Always see a health care professional with any concerns.

According to the American Cancer Society, cancer can begin in different parts of the breast, such in the ducts that carry milk to the nipple or the glands that make breast milk. Men’s breasts don’t produce milk like women’s, but their bodies have these ducts and glands. The most common form of breast cancer in men is the invasive ductal carcinoma, which starts in the milk duct, breaks through the wall of the duct, then grows into the fatty tissue of the breast where it has the potential to spread.

Treatment modalities for breast cancer have greatly improved, but identifying it at an early stage is just as important for men as for women. Men benefit from the same treatment and have good prognoses from a combination of treatments.

The typical treatment is mastectomy, in which the entire breast is removed, although sometimes just the tumor is taken out to conserve the breast. The surgeon may also remove one or more lymph nodes to determine if the cancer has spread.

Radiation therapy uses high-energy waves or particles to kill cancer cells that might have been missed during surgery. Side effects can be nausea and fatigue that can manifest as an exhaustion that isn’t cured by rest and keeps you from doing the things you normally would do.

As with treatment of other forms of cancer, this is a drug cocktail given by infusion or by mouth. If the breast cancer has metastasized, or spread to other parts of the body, this may be the primary treatment.

Hormone Therapy
About 90 percent of men have hormone receptor-positive cancer. Some breast cancers need certain hormones to grow, and therapy blocks the effects of the hormones. Tamoxifen is the standard hormone therapy for breast cancer in men, and they should never take testosterone, which causes breast cancer cells to grow.

Targeting HER2
The protein HER2 makes cancer spread quickly. Trastuzumab, also known as Herceptin, is one drug that is approved to treat metastasize cancer. It stops the protein from making cancer cells grow and may give a boost to the immune system.

Genetic Testing
The BRCA1 or BRCA2 genes are known as the “breast cancer genes.” According to The National Breast Cancer Foundation, “If a man tests positive for a defective gene, most commonly either BRCA1 or BRCA2, that can lead to a future diagnosis of breast cancer and his children have a 50 percent chance of carrying the gene. A male child of a man with breast cancer who inherits the defective BRCA2 gene has only approximately 6 percent chance of eventually developing breast cancer and just over 1 percent with BRCA1.

“A female child of a man with breast cancer who inherits the defective gene has a risk between 40 percent and 80 percent of eventually developing breast cancer. Men with a genetic predisposition to breast cancer are also at higher risk of getting prostate cancer at a younger age than usually diagnosed.”

Education is critical. Men who have a family history of women with breast cancer must be aware of their risks and genetic profile. It can save their lives and the lives of those they love. ■