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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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This information is about breast cancer in men. It should ideally be read with our general information about breast cancer| .
Cancerous cells can develop in the small amount of breast tissue that men have behind their nipples. Breast cancer occurs much more commonly in women and fewer than 1 in 100 of breast cancers occur in men. In the UK, approximately 250 men are diagnosed with breast cancer each year.
The cause of breast cancer in men is not completely understood, but some men seem to be at higher than average risk of developing the disease.
This rare cancer most often occurs in men over the age of 60. It is more common in men who have:
Having several members of the family with cancer of the ovary or colon may also increase a man’s risk of developing breast cancer.
There are special clinics for people who are concerned that they may have an increased risk of developing cancer because of a history of cancer in their family| . These are known as family cancer genetic clinics. Your GP can refer you to one of these clinics if they think you may be at an increased risk of developing breast cancer.
In rare circumstances, men with high oestrogen levels, or men who have been exposed to repeated doses of radiation (particularly at a young age) may be at an increased risk of developing breast cancer. Men who have a rare genetic condition called Klinefelter’s syndrome , and have an extra female chromosome present, have an increased risk of developing breast cancer.
Different types of breast cancer can affect men in the same way that they can women. The most common type of breast cancer to affect men is called invasive ductal carcinoma, which is also the most common type in women. Other rarer types are inflammatory breast cancer| , Paget’s disease| of the breast, and a pre-cancerous condition known as ductal carcinoma in situ (DCIS)| .
The most common symptom is a lump in the breast area. However, other signs may occur such as a change in the size or shape of the breast, an ulcer on the skin, nipple discharge, or turning-in of the nipple (inversion). Another possible symptom is a rash on the nipple or surrounding area.
Your doctor will do a physical examination of the affected breast. Tests will be needed to confirm the diagnosis, and to find out whether the cancer has spread. You may have some or all of the tests described below.
Mammograms may be used to look for changes in the breast, but ultrasound is generally more helpful for diagnosing breast cancer in men.
A scan using sound waves is used to see whether a lump is solid or contains fluid. A small amount of clear gel is applied to the breast area. Then a small microphone-like device is rubbed over the area to show a picture of the breast on a monitor screen.
A thin needle is inserted into the breast in the area of the lump, and some cells are drawn out. This may be done at the same time as the ultrasound, so that the doctor can be sure that the cells are from the affected area of the breast. The cells are examined in the laboratory to see if any are cancerous (malignant).
A small sample of tissue is taken from the breast with a needle and examined under a microscope to check for cancer cells. An injection of local anaesthetic is given to numb the area before the biopsy is taken.
These are done to check your general health before any operation.
The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment.
In some people, cancer can spread to other parts of the body, either in the blood stream or through the lymphatic system. The lymphatic system is part of the body’s defences against infection and disease. The system is made up of a network of lymph glands, or nodes, that are linked by fine ducts containing lymph fluid. Your doctors will usually look at the nearby lymph nodes when staging your cancer.
Generally breast cancer is divided into four stages, from stage 1, which is small and localised, to stage 4, where the disease has spread to other parts of the body. If the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer.
A commonly used staging system is described below:
Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how quickly the cancer may develop. There are three grades: grade 1 (low-grade), grade 2 (moderate or intermediate grade) and grade 3 (high‑grade). Low-grade means that the cancer cells look very like the normal cells of the breast. These cancer cells are usually slow-growing and less likely to spread. In high-grade tumours the cells look very abnormal. They are more likely to grow quickly and to spread.
As breast cancer in men is so rare, there have been very few research studies looking at the treatments for this condition. It behaves in a similar way to breast cancer in women| , and so is usually treated in much the same way. A combination of treatments is often used.
For most men, surgery| is the first choice of treatment. However, men cannot usually have just the lump removed (lumpectomy)| . This is because the amount of breast tissue that most men have is so small, and because the tumour is often near or under the nipple. Most men having surgery need to have all of the breast tissue and the nipple removed (a mastectomy| ). Some or all of the lymph nodes| under the arm are likely to be removed as well.
Most breast cancers need the hormone oestrogen in order to grow. Oestrogen is the female sex hormone, but men have a small amount circulating in their bloodstream. Hormonal therapy| is very effective in reducing the amount of oestrogen in the body, and is used to try to prevent the cancer from returning after surgery. Hormonal therapy may also be used to shrink the cancer if it returns after initial surgery.
Tamoxifen| is the hormonal therapy that is commonly used to treat breast cancer. It works by attaching itself to the oestrogen receptors on the surface of the cancer cells. This prevents oestrogen from entering the cells, and can stop the cells from growing or dividing. Men usually have similar side effects to women who take tamoxifen (such as hot flushes or loss of sex drive). Men may also experience difficulty in achieving erections.
Aromatase inhibitors such as letrozole| , anastrozole| , and exemestane| . In men, oestrogen is made by the conversion of the male sex hormones (androgens). This conversion is carried out by an enzyme called aromatase. Aromatase inhibitors are drugs that block aromatase and therefore block the formation of oestrogen. If aromatase inhibitors are used, they usually need to be given with drugs such as goserelin (Zoladex®)| , that decrease the production of androgens.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy may be used after surgery, if your doctors feel that there is a high risk of cancer cells having spread from the breast to other parts of the body, before the cancer was removed. Chemotherapy is usually given if there are cancer cells found in the lymph nodes under the arm, or if the cancer has spread beyond the breast.
The chemotherapy drugs used to treat breast cancer in men are the same as those used to treat women with breast cancer. Your doctor will discuss with you whether chemotherapy is necessary in your situation.
Radiotherapy| treats cancer by using high-energy rays to destroy the cancer cells. It may be used to reduce the chance of the cancer returning at the site of the scar after surgery. Radiotherapy may also be used to relieve pain or discomfort caused by a cancer that has spread to other parts of the body – for example, the bone| .
Herceptin| is one of a new group of drugs called monoclonal antibodies.
Some breast cells divide and grow when a protein (human epidermal growth factor) attaches itself to another protein called HER2| . Herceptin blocks this process by attaching itself to the HER2 protein, so that the epidermal growth factor cannot reach the breast cancer cells.
Herceptin only works in people who have high levels of the HER2 protein, which you can be tested for. About one in five breast cancers in women are sensitive to Herceptin, but it's thought that fewer men have tumours that are sensitive to it.
Herceptin can be used to treat early breast cancer or breast cancer which has spread (secondary breast cancer| ).
Research into treatments for breast cancer in men is ongoing. Cancer doctors use clinical trials| to assess new treatments. Before any trial is allowed to take place an ethics committee must have approved it to ensure that the trial is in the interest of patients.
You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you, so that you have a full understanding of the trial and what it involves. You may decide not to take part, or withdraw from a trial at any stage. You will then receive the best standard treatment available.
It is often very difficult to find information and support when you are diagnosed with a rare cancer. Men find that they experience many different emotions| , including anger, resentment, guilt, anxiety and fear. Some men find it difficult or embarrassing to talk about their breast cancer, especially as it more commonly affects women. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their illness.
Some men find it helpful to talk things over with their doctor or nurse, or with one of our support service nurses. Close friends and family members can also offer support.
This section has been compiled using information from a number of reliable sources, including:
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