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Male Breast Cancer
Male Breast Cancer
Even though males do not grow boobs like females, they unfortunately also develop breast cancer. Male breast cancer is not a common disorder. For every one hundred women who have breast cancer, one male will develop a similar disorder. However, unlike the female, the male only develops breast cancer in the 6-7 decade of life. It is very unusual for males to have a breast cancer in the 3-4 decade of life. The prognosis for male breast cancer is the same as for breast cancer in females. However, because most males are unaware that breast cancer can occur in males, they frequently do not seek treatment until it is too late. The majority of men diagnosed with breast cancer present late and are in advanced stage of the disease. The prognosis for advanced stage breast cancer is quite poor.
Signs and symptoms
Because breast cancer is a lethal disease, it is important for all to be aware of how its presents. Knowing the male breast cancer symptoms can help save your life. Like all cancers, the best prognosis is for individuals who detect the cancer the earliest and get prompt treatment. Unlike what most individuals think, breast cancer is not painful. It may present as an mass or a lump which may be noticed while in the shower. Most of the time it is the other partner who may identify the breast mass. The other syptoms of breast cancer are - Skin dimpling - Puckering of the skin - Indentation of the nipple - Inversion of the nipple - Red inflamed skin - Excessive redness with dryness - Lump in the axilla
Why breast cancer occurs in males is unknown. Less than 10% of breast cancers in males are familial. These cancers are related to a gene called BRCA 1 or 2. Having this gene places an individual at a higher risk for breast cancer than the average person. Other than this gene very little is known as to why the cancer occurs. There are some risk factors associated with breast cancer. Why some men with risk factors develop breast cancer and why some do not, is again not known. Factors that may make you more susceptible to breast cancer include: - exposure to radiation - age greater than 60 - taking a female sex hormone (estrogen) - liver cirrhosis (fails to break down the female sex hormone) - Kleinfelter’s syndrome - Familial history- chances of acquiring cancer are much higher in families who have cancer - Genetic- those individuals who have the BRCA gene are prone to breast cancer - Obesity- this is a common risk factor for many cancers
When to seek medical advice
Any male who develops a lump in the breast after the 4th decade of life must see a physician. The breast may be benign but the lump must be evaluated to ensure that it is not a cancer.
Screening and diagnosis
There are no screening tests for male breast cancer. The cancer is not very common and thus mammograms are not recommended. Making all males undergo expensive radiological tests which require x rays is not cost effective . For those who have a family history of breast cancer, annual physician visits and perhaps mammograms may be indicated. It is recommended that all males physical exam their breast routinely.
In the majority of cases, the male usually finds the breast mass himself. The individual may have noticed a lump in the breast and goes to the doctor. Unlike females, males usually do not have a proper breast exam by their physicians. In males, the breast exam is the most important aspect for the diagnosis. • breast exam: The entire breast, neck and arm pit (axilla) must be examined. If a mass is present, it is easily palpable • Mammogram: In a mammogram the breast is compressed between two metal plates and x rays are produced to look at the breast tissue. This is fine for females but in males, it is quite difficult. Males do not have large breast and difficult to perform a mammogram. The procedure takes about 20-30 minutes. Most people find the mammogram quite uncomfortable. • Ultrasonography: When abreast mass is palpated and a mammogram is not suitable, an ultrasound can be performed. The ultrasound can identify whether the mass is solid or cystic. • Nipple discharge: Unlike females males do not have discharge from the nipple. It is very rare for nipple discharge to be associated with cancer.
When a mass is found in a breast, the only way to know if there is a cancer is to perform a biopsy. There are several ways to perform a biopsy and this includes: - Fine-needle aspiration: Many a times, the physician will place a needle in the breast mass and perform what is called aspiration. This aspiration biopsy obtains the cells which are later analyzed by a pathologist. The procedure takes a few minutes and is relatively painless- unless the physician mucks around. - Breast biopsy: sometimes the individual needs a proper tissue biopsy and this can be performed either in the Operating room or may be performed by a radiologist using ultrasound.
Breast tissue analysis
Once a breast biopsy is obtained, it is determined if there is a cancer. If a cancer is present, the cancerous cells are analyzed for the presence of female sex hormones receptors. The reason for this is that some breast cancers grow faster in the presence of these sex hormones and drugs can be used to block this effect. At least ¾ of male breast cancers are positive for these sex hormone receptors. The other test is for a protein called HER 2. This is a growth factor which can also stimulate the growth of breast cancer. About 25-30% of male breast cancer contain this growth factor and today we have drugs to block the effect of the growth factor.
The prognosis of a patient with breast cancer depends on the staging (how far and how much it has spread). Once the diagnosis of breast cancer is made, it is mandatory to determine if the cancer has spread. It is criminally negligent to offer any type of medical or surgical treatment on any patient if staging of a cancer has not been done (some patients may have only a few months to live and to put them through unnecessary complicated surgery and painful chemotherapy is unethical and immoral). The treatment of male breast cancer is dependent on the stage. • Stage 0: Cancers in stage 0 are in the very earliest stage and are not visible nor are they palpable. They are only discovered by chance and are identified by histology. These tumors are in their fancy and localized. Removal of the cancer at this stage is curative. Unfortunately, the vast majority of individuals never present in this stage. • Stages 1-4: Breast cancer is staged into 4 different subtypes. Stage 1 is a small localized cancer and may be felt. Stage 4 is where the cancer has spread and offers the worst prognosis. In general, the higher the stage, the worse the prognosis. With the higher stages, the treatment is also somewhat empirical and relies a lot on luck. Not many individuals with the higher stages of breast cancer are alive after 3-5 years.
When a breast mass is detected, there are several radiological test that are often required to determine the spread of the cancer. These tests include: Chest x ray: the chest x ray is not sensitive to detect a breast mass but may identify the presence of any metastatic breast disease to the lungs. In most cases the chest x rays are normal. CT scan: the CT scan is very sensitive in identifying metastasis breast cancer. CT Scan can help determine if there is any cancer spread to the rest of the body. MRI: MRI is an alternative for detection of breast cancer spread. It does not replace a CT scan. The test is excellent for soft tissues and is more expensive. PET scan: This relatively new technique is used to identify cancers but is expensive and only used when the identity of the mass is in doubt. The technique involves making a diagnosis of a malignancy using a radiolabel tracer. It is an expensive technique and can identify tumors very early.
Some types of breast cancers occur in families and this is well known in females. A particular gene , BRCA , has been identified that may increase the risk of breast cancer. In females with a familial pattern of breast cancer, this gene has been routinely identified. However, in men the role of genes and hereditary breast cancer is poorly understood and other genes that may increase breast cancer risk has raised a number of emotional and legal questions about genetic testing. There are still some technical issues with the identification of this gene and even having the gene does not mean that one will develop the cancer. In general, the identification of the gene only helps one become aware that a breast cancer may occur. Annual physical exams by the physician and self examination of the breast is still very important.
The treatment of male breast cancer is similar to the female counterpart and depends on the stage. The general treatment of breast cancer is always surgery and then depends on the stage and age of the patient. Either chemotherapy, radiation or hormonal therapy may be required either singly or in combination.
The surgery for men with breast cancer is similar to women. Once the diagnosis is made, surgery is undertaken. Because the breast mass is much smaller in men, breast conservation is difficulty. In all cases, the entire breast is removed together with the underlying muscles and the lymph nodes from the axilla. The surgery is straight forward and takes about 2-3 hours. The lymph nodes obtained from the axilla are always sent to the pathologist for confirmation on their status (either positive or negative for cancer). The surgery leaves a decent size scar and is somewhat tender afterwards. Most surgeons will leave a drain to collect any residual fluid for a few days. After surgery, physical therapy is recommended to improve arm function. The status of the lymph nodes from the axilla are important in determining further therapy.
Radiation therapy is offered to a patient with breast cancer if there is a high chance of local recurrence. The radiation therapy is given over a period of 6 weeks. One receives 2-3 sessions a week for a total of 6 weeks. This is the total amount of radiation one can receive in a life time. Radiation therapy is not painful. The procedure involves going to a cancer center and the area of the chest is marked. The beam is concentrated in the area. Side effects of radiation therapy include nausea, hair loss, and diarrhea. Long term, the skin will become very leathery and hard.
Chemotherapy is always used when the lymph nodes in the axilla are positive. Positive lymph nodes signify that the cancer has now spread to the body. Chemotherapy is usually administered intravenously. Generally a combination of drugs are administered. Chemotherapy is not fun and that is why many individuals hate it. The majority of people get sick. One may lose hair, develop nausea, vomiting, diarrhea, lose weight and feel like crap.
Hormone therapy has become an important component of breast cancer treatment. The axillary lymph nodes are analyzed to see if they contain receptors for the female sex hormones (Estrogens or progesterone). Because these cancers are dependent on hormones to stimulate their growth, the anti hormonal drugs prevent the growth of breast cancers. The most common hormonal drug to treat breast cancer is Tamoxifen. The majority of breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, such as hot flashes and impotence (the inability to have an erection adequate for sexual intercourse). A variety of other hormonal drugs are also available (aromatase inhibitors- anastrazole, exemestane and letrozole) to treat breast cancer in post menopausal women. At this time, no data exist as to the usefulness of these medications in the treatment of male breast cancer.
In some cases, the breast cancer may be too large and even though the surgeon takes out the whole breast, he may decide to give you additional therapy. This is what is called adjuvant therapy and the type of therapy will be decided by the cancer specialist. Adjuvant therapy is given just in case there may be some cancer left even though it is not visible to the naked eye.
The armamentarium designed to treat breast cancer also utilizes ways to increase the potency of the immune system. Various biological compounds have been developed to fight cancer. For breast cancer, a monoclonal antibody called Herceptin has been shown to be effective against certain types of breast cancer. It is only given intravenously and has some potent side effects which include the risk of fevers, allergy, chills, vomiting and heart problems.
Locally recurrent disease
In some individuals who have undergone removal of the breast, the cancer may come back, usually along the incision of the surgery. If the recurrences is small, then surgery may be done. However, in most cases, this is a poor prognostic signs and radiation plus chemotherapy may have to be tried.
When breast cancer returns, it has generally spread and this is known as metastases. The prognosis for most individual with metastatic disease is poor. The majority of individuals are dead within 1-3 years. There are many types of treatments for metastasis disease but once the diseases has spread, nothing helps. The type of therapies for metastasis disease include: a. chemotherapy b. hormonal therapy- Tamoxifen c. orchidectomy (removal of the testicles to decrease hormone production) d. Luteinizing hormone-releasing hormone with or without total androgen blockade (to decrease the production of sex hormones)-aminoglutethimide e. Progesterone (a female hormone) There is a lot of trial and error when it comes to treatment of metastatic disease. In most cases, supportive therapy is required to treat the pain, nausea or vomiting.
Having a diagnosis of any cancer is traumatic and the same applies to breast cancer. Many individual lose hope right away thinking that the cancer will kill them anyway. Most individual lose control and confidence and become depressed. The best way to cope with any cancer is to know more about it. The more one knows about the disease, the more decisions one can make. Almost every oncologist and your own physician will be glad to answer your questions and there are many cancer self help groups available. Most cancer agencies have the latest information on breast cancer on their web site. There is no doubt that strong relationships are an integral component when dealing with cancer. In fact, friends and family can help increase confidence, increase support and help with daily living activities.
There are no definitive measures to prevent breast cancer. One should just lead a healthy lifestyle, eat right, avoid excess alcohol, not smoke, exercise, take an aspirin everyday and pray a little. If after all this cancer occurs, then it is simply just plain bad luck or bad genes.