Breast cancer in men

In men, breast cancer is very rare. There are about 300 men diagnosed each year in the UK, compared with around 45,700 cases of breast cancer in women. That's about one man for every 150 women diagnosed.

Because so many cases of breast cancer occur in women and it is very rare in men, a lot of information available is directed towards women. But much of the information that men with breast cancer need is the same as for women. The symptoms, diagnosis and treatment are all very similar to women with breast cancer. The risks and causes do vary slightly and we've covered that below. Obviously there are areas where women need different information to men - such as breast reconstruction or the different types of breast shapes (prostheses) available. 

CancerHelp UK has specific information for men about coping with some of the effects of treatment. Some treatments affect men's fertility and sex life. There is information in our coping with cancer section about the effect of cancer treatment on sex for men. There is important information below about finding support, as this can be much more difficult for men with breast cancer, simply because this is a rare situation.

For all other types of information, men with breast cancer should be able to use this whole breast cancer section freely, picking and choosing the information they feel will be of use to them.

As with women, the single biggest risk factor for male breast cancer is getting older. Most cases are diagnosed in men between the ages of 60 and 70. Other risk factors are

• High oestrogen levels
• Exposure to radiation
• Family history or an inherited faulty gene
• Klinefelter's syndrome

High oestrogen levels

All men produce some oestrogen. This is perfectly normal. But high oestrogen levels have been linked to breast cancer. High oestrogen levels can occur in

• Obesity - oestrogen is partly made in the fat (adipose) tissues of the body
• Chronic liver conditions, such as cirrhosis
• Some genetic conditions

Exposure to radiation

Men who have been exposed to radiation repeatedly, over a long period of time, are more likely to develop male breast cancer. This is particularly true if they were young when the radiation exposure took place.

A family history or a recognised breast cancer gene in the family

Men who have female relatives with breast cancer have an increased risk of breast cancer, especially if the women are close relatives (mother or sisters). And if the women were diagnosed at a young age (below 40). Men, as well as women, can inherit faulty genes that can cause breast cancer. Around 3 in 100 breast cancers diagnosed in women (3%) are thought to be due directly to an inherited faulty gene. In men, this may be more common. We think that between 10 and 20 out of every 100 diagnosed in men (10 to 20%) are due to inherited faulty genes. In men with breast cancer the BRCA2 faulty gene is more common than BRCA1.

Klinefelter's syndrome

Klinefelter's syndrome is a rare genetic condition where a man is born with an extra female chromosome. So he is XXY instead of XY. Men with Klinefelter's are about 20 times more likely to get breast cancer than the average man. This makes their breast cancer risk the same as for the average woman.

The most common symptom for men with breast cancer is a lump in the breast area. This is nearly always painless. Other symptoms can include

• Oozing from the nipple (a discharge) that may be blood stained
• Swelling of the breast
• A sore (ulcer) in the skin of the breast
• A nipple that is pulled into the breast (called nipple retraction)
• Lumps under the arm

The tests for breast cancer in men are much the same as for women. You may have a painless scan using sound waves, called an ultrasound. Or you may have a breast X-ray (mammogram). If your scan shows up an area that could be cancer, your specialist will take a sample (biopsy) of breast tissue for examination under a microscope. If these tests show that you have breast cancer, you will probably have other tests to make sure the cancer has not spread. These tests are covered on the page about further tests for breast cancer.

There are different types of breast cancer. The most common type in both women and men is invasive ductal carcinoma. The early, precancerous condition called ductal carcinoma in situ (DCIS) is diagnosed in men quite rarely. DCIS means that there are cancer cells in the breast. But they are all still contained inside the ducts of the breast and cannot spread. Inflammatory breast cancer and Paget's disease and other types of breast cancer are also found very rarely in men.

The same treatments are used for breast cancer in men as for women. These are all covered in detail in the CancerHelp UK section about treating breast cancer. Treatment is decided by the stage of your cancer. This means the size of the cancer and whether it has spread when it is diagnosed. The staging is the same for men's breast cancer as for female breast cancer.

To treat your cancer, you may have one or more of the following treatments

• Surgery
• Radiotherapy
• Chemotherapy
• Hormone therapy
• Biological therapy

Surgery

The most common operation for men with breast cancer is removal of the whole breast (mastectomy) including the nipple. There is not very much breast tissue in men, so it isn't usually possible to leave any behind. Sometimes the surgeon also removes part of the underlying muscle if it is close to the cancer. For men diagnosed with invasive breast cancer the surgeon removes some or all of the lymph nodes in the armpit. The lymph nodes are checked to see whether they contain cancer cells.

For men, implants currently available don't recreate the correct shape of a man’s breast so it is not usual to have breast reconstruction. But sometimes your surgeon may be able to improve the appearance of the chest with more surgery after mastectomy. Once treatment has finished you could have a new nipple created. You need to wait a few months after the mastectomy to allow swelling to go down and the wound to heal. You can look at the CancerHelp UK page about nipple reconstruction. Although the shape can be created, the new nipple won't respond to touch or temperature. Other options include tattooing a new nipple and areola on to the chest. Or stick on nipples - your breast care nurse can tell you where to get them.

Radiotherapy

As the cancer is always close to the muscle of the chest wall in men (because there is so little breast tissue) your specialist is likely to suggest radiotherapy after surgery. This reduces the risk of the cancer cells growing back in the chest wall in the future. You usually have radiotherapy for a few minutes daily from Monday to Friday, from 3 to 6 weeks. Some hospitals give radiotherapy on alternate days, rather than every day.

Chemotherapy

Chemotherapy is sometimes used to shrink a large cancer before surgery but this is not common. Chemotherapy is most often given after surgery and before radiotherapy. Your doctor will take various factors into account to see whether chemotherapy is needed to help reduce the chance of the cancer coming back. Your doctor will usually recommend chemotherapy if cancer cells were found in the lymph nodes under the arm. Of if the tumour is larger than 2 cm. You may also be advised to have chemotherapy if you are young or if the cancer is high grade.

Hormone therapy

Breast cancer cells can have oestrogen receptors or progesterone receptors. Most male breast cancer cells do have hormone receptors. This is known as being hormone receptor positive. About 9 out of 10 male breast cancers (90%) are oestrogen receptor positive, which means that they need oestrogen in order to grow. Your specialist will arrange tests on your cancer cells when you are first diagnosed. This shows if the cancer cells have hormone receptors. Men have small amounts of oestrogen in their body. Hormone therapies block oestrogen from making cancer cells grow. So they can reduce the chance of the cancer coming back.

The most common hormone therapy for male breast cancer is tamoxifen. The side effects are much the same as in women. Tamoxifen can make you feel sick when you first start taking it, but this usually wears off quite quickly. The most common side effect for men and women is hot flushes. Tamoxifen may also cause weight gain, difficulty sleeping, low mood and depression. In men, tamoxifen may also cause a loss of sex drive. This has been reported in up to 3 out of 10 men taking tamoxifen. There is information about how to cope with the effects of cancer treatment on your sex life in the section of CancerHelp UK about coping with cancer.

Other hormone therapies are used to treat breast cancer, including aromatase inhibitors. Large studies have shown that aromatase inhibitors reduce the chance of breast cancer coming back in women who have had their menopause, but we need more research before we know how well aromatase inhibitors work in men.

There is more information about hormone treatments in the hormone therapy for breast cancer page.

Biological therapy

Your cancer cells will also be checked for receptors called HER2 receptors. If your cancer cells have a lot of these receptors, you may be prescribed a biological therapy. You can look at our page about biological therapy for breast cancer for more information.

If the cancer comes back after treatment or has spread when it is diagnosed, chemotherapy, hormone therapy or biological therapy may be used. CancerHelp UK has a section about secondary breast cancer.

Coping with a breast cancer diagnosis is difficult. But as male breast cancer is rare it can be particularly difficult, so you may feel very confused and isolated. It is very common to hear about breast cancer in women but not at all common to hear about it in men. So it can sometimes be difficult even to believe that the diagnosis is right.

As male breast cancer is rare, men are often treated in large, specialist hospitals where there is expertise in dealing with the disease. So your consultant may know other men with breast cancer you could talk to. Or you could contact the charity Breast Cancer Care. They have male volunteers you can talk to on the phone. You could also check out Cancer Chat - Cancer Research UK's discussion forum. It is a place for anyone affected by cancer to share experiences, stories and information with other people who know what you are going through.  Or you could try one of the web based contact networks, such as MyWavelength. This is a free support network where you can get in touch with other people with the same type of cancer.