Breast cancer in men
Breast cancer is rare in men. There are about 350 men diagnosed each year in the UK. This compares to around 55,000 cases in women.
About 1 in 100 (about 1%) of breast cancer cases in the UK are in males.
There are some similarities between male breast cancer and female breast cancer. But there are also important differences between the two. The most common type in both women and men is called 'invasive ductal carcinoma - no special type'.
Some men develop rarer types of breast cancer, such as inflammatory breast cancer. Or they might develop conditions related to breast cancer but these are very uncommon. They include:
- ductal carcinoma in situ (DCIS)
- invasive lobular cancer
- Paget's disease of the breast
Risk factors for breast cancer in men
The risk factors for male breast cancer include:
The single biggest risk factor for male breast cancer is getting older. Most breast cancers are diagnosed in men between the ages of 60 and 70.
High oestrogen levels
All men produce small amounts of the hormone called oestrogen. This is perfectly normal. But high oestrogen levels have been linked to a higher breast cancer risk. High oestrogen levels can occur in:
- men who are very overweight (obese)
- chronic liver conditions, such as cirrhosis
- some genetic conditions
Klinefelter's syndrome is a rare genetic condition where a man is born with an extra female chromosome. This means that he has XXY chromosomes instead of XY. This leads to a hormone imbalance where the body makes less testosterone.
Men with Klinefelter's have an increased risk of developing breast cancer. But this doesn't mean that they will definitely develop it. Breast cancer in men is rare. So even if men have an increased risk (as with Kleinfelter’s), their risk remains quite low.
Exposure to radiation
Men previously exposed to radiation to the chest area are at an increased risk of developing breast cancer.
Family members with breast cancer or a breast cancer gene
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). The risk also increases if the women were diagnosed at a young age (below 40). Men, as well as women, can inherit faulty genes that increase the risk of breast cancer.
Around 2 in 100 breast cancers diagnosed in women are thought to be due directly to an inherited faulty gene (around 2%). In men, this might be more common. Doctors think that around 5 to 10 out of 100 breast cancers diagnosed in men are due to inherited faulty genes (around 5 to 10%). In men with breast cancer, changes in the BRCA2 faulty gene are more common than BRCA1.
Symptoms of breast cancer in men
The most common symptom for men with breast cancer include:
- lump in the breast that is nearly always painless
- oozing from the nipple (a discharge) that may be blood stained
- a nipple that is pulled into the breast (called nipple retraction)
- swelling of the breast (gynecomastia)
- a sore (ulcer) in the skin of the breast
- lump or swelling under the arm
- a rash on or around the nipple
If you have any of these symptoms it is important to go to your GP straight away. Finding a cancer early gives the best chance of successful treatment.
Diagnosing the cancer
You usually have a scan of the breast and the lymph nodes under your arm (axilla) called an ultrasound. You might also have a breast x-ray (mammogram).
If these tests show an area that could be cancer, your doctor or breast cancer nurse takes a sample (biopsy) of breast tissue. This is then examined under a microscope by a specialist. If these tests show that you have breast cancer, you might have other tests to see whether the cancer has spread.
These tests include:
- an MRI scan
- a bone scan
- a CT scan
- a liver scan
Treatment for breast cancer in men
At present, the same treatments are used for breast cancer in men as for women.
To decide on the most appropriate treatment, doctors generally take into account:
- the type of breast cancer
- the size of the cancer and whether it has spread (the stage)
- how abnormal the cells look under the microscope (the grade)
- whether the cancer cells have receptors for particular hormones
- whether the cells have receptors for targeted cancer drug therapy
To treat your cancer, you might have one or more of the following treatments:
- hormone therapy
- targeted cancer drug therapy
The most common operation 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.
Some men may have breast conserving surgery (removing the lump and a margin of healthy tissue around it). This depends on both the size of your breast and the size of the cancer. This type of surgery is less common than a mastectomy. Your surgeon will let you know if this is suitable for you.
The surgeon might also remove some of the lymph nodes from the armpit. They send the nodes to the laboratory to see if they contain cancer cells. Or the surgeon might check the lymph nodes closest to the breast using a procedure called sentinel node biopsy.
This photo shows the marks made before a mastectomy and sentinel node biopsy.
The chest 1 day after a mastectomy operation.
The same man 3 months after the operation.
Creating a new nipple
Once treatment has finished your surgeon can make a new nipple for you if you want it. You need to wait a few months after the mastectomy to allow any swelling to go down and the wound to heal.
The surgeon might be able to create the shape of a nipple using the skin from another part of your body (a skin graft). For example, the surgeon might use skin from your groin. The new nipple won't have any feeling, and won't respond to touch or temperature.
Other options include tattooing a new nipple and areola on to the chest. Or you can use stick on nipples. Your breast care nurse can tell you where to get them.
You might have chemotherapy after surgery. This helps to reduce the chance of the cancer coming back or spreading.
Your doctor will usually recommend chemotherapy if you have one or more of the following:
- cancer cells in the lymph nodes under the arm
- a tumour larger than 2 cm
- you are young
- the cancer is high grade
Sometimes chemotherapy is given before surgery to shrink a large cancer and make it possible to remove it.
Your specialist is likely to suggest radiotherapy after surgery. This treatment lowers the risk of the cancer cells growing back in the area of the breast in the future. You usually have radiotherapy for a few minutes each day from Monday to Friday, for 3 to 6 weeks.
Some breast cancer cells are stimulated to grow by the hormones oestrogen or progesterone. Men have small amounts of oestrogen and progesterone in their body. More than 95% of male breast cancer cells have receptors for these hormones. This is called hormone receptor positive breast cancer.
Your specialist will arrange receptor tests on your cancer cells when you are first diagnosed. If your cancer cells have hormone receptors, your doctor might prescribe hormone therapy for you. This can help to reduce the chance of the cancer coming back. You usually take these therapies for at least 5 years.
The most common hormone therapy for male breast cancer is tamoxifen. Side effects include:
- hot flushes
- a lower sex drive
- feeling sick – this might wear off once you have been taking it for a while
- weight gain
- difficulty sleeping
- sadness or depression
Targeted cancer drug therapy
Your doctor will check your cancer cells for proteins called HER2 receptors. But these are rarely found in male breast cancer. If your cancer cells have a lot of these receptors, your doctor will prescribe a targeted drug treatment for you.
The most common targeted drug for breast cancer is trastuzumab (Herceptin).
If the cancer has spread beyond the breast
Some men are diagnosed with cancer that has already spread. Or the cancer might come back and spread some time after treatment. This is called secondary breast cancer, advanced breast cancer, or metastatic breast cancer.
In this situation your doctor might recommend:
- hormone therapy
- targeted cancer drug therapy
- a combination of these treatments
It is very common to hear about breast cancer in women. But it isn't common to hear about it in men.
Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if you have a rare cancer. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.
As male breast cancer is rare, you are likely to have treatment in a large, specialist hospital. So your consultant may know other men with breast cancer you could talk to.
Look at Cancer Chat
Cancer Research UK’s discussion forum is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.
Contact men with breast cancer
A charity called Breast Cancer Now has male volunteers you can talk to.
After treatment you usually have regular check ups. At the check ups your doctor or a breast care nurse will examine you and ask about your general health. This is your chance to ask questions and to tell them if anything is worrying you.
How often you have check ups depends on your individual situation but they might go on for at least 5 years.
It’s important to remember that you can contact your doctor or nurse between appointments if you are concerned about a symptom or have questions. You don't have to wait for your next appointment. You can also speak to your GP.
In some hospitals you don't have regular appointments after treatment. But if you have new symptoms or are worried about anything you can phone your doctor or breast care nurse or make an appointment to see them.
UK guidelines say that everyone who has had treatment for early breast cancer should have a copy of a written care plan. The care plan has information about tests you will have, and signs and symptoms to look out for. It will also include contact details for specialist staff, such as your breast care nurse.
Trials and research
It is difficult to organise trials and research for rare cancers. For example, it can be hard to recruit enough men with breast cancer within a certain time. So a group of experts from all over the world has developed an International Male Breast Cancer Program.
Part one of the programme is collecting information about men who were diagnosed with breast cancer over the past 20 years. Part 2 will collect information about men being diagnosed now.
The programme will look at:
- risk factors for male breast cancer
- types of breast cancer
- the proteins (markers) on the cancer
- how well treatment works
- quality of life and wellbeing.
The programme aims to run clinical trials specifically for men with breast cancer.
There are similarities between male breast cancer and breast cancer in women. But some researchers think there are important differences. These differences might help to develop new treatments in the future if researchers can understand them more fully.
Some breast cancer trials are recruiting women only. But increasingly, treatment trials are recruiting men with breast cancer as well as women.
Trials are trying to improve standard treatments for breast cancer, as well as looking at new treatments.