In New Zealand, around 25 men are diagnosed with breast cancer each year.
Men have a small amount of breast tissue, located beneath their nipple so can also get breast cancer (sometimes referred to as chest cancer). Women have more breast tissue than men, and that's why they are more likely to get breast cancer.
Each year, 25 men will be diagnosed with breast cancer in New Zealand.
The diagnosis, treatment and survival rates for both are very similar.
Breast Cancer Foundation NZ would love men to know what signs and symptoms to look out for. For most men, breast cancer doesn't come to mind when they notice a change in their nipple or chest tissue, which can delay diagnosis. Learn the signs of male breast cancer, so you can detect it early.
Signs and symptoms
- A lump or area of thickened tissue. This is most commonly painless and situated close to, or behind, the nipple.
- Skin changes such as puckering or dimpling, redness or ulceration, or any change in shape of chest (breast) tissue.
- Nipple changes such as a newly indrawn, retracted nipple, or a nipple pointing in another direction. The nipple could also be itchy, scaly, or ulcerated.
- Fluid from the nipple. This might be clear or bloodstained.
- Unusual and persistent breast/chest pain or tenderness.
- Lump in the axilla (armpit).
These symptoms may also be signs of a benign (non-cancerous) breast condition but it’s important to have any changes checked by a doctor. It's important to note that enlargement of both breasts is usually not cancer. This is usually gynaecomastia, a benign enlargement of the glandular tissue in the breasts. This is commonly due to a hormone imbalance and may be caused by weight gain.
Risk factors
- Getting older. Most cases are diagnosed in men over the age of 50.
- Having a strong family history of breast and/or ovarian cancer. .
- 10 – 20% of male breast cancers are associated with an inherited fault in a BRCA gene. Men who carry an inherited BRCA gene mutation (most commonly BRCA2) have an increased risk of developing breast cancer. The majority of male breast cancers happen in men who have neither a family history of breast cancer nor an inherited gene abnormality - like BRCA2.
- Previous treatment with radiation therapy to the chest (e.g. treatment for lymphoma). The risk is greater if radiation exposure occurred at a young age.
- Klinefelter's Syndrome - a congenital (present at birth) chromosomal disorder. Affected males are born with an extra X (female) chromosome (XXY rather than XY) resulting in lower testosterone production and high levels of oestrogen. This makes their breast cancer risk the same as for the average woman. Men affected with Klinefelter's Syndrome have enlarged breasts, sparse facial and body hair, small testes and an inability to produce sperm.
- High oestrogen levels associated with obesity or being overweight. This is associated with breast tissue enlargement such as gynaecomastia.
Diagnosis
The tests used to investigate breast changes in men are the same as those used for women. The ‘triple test’ is used to find the reason for a change in the breast/chest tissue and to diagnose cancer.
This consists of:
- A clinical breast examination, including an examination of lymph nodes under the arm and above the collar bone, and a discussion about your medical and personal history.
- Imaging of both breasts with mammogram and ultrasound.
- Biopsy of the area of concern to obtain a diagnosis.
Treatment
Surgery
The surgical treatment for men is usually mastectomy, because they have much less breast tissue. Mastectomy usually involves removing all of the breast tissue, plus the nipple, areola and some of the surrounding skin. Reconstruction can be used to improve the appearance of the chest wall if needed. Implant reconstruction is not an option. Nipple reconstruction may be an option, or 3D tattooing can give the appearance of a nipple.
One or more lymph nodes will usually be removed from the armpit when the mastectomy is performed to check whether the cancer has spread. This allows the disease to be staged and helps with treatment decisions.
Adjuvant treatment
Adjuvant treatment (after surgery) may include hormone-blocking therapy, radiation therapy, chemotherapy or other targeted therapy. Treatment plan will depend on the characteristics of the tumour, such as size, grade and stage, and whether the cancer cells have receptors for oestrogen, progesterone and HER2.
Most male breast cancers are hormone receptor positive, which means that oestrogen can stimulate the growth of the cancer cells. Tamoxifen is a medication which blocks the action of oestrogen and is a common treatment option to reduce the risk of recurrence. While aromatase inhibitors, another class of hormone-blocking drugs, are often used to treat post-menopausal women with breast cancer, they have not been well studied in men so are not commonly used as a first line of hormone therapy.
Herzuma is a targeted biological therapy, can be given for men with HER2-positive disease.
Support
Some men may feel embarrassed and isolated after diagnosis of a disease they didn't know they could get, or one that's typically thought of as a "woman's cancer".
You might find it helpful to talk with others about your diagnosis and its impact on you. This may include your GP, breast care nurse, psychologist/counsellor or other men who have had the same experience.
We provide three free counselling sessions for anyone who has been diagnosed with breast cancer.
If you have any questions or concerns, phone the Foundation's confidential advice line 0800 BC NURSE (0800 226 8773) - available Monday – Friday. You can leave a message if you call outside office hours, or you can email our breast nurse at breastnurse@bcf.org.nz.
Recommended reading
Cancer Australia provides a useful resource for men with breast cancer.
Professor John Boyages has written a helpful book for men with breast cancer.