Is there breast cancer in men? Every year in Russia, about 50 thousand people get breast cancer. Approximately 1-1.5% of these cases occur in oncopathology in the stronger sex. Cancer in men differs little from “female” in aggressiveness, but is more often found at stages 3 and 4. Men usually get sick in middle and old age.
Causes of Breast Cancer
The chest in men is represented by a small amount of undeveloped glandular tissue, fatty tissue and connective fibers. Under the influence of adverse internal and external factors, atypical cells may appear in the mammary glands. Their structure and physiology are very different from the norm. Over time, such cells go through the path of progression and become increasingly malignant.
Causes of breast cancer in men:
- unfavorable genetics
- hyperestrogenism of any etiology,
- elderly age,
- bad habits (smoking, addiction to alcohol),
- repeated chest injuries,
- radiation load
- work in hazardous industries, etc.
An important factor in the occurrence of breast cancer in men is heredity. Every fifth patient with this diagnosis has a relative with a similar pathology. Scientists have proven that BRCA2 mutations play a large role in the disease of a malignant breast tumor.
In addition, one of the genetic diseases, Klinefelter's syndrome, is highly likely to lead to oncology. In patients with this pathology, in the classical version, there is one additional X chromosome (47, XXY). Such a set of genes is associated with a low level of androgens, underdevelopment of the testicles, and gynecomastia. Men with excess X chromosome have relative hyperestrogenia. It is probably because of her that breast cancer develops.
The older the man, the higher his risk of breast cancer. Most patients experience pathology in old age.
The reasons for the high risk of the disease in this group of patients:
- age-related testosterone deficiency due to andropause,
- a high prevalence of metabolic disorders (diabetes mellitus, etc.),
- accumulation of adverse effects.
Excess weight in men is associated with hyperestrogenia. Most androgens are transformed in adipose tissue into female sex hormones. The higher the body mass index and waist volume, the more often oncology develops.
Alcohol has a strong negative effect on the liver tissue. Alcoholism naturally leads to cirrhosis. Disorders in the liver are also manifested by the activation of the conversion of androgens to estrogens in hepatocytes. In addition, some alcoholic beverages (beer) contain analogues of female sex steroids, which have a direct effect on glandular tissue.
Disturb the normal hormonal balance and narcotic substances. For example, opioids, hash, marijuana cause persistent hyperestrogenia.
Is there breast cancer in men?
Representatives of the stronger sex can not boast of such magnificent forms that are present in women. However, they do have a small amount of breast tissue. In fact, the "breast" of an adult male is similar to the female until puberty. It consists of many ducts surrounded by tissues. In women, these cellular elements grow and develop in accordance with hormonal changes. Precisely because it is breast tissue, a stronger sex can also suffer from cancer.
Breast cancer in men is a very rare disease. The likelihood of its occurrence increases with age. The most risky period is considered to be from 60 to 70 years. Many men consider this type of cancer to be exclusively a female prerogative, and therefore often ignore the early manifestations of the disease.
What is gynecomastia?
Separately, it is necessary to talk about such a pathology as gynecomastia. The fact is that breast enlargement in men is not always cancer. Gynecomastia is a pathological proliferation of breast tissue of a benign nature. This is a precancerous condition that requires rational treatment. The disease “signals” that a malfunction has occurred in the body. The neoplasm is usually located under the nipple and noticeably with the naked eye.
Gynecomastia in adolescents is considered a natural phenomenon. The disease is caused by a hormonal imbalance in the body. This is also true for older people. Gynecomastia today is diagnosed several times more often than breast cancer in men, but both pathologies are outwardly similar. That is why any growth in the nipple should be an occasion to visit a doctor’s office.
Types of Breast Cancer in Men
- Ductal carcinoma. A neoplasm is formed in the ducts of the breast, but does not go beyond it. The disease is successfully treated surgically and has a favorable prognosis.
- Infiltrative ductal carcinoma. A tumor can grow into fatty tissue and also metastasize to other tissues. This type of disease accounts for approximately 80% of all detected cases of the disease.
- Infiltrative lobular cancer. Pathology is extremely rare. Malignant cells can spread beyond the lobules where they formed.
- Paget's disease. A neoplasm is formed in the ducts of the gland and then spreads through the nipple.
- Edematous infiltrative cancer. This type of disease is considered very aggressive. Cancer cells are characterized by the ability to block blood vessels in the skin of the chest, preventing the normal flow of lymph through the tissues.
Causes of the disease
We have already figured out whether men can have breast cancer. Now you need to understand the mechanism of development of this disease.
The main cause of oncology in representatives of the stronger sex, doctors consider hormonal imbalance. Violations are usually caused by an excess of estrogen, which is not fully utilized by the liver. This hormone is produced in adipose tissue, so the risk of developing the disease is increased in overweight men.
The lack of androgens, which in medicine is called Klinefelter's syndrome, also contributes to the occurrence of neoplasms. With this pathology, several X chromosomes are present in the cell nucleus instead of one. Against the background of increased estrogen levels and deficiency of male hormones, the body of a teenager acquires a feminine look. His voice becomes soft, and his hairline is noticeably thinning.
Another important factor is age. As you age, the production of androgens in the body decreases, and the estrogen content increases. The older the man, the greater the likelihood of developing a tumor. Radiation therapy is also capable of provoking the disease. It is usually used for the treatment of cancer pathologies.
Breast cancer in men is due to a genetic predisposition. If close relatives in the family had the same diagnosis, automatically the person falls into the risk group. The fact is that a violation of the structure of some genes affects the production of protein. This substance is responsible for inhibiting the growth of abnormal cells.
How to independently determine the ailment?
Breast cancer in a man is always accompanied by painful discomfort. This is the main symptom that you should pay attention to first. The initial stage of the disease is rarely manifested by characteristic signs, but a certain set of symptoms can be observed:
- change in the shape of the nipple,
- swollen lymph nodes
- the appearance of a tumor below the nipple.
Starting from the second stage, skin integuments are gradually involved in the pathological process, ulcerations appear. You can notice how the muddy liquid with impurities of blood oozes from the nipple. Such symptoms of breast cancer in men cannot be ignored. Immediate seeking help from a doctor increases the chances of a favorable outcome of the disease.
Diagnosis of the disease begins with a consultation with an oncologist. The specialist conducts a physical examination of the patient, palpates the affected area. This is necessary to determine the localization and approximate size of the neoplasm. Then a mammogram is prescribed. During the study, the patient should undress and press his chest into a special apparatus. Sometimes tissue compression is accompanied by painful discomfort, but this is necessary to obtain high-quality images. The next step in the diagnosis is ultrasound. Ultrasound examination allows you to get an accurate image of the tumor.
Usually the above manipulations are enough to hear a man diagnosed with cancer. The causes of the disease, more precisely the nature of the neoplasm, can be determined using a biopsy. The procedure is performed under local anesthesia. The doctor inserts a thin needle into the seal, through which a small amount of contents is pumped out of the tumor. Then the resulting material is studied in laboratory conditions.
Tumor Treatment Methods
To combat breast cancer, modern medicine offers several treatment options: surgery, radiation, hormone and chemotherapy. The choice of a specific tactic depends on the stage of the pathological process and the patient’s health status.
Surgical treatment of breast cancer in men is aimed at removing the neoplasm and surrounding tissues. Most patients with this diagnosis undergo a radical mastectomy. During surgery, the surgeon removes the entire breast.
Radiation therapy is not used as an independent method of treatment. It is used to destroy cancer cells remaining after surgery. For treatment, high-energy rays are used. They kill pathological elements and slow down the course of the disease.
Chemotherapy is based on the use of cytotoxic drugs. Such drugs kill active cancer cells. Typically, two or more drugs are used in the treatment. Chemotherapy has a number of side effects. The fact is that the drugs used for treatment kill not only the "bad", but also healthy elements.
Some types of cancer depend on the content of certain hormones in the blood. These are the so-called hormone-dependent tumors that develop with elevated estrogen levels. Doctors usually use Tamoxifen for treatment. This drug is also used for the female form of breast cancer.
Alternative Treatment Options
None of the alternative therapies can cure a man’s breast cancer. However, alternative medicine helps to combat side effects from medications. Alternative treatments that are used in many Western countries today are aimed at suppressing depression and fear. It is these disorders that cancer patients experience.
In order to help a person overcome anxiety and depression, the following methods are used in the West:
- Creative activity. Poetry, dancing and drawing help people relieve stress. Many oncology departments specifically hire teachers to conduct group classes for patients.
- Exercise allows you to forget about the disease and distract from experiences.
- Meditation. Relaxation techniques help a person to abstract from earthly problems.
- Prayer. Believers are able to draw strength from religious teachings. In many developed countries, priests working in hospitals are not uncommon today.
Breast Cancer Prevention
Any disease is easier to prevent than to treat. To reduce the likelihood of breast cancer, every man can give up alcohol, monitor weight and eat right. This is the simplest disease prevention.
Oncology of this form in men is very rare, but more often has an unfavorable outcome. The reason is quite simple: most ignore the initial signs of breast cancer. In men, the mammary gland is actually absent. On the other hand, breast tissue is present in large quantities. If there is an organ, a disease may also occur. Cancer and its complications are easy to prevent if you show a little attention to your own body.
Chest injuries in the glands lead to inflammation. This process is characterized by hyperemia, local accumulation of immune cells and a change in the composition of tissue fluid. Chronic inflammation is a risk factor for oncology.
Irradiation and exposure to harmful working conditions affects the genome of cells. Mutations occur in tissues. If such atypical cells are preserved, and not destroyed by immunity, an oncological tumor occurs.
Symptoms of breast cancer in men
Fig. 1 - Symptoms of breast cancer in men.
Signs of the disease in men can be detected very early. In the chest area, representatives of the stronger sex do not have a large amount of soft tissue. The tumor may be visible to the eye or palpable even with small sizes. But, unfortunately, neither men nor doctors usually have caution regarding this form of cancer. Therefore, with all the possibilities of early diagnosis, oncology is more often detected at a late stage.
Signs of the disease in men:
- neoplasm in the chest area (usually under the areola),
- retraction of the nipple
- wrinkled skin areola,
- skin ulceration,
- skin redness
- discharge from the nipples,
- an increase in axillary lymph nodes.
The tumor to the touch may be heterogeneous, fused with surrounding tissues. Usually, the neoplasm itself is painless on palpation.
Diagnosis of the disease
Cancer can detect a doctor of any specialty. In most cases with symptoms of the disease, patients go to the therapist or surgeon. To clarify the diagnosis, an examination by a mammologist-oncologist is necessary.
Comprehensive examination includes:
- palpation of the mammary glands and local lymph nodes,
- radiography (mammogram),
- Breast ultrasound,
- tomography (CT, MRI),
- suction biopsy
- study of discharge from the nipple for atypia,
- study of discharge from an ulcer for atypia,
- hormonal profile
- tumor markers (Ca-15-3, BRCA, CEA).
Forms and stages of breast cancer
Based on the diagnostic results, an accurate diagnosis is established, including the form and stage of oncology.
The main types of cancer in men:
- ductal cancer non-invasive,
- ductal carcinoma infiltrative,
- lobular cancer infiltrative,
- Paget's cancer
- edematous-infiltrative neoplasm.
Table 1 - Stages of breast cancer.
|0||In situ neoplasm (“in place”)|
|1||The volume of pathological tissue up to 2 cm, no metastases|
|2||Volume up to 2 cm and metastases to the lymph nodes / volume 2-5 cm and metastases to the lymph nodes / volume more than 5 cm without metastasis|
|3A||Tumor more than 5 cm and metastases to the lymph nodes|
|3B||Tumor invading surrounding tissue|
|4||Any tumor and the presence of metastases to distant organs (e.g., liver)|
Treatment of breast cancer in men
Radical and conservative treatment is given to patients with breast cancer. Most often, a man requires a complex effect on the oncological process.
The following methods are applied:
- radiation therapy,
- chemotherapeutic treatment
- hormone therapy.
If cancer is detected at an early stage (0 or 1), then surgical treatment is necessary. If it is possible to remove all glandular tissue, then further treatment in most cases is not recommended. According to the results of histology, chemotherapy is sometimes prescribed (if the tumor is highly aggressive). If part of the mammary gland is preserved, then the patient is additionally given radiation therapy.
Treatment of stages 2 and 3 of breast cancer in men combines surgery, radiation, hormone therapy and chemotherapy (if there are metastases in the lymph nodes).
If the patient is diagnosed with stage 4, then the combination of chemotherapy and hormonal drugs comes first in the treatment regimen.
In men, radical removal of the entire glandular tissue (mastectomy) is preferable.
Fig. 2 - Radical removal of the mammary gland in men.
- simple (removal of glandular tissue, nipple),
- radical modification (removal of glandular tissue, nipple, regional lymph nodes),
- radical (removal of glandular tissue, nipple, regional lymph nodes, pectoralis major and / or minor).
Organ-preserving operations are recommended extremely rarely and only at the very early stages of the process.
Radiation therapy is usually prescribed after organ-preserving surgery or radical treatment of a tumor of stage 2-4.
The main treatment is remote. It involves irradiation from the outside. The effect is on the area of the mammary gland and other areas of the chest.
Benign breast tumors in men
Consider this chapter a small departure from the general theme: without it, our article would not be completely complete. The fact is that not every enlargement of a man’s mammary gland is cancer. Гораздо чаще дело обстоит как раз наоборот: gynecomastia — самая частая «мужская» проблема с молочными железами. Гинекомастия — патологическое разрастание ткани молочной железы доброкачественной природы. It begins to appear as a small (button-sized) formation under the nipple or areola, which can be seen with the naked eye and felt. In some men, gynecomastia is more pronounced and more like a woman’s breast.
Signs of gynecomastia If gynecomastia appears in adolescents, then this is quite natural and is associated with a change in hormonal balance in adolescence. This, incidentally, is true for older men. There are other reasons for the development of gynecomastia - pathological: diseases of the endocrine system and liver, obesity, side effects of certain drugs, Kleinfelter syndrome.
Although gynecomastia in men happens much more often than breast cancer, both of these conditions are very similar in appearance, so any growth in the area of the nipple should serve as an “iron” reason for visiting a doctor.
Chemotherapeutic agents are prescribed to patients with aggressive tumors of any stages. In some cases, this effect has to be abandoned (in a serious condition of the patient). Chemotherapy drugs block the growth and reproduction of cancer cells within the neoplasm itself and in metastases.
- chemotherapy as the main method (at stage 3-4),
- neoadjuvant (in preparation for radical treatment),
- adjuvant (for the destruction of metastases).
Progressive chemotherapy is a means of targeted (targeted) therapy. They have fewer side effects and a better safety profile. Successful examples of such medicines are Trastuzumab, Pertuzumab, Lapatinib.
Types of Breast Cancer in Men
Just list them with a little explanation:
- In situ ductal carcinoma or noninvasive ductal carcinoma. A tumor forms in the ducts of the mammary gland, but does not grow into adipose tissue and does not extend beyond the gland. It makes up 10% of all detected cases of breast cancer in men. Almost always successfully treated surgically,
- Infiltrative ductal carcinoma. Unlike the previous type, this cancer grows into fatty tissue and can metastasize to other organs and tissues. It accounts for 80% of all detected cases of breast cancer in men,
- Infiltrative lobular (lobular) cancer. This cancer begins its destructive activity in the lobes of the mammary gland (clusters of cells that produce breast milk in women), and then grows into fatty tissue. It’s extremely rare in men,
- Paget's disease. This type of cancer begins in the ducts and spreads to the nipple or areola,
- Edematous Infiltrative Breast Cancer. Aggressive but rare type of cancer.
About 90% of breast tumors in men are sensitive to estrogen and / or progesterone. Such neoplasms respond to the use of hormonal agents.
The following drugs are used:
- antiestrogens (blocking estrogen receptors), an example is Tamoxifen,
- aromatase inhibitors (reduce estrogen levels, inhibit the conversion of androgens to estrogens), for example, Arimidex,
- LH releasing factors (luteinizing hormone inhibitors, reduce androgen levels), an example is Zoladex,
- synthetic progesterone derivatives (compete for receptors at the level of tumor cells), for example, Megestrol.
Risk factors, causes of breast cancer in men
The true reasons for the development of breast cancer in men are not known, but the researchers were able to identify a number of factors that could contribute to this. As with women, many of these factors are associated with hormonal balance.
- Age. The larger it is, the higher the risk of getting cancer (the average age of a patient with breast cancer is 68 years).
- Burdened by heredity. In every fifth patient with breast cancer, the same disease was diagnosed in one of his close relatives.
- Hereditary genetic mutations. Men with a BRCA2 gene mutation have an increased risk of developing breast cancer.
- Kleinfelter's syndrome. This is a hereditary disease that occurs in 1 out of 1,000 men. Men with this syndrome suffer from a lack of testosterone: they have small testicles, an excess of estrogen, gynecomastia, often infertility.
- Exposure to radiation.
- Alcohol abuse.
- Liver disease.
- Reception of estrogen (for example, in the treatment of prostate cancer).
- Undescended testes or orchiectomy.
- Industrial hazards, such as gasoline vapors or exposure to high temperatures in the steel industry.
Symptoms of breast cancer in men
- thickening or swelling, which is usually (but not always) painful to the touch,
- retraction or puckering of the skin on the chest,
- retraction of the nipple
- redness or peeling of the skin or nipple,
- discharge from the nipple.
Sometimes breast cancer can spread to the axillary or subclavian lymph nodes, then the seal will be felt in these places and even before the tumor appears at its main location.
Once again: these symptoms are not a unique “conquest” of breast cancer: in most cases, this is gynecomastia. However, only a doctor can judge this.
How to identify early stage breast cancer in men
There are a lot of similarities between the male and female versions of breast cancer, but there are important differences that affect its early detection.
1. Breast size. This is the most obvious difference between the female breast and the male, playing the latter on the arm: a smaller breast size facilitates the detection of a tumor. On the other hand, men should be more careful: due to the small size of the mammary gland, the tumor does not need much time to grow into nearby organs and tissues and begin to “walk” through the body with metastases.
2. Lack of awareness. Many men think that breast cancer is "not about them," and do not pay enough attention to the suddenly appearing alarming symptoms from the list above. They attribute this to infection, to anything, but their thoughts do not allow it to be cancer. Some are embarrassed by the presence of a seal in the mammary gland, afraid to question their masculinity in front of an outsider. This can delay the visit to the doctor and, as a result, reduce the chances of a successful outcome.
If a man has had cases of breast cancer in his family (moreover, it doesn’t matter on the male or female line), then he must undergo special care with all the necessary diagnostic tests. So, genetic testing is used to detect mutations of the BRCA gene. But mammograms, as part of a standard set of preventive studies, are usually not done to men, and they resort to it only in cases when a seal has already been found in the mammary gland.
As for genetic testing, if mutations of the BRCA gene were detected, then the man is at risk and will need to be regularly observed by an oncologist.
Can breast cancer be prevented?
A man can reduce the risk of developing breast cancer to a certain extent by maintaining optimal body weight and limiting alcohol consumption. But since oncologists do not have a clear understanding of the causes of cancer, no specific measures are known to prevent it.
To date, the best strategy to reduce the number of deaths caused by this disease is timely diagnosis and timely treatment. For men, this is a serious problem, because they tend to ignore the appearance of small seals and / or tumors, and consult a doctor only when the tumor reaches an impressive size. Therefore, breast cancer in men is diagnosed at a later stage than in women.
Most men with breast cancer have to meet the surgeon's scalpel. Most often, an operation called mastectomy is performed: the complete removal of all breast tissue, sometimes together with nearby tissues.
The following types of mastectomy are distinguished:
- simple mastectomy: the mammary gland, including the nipple, is removed, but the axillary lymph nodes and muscle tissue under the gland remain intact
- modified radical mastectomy: axillary lymph nodes are removed along with the mammary gland,
- radical mastectomy: the most large-scale operation of all of the above, when in addition to the mammary gland and axillary lymph nodes, the muscles of the chest wall are also removed. Used in advanced stages of cancer.
As for such a popular therapeutic option for women as organ-saving breast surgery, it is used relatively rarely in men. The essence of this surgical intervention is to remove only the tumor and a small amount of normal tissue along its edges. And the male breast has too little tissue under the nipple, so the removal of the tumor is almost always associated with the complete removal of the mammary gland. Moreover, its small size contributes to more active tumor growth in the nipple, skin or chest wall in the early stages of the disease. However, in some cases, if the tumor has not penetrated the nipple, this type of surgery is also used in men.
This is another, along with chemotherapy, a systemic method of treating cancer, which can be used as a means of adjuvant or neoadjuvant therapy, as well as in cases of cancer recurrence or metastasis.
Some breast tumors grow under the influence of the female sex hormone estrogen, which is also present in men, but in smaller quantities. About 9 out of 10 breast tumors have hormonal receptors on the surface of their cells. In this regard, the so-called estrogen-positive and progesterone-positive cancers are distinguished, which respond well to hormone therapy.
The arsenal of pharmacological agents used in the framework of hormone therapy for breast cancer, today is as follows:
- antiestrogens (Tamoxifen, Fareston) - block estrogen receptors on the surface of the tumor,
- aromatase inhibitors (Arimidex, Femara) - inhibit the secretion of estrogen by the adrenal glands,
- Faslodex - not only blocks, but also completely destroys estrogen receptors,
- releasing factors of luteinizing hormone (Lupron, Zoladex) - block the secretion of androgens by acting on the pituitary gland (most breast tumors in men have receptors for androgens),
- Megestrol - competes with hormones for receptors on tumor cells.
Unlike chemotherapy drugs, targeted drugs affect only the tumor itself and have fewer side effects.
On the surface of some breast tumors, a larger than usual amount of HER2 / neu protein, which stimulates its growth, is concentrated. Such tumors are particularly aggressive in terms of capturing new territories. In this regard, preparations were synthesized that target this protein: Trastuzumab (Herceptin), Pertuzumab (Pergeta), Lapatinib (Tikerb), which are quite successfully used in breast cancer in women and, according to some, in men.
Auxiliary pharmacotherapy is not used to destroy the tumor itself, but to mitigate the effects caused by it and eliminate side effects caused by direct treatment methods.
Bisphosphonates are drugs that strengthen bones, reduce the risk of fractures and alleviate pain caused by breast cancer metastases. Hormone therapy with aromatase inhibitors and luteinizing hormone releasing factors promotes thinning of the bones (osteoporosis) - in this case, bisphosphonates will also be useful. The most commonly used drugs for this type of cancer are Pamidronate (Aredia) and Zoledronic acid (Zometa).
Relatively recently, a new drug, Denosumab, was developed, which proved to be even better than bisphosphonates: in clinical trials, it showed itself better than Zometa and confirmed its ability to help in cases where bisphosphonates are ineffective.