Can males get breast cancer?

PHOTO: Can males get breast cancer?

Men with a very strong family history of female and male breast cancer may have a higher risk of developing breast cancer themselves.

Q: I am a 78-year-old man. About four months ago, l was told that my kidneys were failing badly and that l had no choice but to start dialysis.

About a month ago, while going through dialysis, l felt a little irritation and a small lump on the right side of my right nipple. Within three weeks, the lump grew quite big.

Since l had a medical appointment with my vascular surgeon, the doctor at the dialysis centre advised me to bring this to the surgeon's attention. I did and he referred me to a breast cancer specialist.

The breast cancer specialist sent me for an ultrasound scan and X-rays and these confirmed that l have male breast cancer. This is the first time l have heard of male breast cancer. I thought only women had breast cancer.

What causes male breast cancer? Does it have anything to do with kidney dialysis? Who are the men who are likely candidates for male breast cancer? How serious can it get? Can those who have this form of cancer avoid surgery or are there alternative treatment methods for such cancer?

Is the incidence of this ailment on the increase? What do men have to do to avoid this form of cancer? Even if this form of cancer is a rare illness, people still need to be aware of it and do whatever is necessary to prevent themselves from developing it.

A: Male breast cancer is not very common compared to female breast cancer. In Singapore, we see about 1,500 new cases of female breast cancer every year.

Male breast cancer cases comprise about 1 per cent of this number. As the number of cases is small, we are not able to determine if the incidence of male breast cancer is on the rise.

We do not know the exact cause of male breast cancer. But male breast cancer usually has nothing to do with kidney failure or dialysis.

Men with a very strong family history of female and male breast cancer may have a higher risk of developing breast cancer themselves.

However, because male breast cancer is very uncommon, many men are not aware of it and think that it may not happen to them. As a result, they do not seek medical treatment when they develop problems in their breasts.

Symptoms

Symptoms

The most common presentation of male breast cancer would be a lump in the breast.

Despite having discovered such a lump, many of our male patients do not seek medical treatment early because they are unaware of the existence of male breast cancer.

They think that the lump is innocuous or not suspicious and, therefore, do not seek medical help until the lump has become significantly larger, is bleeding or is breaking through the skin.

Apart from a lump in the breast, male patients may notice some bleeding or ulceration over the breast. Some of them may discover an enlarged lymph node or lump in their armpit region.

Lymph nodes are small, oval glands in the body that are part of the immune system. They filter fluid that bathes the tissues in the body, trapping bacteria, viruses and other foreign substances, which are then destroyed by white blood cells called lymphocytes in the lymph nodes.

When a man comes to the clinic with a lump in the breast, we usually do an ultrasound scan and sometimes a mammogram of the breast.

Depending on our clinical suspicions and the findings of the imaging tests, we will then proceed, if necessary, to biopsy this lump to determine the character and nature of the lump. This means we will take a sample of tissue from the lump and analyse the cells.

Treatment

Treatment

If the biopsy shows that the lump is cancerous, then treatment will usually involve surgery and/or chemotherapy, as well as hormonal therapy and radiation therapy depending on the stage of the cancer.

In view of the small size of the male breast, surgery is usually mastectomy with some form of axillary lymph node biopsy. This means removal of the whole affected breast and some or several lymph nodes in the adjacent armpit.

The type of chemotherapy, hormonal therapy and radiotherapy given to male breast cancer patients is usually similar to that given to female breast cancer patients.

The prognosis for male breast cancer is generally the same, stage for stage, as female breast cancer.

The national five-year survival rates for breast cancer from 2006 to 2010 are 96 per cent for stage 1 cancer, 88 per cent for stage 2, 68 per cent for stage 3 and 25 per cent for stage 4.

However, because many of our male patients seek help late, their cancer is diagnosed at a much later stage than many female patients and therefore, the prognosis is poorer.

However, patients diagnosed with early male breast cancer who undergo appropriate and timely treatment can have a good prognosis and long-term survival.

There is no way to avoid male breast cancer.

Therefore, men are advised to seek medical help the moment they notice an abnormality (such as a lump) in the breast.

Even though they are men, they should have no hesitation in seeking early medical assessment in order to determine the nature and the character of the lump.

Dr Yong Wei Sean
Senior consultant at the department of surgical oncology at the National Cancer Centre


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