Male Breast Cancer

Although breast cancer is predominantly a female disease, males are not immune to this cancer. Male breast cancer comprises 1% of all breast cancer diagnosis.

Risk factors for Male Breast Cancer:

  1. Age: The risk increases with increasing age and male breast cancer usually presents in the 6th or the 7th decade of life
  2. Family history of breast cancer/ Inherited gene mutations: The chances of male breast cancer are higher in people with BRCA 2 mutation and a positive family history of breast cancer
  3. Alcohol
  4. Klinefelter’s syndrome: Men with Klinefelter syndrome have small testicles (smaller than usual). Often, they are unable to produce functioning sperm cells, making them infertile. Compared with other men, they have lower levels of androgens (male hormones) and more estrogens (female hormones). For this reason, they often develop gynecomastia (benign enlargement of the male breast), which is also a differential diagnosis of male breast cancer.Patients with this syndrome have a higher incidence of Male Breast Cancer.
  5. Radiation exposure
  6. Exposure to estrogen: Excessive exposure to estrogen increases the chances of male breast cancer.
  7. Liver disease
  8. Obestiy
  9. Testicular problems: Undescended testis, mumps and Klinefelter’s syndrome increases the chances of male breast cancer.

A common differential diagnosis of Male Breast Cancer is Gynecomastia (benign enlargement of the male breast). Gynecomastia usually results from an imbalance between androgen and estrogen production. This is commonly seen in adolescents or in elderly patients because testosterone levels increase during puberty and decrease with age. Besides these causes, many drugs—including steroids, antidepressants, diuretics, and antihypertensive medications—have also been implicated in the development of gynecomastia, although as many as 50% of cases have no known identifiable cause.

Certain risk factors are common to both gynecomastia and carcinoma: breast irradiation, mumps orchitis, and bilateral cryptorchidism (undescended testis), Klinefelter’s syndrome.

Male Breast Cancer

Male Breast Cancer

Gynecomastia

Gynecomastia

Symptoms:

Lack of awareness is the major cause which prevents early diagnosis of this condition in males. Following are the danger signs, which can point towards a male breast cancer:

If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:

  • a lump in the breast
  • nipple pain
  • an inverted nipple
  • nipple discharge (clear or bloody)
  • enlarged lymph nodes under the arm

Diagnosis: 

Diagnosis of male breast cancer is achieved on the same lines as female breast cancer. Patient is usually subjected to an imaging test followed by histo-pathological confirmation of the diagnosis.

Some patients also require extensive work-up to rule out metastasis to other parts of the body.

Management & Prognosis:

Management of male breast cancer is similar to female breast cancer.

By virtue of the proximity between most male breast cancers and the skin and chest wall, extension to or invasion of these structures is more commonly observed than in women but the prognosis of male breast cancer remains the same as female breast cancer.

For more information regarding the management of this condition, click here

Sporadic, Familial and Hereditary Breast Cancer Definitions

This is in continuation to my previous post ‘Criteria for Genetic Testing in Breast Cancer’. It is important for both patients and healthcare professionals to understand these definitions and their implications.

Sporadic Breast Cancer

Sporadic breast cancer is breast cancer with no other family history of breast carcinoma through two generations including siblings, offspring, parents, and both maternal and paternal aunts, uncles, and grandparents.

These patients do not require genetic testing for BRCA genes and risk-reduction procedures.

Familial Breast Cancer

Familial breast cancer is breast cancer with a family history of one or more first or second-degree relatives with breast cancer that does not fit the hereditary breast cancer definition given later. It is important to note that a patient with one or more first degree relatives with breast cancer in this familial breast cancer category has a substantial excess lifetime risk of breast cancer when compared with patients in the general population, who do not have affected first-degree relatives. A study found that risk ratios for breast cancer increased with increasing number of first-degree relatives involved (1.80, 2.93, and 3.90, respectively, for one, two, and three first-degree relatives).

As yet, genetic and environmental causes of familial (as opposed to hereditary) cancer are incompletely described. Some cases that demonstrate a familial pattern are found on germline testing to have BRCA1 or BRCA2 mutations, and it is difficult to know exactly where to set the threshold for genetic testing. However, quantitative risk assessment of breast cancer is extremely useful for the familial category of at-risk women and guides medical decision-making about chemoprevention, high-risk surveillance using breast magnetic resonance imaging (MRI), and prophylactic mastectomy.

Patients with increased risk should undergo the BRCA test and if they test positive, they should be counselled about risk reduction techniques.

Hereditary Breast Cancer

Hereditary breast cancer is characterized by a significantly earlier age of onset of breast cancer (before 45 years of age), bilateral breast cancer, a greater frequency of multiple primary cancers such as cancers of the breast and ovary in the HBOC syndrome(Hereditary Breast and Ovarian Cancer Syndrome), and an autosomal dominant inheritance pattern for cancer susceptibility (multiple family members with breast or ovarian cancer).

These patients should undergo BRCA testing and should be counselled about the various risk reduction techniques (which I will be discussing in my next post).

Criteria for Genetic Testing in Breast Cancer

The recent news of Angelina Jolie’s prophylactic mastectomies has created a lot of anxiety and confusion in the minds of young ladies. Ever since the news hit the media, we are getting 2-3 queries each day regarding genetic testing and risk reduction surgery. I will try to address the whole issue in a few blog posts. In this post, I am highlighting the indications for genetic testing (BRCA 1 & 2).

Before I enumerate the various indications, I would like to clarify a couple of points.

  • Not all women require genetic testing. Only those who meet one or more of the criteria highlighted below are candidates for genetic testing.
  • Even those who test positive for the gene, require extensive counselling before they adopt any risk reduction technique.

The criteria for genetic testing are:

  • Member of a family with a known mutation in breast cancer susceptibility gene.
  • Member of a family with two or more breast primaries (cancers)
  • Two or more individuals with breast cancer on the same side of the family (maternal or paternal)
  • One or more relative with ovarian cancer from the same side of the family (maternal or paternal)
  • First or second degree relative with breast cancer below the age of 45 years
  • Breast cancer diagnosed in a male relative
  • A women of Ashkenazi Jewish descent (high risk population for BRCA mutations and breast cancer)

Myriad Genetics holds the patent for BRCA testing and ever since Angelina’s news broke out, they have increased the prices of the test to $4000.