Breast cancer in the man

Male breast cancer: Rare, but possible

Not only women get breast cancer. Men may also develop a breast cancer in rare cases. But they only account for one percent of all breast cancer cases. In concrete figures: In 2014, 650 new cases of breast cancer in men were registered in Germany; In 134 male patients, the malignant tumor resulted in death. For comparison: among the women there were 69,220 new cases and about 17,670 deaths from breast cancer in the year in question.

On average, male breast cancer develops at the age of 71 years. The mean age of onset in women is lower at about 64 years.

Breast cancer is often diagnosed in men at a later stage than in women. One reason for this is that there is no breast cancer screening program for men (such as mammography screening for women). In addition, many men (and sometimes even doctors) do not first think of a possible breast cancer disease in changes in the male breast area.

Breast cancer (man): causes

There are several known risk factors for breast cancer in men. However, there are also many affected people who can not identify any noticeable risk factor in retrospect.

Genetic risks

More often than in a woman, male breast cancer is genetically predisposed: in both sexes, certain genetic mutations (mutations) can significantly increase breast cancer risk. These mutations may either have occurred spontaneously or inherited from the parents. Such gene alterations, which are associated with a higher risk of breast cancer, concern for example the genes BRCA-1 and BRCA-2. Not only do they increase the risk of breast cancer, but they also increase some other forms of cancer, such as prostate cancer, pancreatic cancer and colorectal cancer.

Another link between genes and breast cancer is Klinefelter syndrome – a congenital disorder of the chromosome number in males. The sufferers have one or more additional female X chromosomes. This is associated with a 20- to 60-fold increased risk of breast cancer.

hormones

The male body produces not only male sex hormones (androgens such as testosterone) but also small amounts of female sex hormones (estrogens, progesterone). A Shift in the balance of hormones can promote breast cancer in men.

This shift can be based on a man being clear more estrogen than usual produced. The trigger for this can be about strong overweight. Affected men are therefore more susceptible to breast cancer. By the same mechanism, the Klinefelter syndrome described above also increases the risk of male breast cancer.

An elevated level of female sex hormones in males results from increased levels Estrogen intake from the outside, An example is the intake of estrogen supplements for sex change (from man to woman).

The normal balance of sex hormones in men can also be reduced by one decreased testosterone production be disturbed. Then the risk for male breast cancer is also increased. The cause of decreased testosterone levels may be, for example, cirrhosis of the liver, undescended testicles (in childhood), or previous orchitis or epididymitis. Too little testosterone also have men who have removed the testes (orchiectomy), for example, because of testicular cancer.

Bodybuilders may also be at increased risk for breast cancer if they use hormones to improve their performance (anabolic steroids). These doping agents are similar in structure to testosterone. It is known that excess testosterone in the male body is partially converted to estrogen. The same is suspected for anabolic steroids. Therefore, the anabolic steroids could disturb the hormone balance so that male breast cancer is favored.

radiation

In both sexes, long-term or high-dose radioactive radiation in the breast region increases the risk of breast cancer. Affected are, for example, people who have received a radiotherapy in the upper body due to a previous cancer (such as lung cancer).

Other risk factors

Other risk factors for breast cancer in men are diabetes, prostate cancer and hyperthyroidism. Also high alcohol consumption and lack of exercise (promotes overweight!) May promote male breast cancer. Also at risk are men who often come into contact with petroleum, exhaust fumes or high temperatures.

Breast Cancer (Male): Symptoms & Diagnosis

The following symptoms may indicate breast cancer and should therefore be clarified by a doctor:

• Knots or indurations in the chest
• Retractions of the breast or nipple
• Inflammation or discharge from the mammary gland
• Inflammations or wounds in the chest that do not heal
• enlarged or hardened lymph nodes in the armpit

In advanced cancer stages Patients often show weight loss and decreased performance. If the tumor has already metastasized, further symptoms are possible. For example, skeletal metastases are often noticeable by bone pain. Cough and shortness of breath may be signs of lung or pleura metastases. Liver metastases trigger about digestive problems and weight loss.

investigations

The first point of contact for suspected breast cancer in men is usually the family doctor, If necessary, he can refer the patient to specialists, such as one Specialist in male diseases (Andrologist, urologist) or one breast cancer center.

In order to clarify the breast cancer suspicion, the following steps are recommended in both men and women:

• Doctor-patient interview to collect the medical history (anamnesis)
• physical examination
• Mammography (chest x-ray)
• Ultrasound examination of the breast

In women suspected of having a suspected breast cancer, magnetic resonance imaging (magnetic resonance imaging, MRI) with contrast media is often used. Whether such an investigation can support the diagnosis of breast cancer in men is still unclear.

Surely, breast cancer can be detected by taking and analyzing a tissue sample (biopsy). The laboratory also tests whether the cancer cells react to sex hormones, which is important for therapy planning.

Further investigations can show if and how far the breast cancer has already spread in the body. This is done in a similar way as in female patients. For example, bone scintigraphy helps detect metastases in the skeleton. X-ray images of the chest (chest X-ray) reveal lung metastases.

Note: All men with breast cancer should be offered genetic counseling and participation in research studies.

Breast cancer (male): treatment

Breast cancer in men has not been studied as well in studies as that of women. Like the diagnosis, the treatment is based on the recommendations for breast cancer of the woman. First and foremost is the surgical removal of the tumor. Depending on the stage of the tumor, the individual risk of relapse and possible comorbidities, further therapies often follow the operation.

surgery

Breast cancer in men is usually operated on. Most of the time, the entire diseased breast must be removed (mastectomy), because men have very little overall breast tissue and the tumor often sits quite centrally. If the tumor is very small in relation to the breast, it may be possible to perform breast conserving surgery.

During the procedure, it is checked whether adjacent lymph nodes are already affected by the cancer. If yes, they will be removed at the same time.

radiotherapy

Breast cancer in men is often additionally treated with radiotherapy after surgery (adjuvant radiation). With that one wants to kill possible tumor remainders. For example, adjuvant radiotherapy is recommended when the tumor measures two centimeters or more in diameter. Even in tumors that do not grow hormone-dependent, the chest wall is usually irradiated after surgery.

(Anti) hormonal therapy

Breast cancer in men almost always shows a hormone-dependent (more precisely: estrogen-dependent) growth: The cancer cells carry numerous estrogen receptors on their surface. Then comes an anti-hormone therapy tamoxifen (after surgery, ie adjuvant) in question. The drug occupies the estrogen receptors on the tumor so that the female sex hormone can no longer dock and promote cancer growth. This can reduce the risk of relapse.

Tamoxifen should usually be taken after the operation for five years. Possible side effects include decreased sexual desire, impotence, hot flashes and mood swings. Many male patients can not cope with these side effects and therefore stop the hormone treatment.

For women with estrogen-dependent breast cancer, other drugs are available for hormone treatment, including the so-called aromatase, However, these are generally not recommended for male breast cancer – Studies have shown that the administration of aromatase inhibitors in male patients is associated with a significantly increased mortality rate. The drugs are therefore only in certain cases into consideration, for example, if the breast cancer is already well advanced and has already formed metastases.

chemotherapy

Breast cancer in men is after surgery (adjuvant) are often treated additionally with chemotherapy. This can improve the prognosis of the patient. In the case of an advanced tumor, it may also be useful to administer the chemotherapeutic agents (cytostatics) even before the surgical procedure. These neoadjuvant Chemotherapy should reduce the size of the tumor so that it can be better removed.

Chemotherapeutics are very effective cell killing drugs. But they can also have significant side effects. The decision for or against chemotherapy therefore depends on several factors. In addition to the tumor stage, this includes the age and the individual state of health of the patient as well as any comorbidities. In addition, the doctor takes into account in the treatment planning how well the patient tolerates the chemo and whether he wishes such a treatment at all.

Antibody therapy

Breast cancer in men is (as in women) sometimes HER2-positive, That is, there are numerous docking sites for growth factors (HER2 receptors) on the surface of the cancer cells. Here is a treatment with antibodies against these receptors, for example, trastuzumab. In female patients, this antibody treatment is often very effective. Experts therefore assume that HER2-positive breast cancer in men can be treated with trastuzumab. However, there are no documented proofs yet.

Breast cancer (man): rehab and aftercare

Breast cancer rehabilitation aims to prevent or alleviate the physical, emotional and social consequences of the disease and therapy. Possible building blocks of the individual rehabilitation plan include a sports and exercise program, psychological counseling and support for professional reintegration.

When it comes to aftercare, it is important to recognize a possible relapse of breast cancer at an early stage. For this, men must go to a doctor for breast cancer for regular examinations. These follow-up examinations are initially very tight and later at longer intervals.

In principle, rehabilitation and aftercare are based Breast cancer in the man to the appropriate recommendations for women with breast cancer.