Most people, especially women, nowadays understand that screening mammography has demonstrated a reduction in breast cancer deaths in women. Nevertheless, breast cancer remains the second–leading cause of cancer-related deaths among women. The average lifetime risk for breast cancer in women is approximately 13%. In 2020, the American Cancer Society estimates 13% of newly diagnosed female breast cancer patients will die.
Less known to the general population is that, although breast cancer in men is rare, its frequency has increased over recent decades, particularly in the United States, Canada and the United Kingdom. The average lifetime risk of breast cancer in men is 1/833 males or 0.1%. The incidence of breast malignancy in men for 2020 is estimated at 1% of all breast cancers. Approximately 2,620 new cases will be diagnosed, and of those cases the death rate is estimated at 20%, according to the American Cancer Society.
Risk factors for men are like those for women and include marital status (never married at higher risk), previous breast pathology, gynecomastia (abnormal breast growth), previous testicular disease, genetic mutations BRCA1, and BRCA2 and family history of breast cancer. Hormonal imbalance or exogenous estrogen therapy as used with prostate cancer patients and transgender women puts these patients at higher risk than the average adult male. Numerous medications can incite male breast growth as well as various medical conditions such as liver disease or cirrhosis.
Gynecomastia is the most common finding in the setting of male breast enlargement. Gynecomastia caused by hormonal changes during puberty is relatively common. In most cases, the swollen breast tissue will go away without treatment within six months to two years. Breast cancer is extraordinarily rare in teenagers, so much so that most organizations do not keep statistics for the disease in this age group. Nevertheless, many clinicians refer adolescent males to my clinic for a palpable lump or nipple discharge that results from benign gynecomastia.
Typically, men present to my breast clinic for a palpable or painful area in one or both breasts. Both mammograms and ultrasound exams play a role in diagnosis. Less frequently, men present for screening because of family history of breast cancer, usually in a first-order female relative. However, those with a sister or mother who have or had breast cancer are three times more likely to be diagnosed with cancer.
A recent published study from the New York University School of Medicine demonstrated that a mammogram was more effective in detecting cancer in men with high risk than in women with average risk. Those men who already had a prior diagnosis of breast cancer are 84 times more likely to get cancer again than those men without a personal breast cancer history.
This October as we remember those women who have had breast cancer including those unfortunate women who have perished, we need to realize that breast cancer doesn’t discriminate. Men need to be more aware of potential breast cancer risk factors and that they also can develop this malignancy.
