Breast cancer in men

Breast cancer is often thought of as a cancer exclusive to women, with over 55,000 cases diagnosed in women in the UK every year. However, around 350 men in the UK are also diagnosed with breast cancer every year. While this makes breast cancer very rare in men, it is nonetheless important to know the symptoms, so you can seek treatment as early as possible to improve your chances of recovery. 

Risk factors for breast cancer in men

Men have a small amount of breast tissue behind their nipples, which is where breast cancer can arise. Fewer than one in every 100 cases of breast cancer occurs in men and usually in those aged over 60, making age the main risk factor. 

Other risk factors include exposure of your chest area to radiation, having close female relatives who have had breast cancer, and having high oestrogen levels. All men produce the hormone oestrogen but higher than average levels can increase your risk of breast cancer. Oestrogen levels can be raised if you are overweight, have a chronic (long-term) liver condition (eg liver disease or liver cirrhosis) or have certain genetic conditions (eg Klinefelter syndrome).

In women, inherited faults in the genes BRCA1 and BRCA2 increase their risk of breast cancer. This is also true in men, and consequently, if you think you may carry these inherited gene faults, you should see your GP. They may refer you for genetic testing and genetic counselling and advise you on how to detect the signs of breast cancer early. 

Signs of breast cancer in men

Symptoms of breast cancer in men are similar to those in women.

They include a hard, usually painless lump in your breast or a lump or swelling under your arm. Changes may also occur to your nipple, including blood-streaked discharge from your nipple or your nipple pulling into your breast.

The skin around your nipple can change too, becoming hard, red or swollen, or developing a persistent rash, sore or ulcer. Your breast may also become swollen.

If you notice any of these symptoms or are worried that you may be at risk of breast cancer due to a family history of the condition, you should see your GP.

Getting a diagnosis

Your GP will discuss your symptoms and ask about your medical history and family history of cancer. They may then perform a physical examination of your breast and the surrounding tissue. If appropriate, they will refer you for imaging tests, such as an ultrasound scan or a mammogram (breast X-ray).

If your scan results suggest cancer may be present, a tissue sample (biopsy) will need to be collected, usually using a needle or a special device called a biopsy punch. The biopsy will be examined under a microscope in a lab to confirm whether breast cancer is present and what type. 

If you get a positive test result (ie you have breast cancer), your doctor may then refer you for more imaging tests to determine if the cancer has spread and how far. This may include a bone scan, CT scan, liver scan and/or MRI scan. 

Types of breast cancer in men

Men can develop the same types of breast cancer as women, most commonly invasive ductal carcinoma, invasive lobular carcinoma and ductal carcinoma in situ (DCIS).

Invasive ductal carcinoma refers to breast cancer that starts in the ducts (tube-like structures) of the breast tissue and spreads to other parts of the breast. Similarly, invasive lobular carcinoma starts in the lobules (glands at the ends of ducts) of the breast tissue and spreads to other parts of the breast. DCIS refers to breast cancer that is limited to the lining of the ducts in the breast. However, DCIS can develop into an invasive type of breast cancer.

Both men and women can develop other types of breast cancer. However, these tend to be less common and include inflammatory breast cancer and triple negative breast cancer.

Treating breast cancer in men

As with breast cancer in women, treatment depends on the type of breast cancer you have, how far it has progressed, the size of your tumour and whether your cancer responds to certain hormones. 

Treatment may include surgery to remove affected tissue, radiotherapy, where radiation is used to kill the cancer cells or chemotherapy, where drugs are used to kill the cancer cells. If your breast cancer responds to certain hormones, you may have hormone therapy to slow down or stop the growth of the cancer cells. If you have certain proteins on the surface of your breast cancer cells, you may have targeted cancer drug therapy.

In most cases, a combination of treatments is needed. 

Surgery usually involves removing the entire breast, including the nipple (mastectomy). You may also need to have some of the underlying muscle removed if your breast cancer is very close to it, as well as several lymph nodes in your armpits — the lymph node tissue will later be checked in a lab for the presence of any cancer cells. 

After surgery, further non-surgical treatment (eg radiotherapy or chemotherapy) is usually recommended to reduce the risk of the cancer returning. In some cases, non-surgical treatment is also recommended before surgery to help shrink the tumour before it is removed. 

Treating breast cancer that has spread

If your breast cancer has spread beyond your breast, it is called metastatic breast cancer. The most common places breast cancer spreads to include the brain, bones, liver, lungs and lymph nodes.

As before, the specific type of treatment you receive will depend on the type of cancer you have, how far it has progressed and whether it responds to certain hormones. Based on this your doctor will recommend further non-surgical treatment, which may include one or more of the following: chemotherapy, hormone therapy, radiotherapy or targeted cancer drug therapy.