Although perceived as a female disease, breast cancer affects men too, like Matthew Knowles, Beyoncé’s father. Dr Justus Apffelstaedt tells us more…
“For every 100 women that we see with breast cancer, we see one man,“ says Dr Justus Apffelstaedt, a Cape Town-based specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology.
Although the risk is low in comparison to cancers such as lung, prostate or colon, men at any age may develop breast cancer. However, it is usually detected in men between 60 and 80 years of age (compared to women, usually detected from the age of 40).
The National Cancer Registry states that the lifetime risk of suffering from breast cancer in males is in between 1 in 500 to 1 in 1 000, depending on race.
Types of breast cancer found in men
The following types of breast cancer are found in men:
- Infiltrating ductal carcinoma: Cancer that has spread beyond the cells lining ducts in the breast. Most men with breast cancer have this type of cancer.
- Ductal carcinoma in situ: Abnormal cells that are found in the lining of a duct; also called intraductal carcinoma.
- Inflammatory breastcancer: A type of cancer in which the breast looks red and swollen and feels warm.
- Paget disease of the nipple: A tumour that has grown from ducts beneath the nipple onto the surface of the nipple.
- Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast).
What causes breast cancer in men?
Family history and known carriers of the breast cancer gene mutation BRCA-1 and 2 have a higher chance of breast cancer.
Other genes linked to breast cancer include P53, P65, ATM en CHECK2.
Hereditary breast cancer makes up approximately five to 10% of all breast cancer. Some genes related to breast cancer are more common in certain ethnic groups.
Other risk factors include:
- Being exposed to radiation.
- Having a disease related to high levels of oestrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder).
How is breast cancer detected in men?
Men with breast cancer usually have lumps that can be felt.
As men’s breasts are usually not as big as women’s and a mass is therefore more easily palpated by the man. On the other hand, in contrast to women health care seeking behavior in men is not well developed and most cases that we see are fairly advanced.
The following tests and procedures may be used:
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The following are different types of biopsies:
- Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle.
- Core biopsy: The removal of tissue using a wide needle.
- Excisional biopsy: The removal of an entire lump of tissue.
- Oestrogen and progesterone receptor test: A test to measure the amount of oestrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumour is checked in the laboratory to find out whether oestrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop cancer from growing.
- HER2 test: A test to measure the amount of HER2 in cancer tissue. HER2 is a growth factor protein that sends growth signals to cells. When cancer forms, the cells may make too much of the protein, causing more cancer cells to grow. If cancer is found in the breast, tissue from the tumour is checked in the laboratory to find out if there is too much HER2 in the cells. The test results show whether monoclonal antibody therapy may stop cancer from growing.
How is breast cancer in men treated?
Treatments for breast cancer in men and women are generally the same. Many men benefit from a combination of different treatments. Here’s an overview of the various approaches:
- Surgery. The typical treatment for men is a mastectomy, in which the entire breast is removed. Breast-conserving surgery – in which just the tumour is taken out – isn’t usually possible for an obvious reason. Men don’t have much breast tissue, to begin with. The surgeon will also take out one or more of the lymph nodes to see if the cancer has spread.
- Radiation therapy. Radiation is used commonly after surgery for breast cancer in men, as these tumours are often advanced and without radiotherapy, there is a high chance of recurrence.
- Chemotherapy. This is treatment with drugs – either taken by mouth or by injection – that attack cancer cells. Chemotherapy is often used after surgery to lower the risk of cancer coming back. For men with advanced cancer or cancer that has spread to other parts of the body (metastatic cancer), chemotherapy may be the primary treatment
- Hormonal therapy. Some kinds of breast cancer need certain hormones to grow. Hormonal therapy blocks the effects of these hormones, choking cancer. Your doctor might use tamoxifen or other drugs. The effects of the new aromatase inhibitors like Arimidex and Femara – as well as the drug Aromasin, known as an aromatase inactivator – haven’t been studied much in men. Sometimes, removal of the testes is used to reduce the amount of certain male hormones in the system. Men with breast cancer should never take testosterone. Hormonal therapy is often used after surgery to lower the risk of cancer coming back. For men with locally advanced or metastatic cancer, it may be the primary treatment.
- Biological therapy. This is a new approach. Some men have an excess of a protein that makes cancer spread quickly. Herceptin is a drug that’s been approved to treat metastatic breast cancer. It stops this protein from making the cancer cells grow. It may also boost your immune system, giving it more strength to fight cancer itself.
What role do male hormones and/or oestrogen play?
Evidently hormones play an important role, but because the incidence of the disease in men is so rare, there is not intensive research available and the precise role of hormones is unknown.
Men that are treated with oestrogen blockers – does this have an effect? E.g. mood swings, feeling irritated or angry
Men have very limited side effects to estrogen blockers. We previously did orchiectomy as part of the hormonal treatment, however, we found this to be not acceptable to the patients.
Are the chances of survival higher for men?
No – the chances for survival are lower than for women for a variety of reasons.
The most important being that men are less likely to go to a doctor and therefore present themselves with advanced cancers.
Due to the anatomy of the male torso with very little breast tissue, small tumours infiltrate into the surrounding tissue which can then easily spread.
If a man is diagnosed with breast cancer, does this increase the chances of his daughters developing cancer?
Yes. Each man that is diagnosed with breast cancer should go for genetic testing. The chances are high that he is a carrier of the breast cancer gene mutations and therefore this would be inherited by his children.
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