Pink October: Putting the focus on male breast cancer

Dear Dr G,

I would like to take the opportunity this month to highlight breast cancer awareness during Pink October.Dr G

I think the public should be aware that breast cancer can also affect men.

I would like to share my story as I noticed a lump in my chest six months ago. I was not so bothered initially as I generally have “man boobs”, anyway.

When the lump grew bigger, I consulted a doctor who immediately started investigations.

I was utterly shocked when the doctor told me breast cancer can affect men too.

I underwent some uncomfortable mammography and a biopsy, and I am fortunate that the result excluded breast cancer.

I am now aware of the discomfort and anxiety women go through for breast cancer screening.

I also hope my scare can be an opportunity to put Dr G on the spot to focus on male breast cancer.

Can you tell me how common breast cancer is in men?

What are the risk factors in getting breast cancer?

Is it true men tend to present late and have more late-stage cancers?

Thank you and Happy Pink October to you and your readers.

Yours truly,
Pinky Perry

Breast cancer occurs when abnormal cells form in the breast tissue. While female breast cancer cases are significantly higher, accounting for more than 99% of all diagnoses, it is essential not to overlook the occurrence of breast cancer in men.

Male breast cancer is rare and estimated to account for about 1% of all breast cancers.

The American Cancer Society’s 2021 projections were that 2,650 new cases of invasive breast cancer would be found in men, leading to approximately 530 deaths.

The incidence of male breast cancer has been increasing over the decades, typically affecting men in their 60s and 70s.

Worldwide statistics indicate 20,000 deaths from male breast cancer annually.

However, its far lower incidence has led to large-scale breast cancer studies routinely excluding men.

Our current knowledge of male breast cancer is far less than female breast cancer and often rests on small, retrospective single-centre studies.

The exact causes of breast cancer in men remain unclear, but certain risk factors have been identified. These include advancing age, family history of breast cancer, exposure to oestrogen, certain genetic mutations, Klinefelter syndrome, liver disease, obesity and radiation exposure.

The most well-known risk factor for male breast cancer is genetic mutation of the BRCA (breast cancer) gene.

Other causes may include alcohol abuse, ionising radiation and exposure to female hormones.

Klinefelter Syndrome, where a man has inherited an extra X chromosome, results in breast enlargement and testicular failure. Sufferers have a 20- to 50-fold increased risk of developing breast cancer.

It is thought that this increased risk is primarily due to their high oestrogen levels relative to androgen, resulting in the cancerous changes.

The symptoms of breast cancer in men are often similar to those experienced by women. They include a lump or thickening in the breast or armpit, nipple discharge, changes in breast shape or size, redness or scaling of the nipple or skin, and nipple inversion.

Early detection is crucial for successful treatment, so it is recommended that men regularly perform self-examinations and report any abnormalities to a healthcare professional.

As is the case with women, diagnosis of breast cancer in men involves several steps: a physical examination, imaging tests (such as mammograms and ultrasound), and a biopsy to analyse tissue samples for cancer cells.

Molecular diagnostic tests such as genetic testing may also be recommended.

The survival rate of male breast cancer was thought to be generally worse than among women, due to gynaecomastia (or “man boobs”) masking the illness.

Lack of awareness was also thought to result in late presentation of the disease, with higher risks of metastasis, as the distance for cancerous infiltration of the skin and muscles is typically shorter in men than in women.

However, a large study by the National Institutes of Health reported the percentage of cases presenting with purely localised disease was 63.1% in men and 45.4% in women; with a spread to local lymph nodes; 29.1% (men) and 43.6% (women); and with distant metastases, 5.7% (men) and 8.1% (women).

Breast cancer diagnosis and treatment in men often faces challenges owing to the relative lack of awareness and stigma surrounding this disease. It is important to stress that breast cancer can afflict anyone regardless of gender.

By raising awareness, encouraging regular screenings, and fostering an open dialogue around this topic, we can break the stereotypes and support individuals affected by breast cancer.

A male breast cancer advocacy group started the Brandon Greening Foundation for breast cancer in men in 2009. The charity advocates both men and women to wear pink, celebrating the lives of survivors and remembering the deceased.

In addition, the campaign also provides support for the millions affected by breast cancer and more importantly, pushes for cutting-edge research into a cure.

The famous actress Audrey Hepburn once said: “Pink isn’t just a colour, it’s an attitude!”For Pink October, Dr G hopes to spread solidarity and a pink attitude in creating awareness and fighting breast cancer in both women and men.