Breast cancer is the second most common cancer worldwide. In males, this cancer is considered as the non-negligible cause of cancer deaths.
Over the last few decades, people are more aware of factors associated with increasing risk of breast cancer. Also, potential treatments have been evaluated and approved over the time to treat this cancer.
Although, males found to develop this cancer at more advanced stages (3 or 4) in comparison to females. It's infrequency and unawareness in males is the major reason for its diagnosis at later stages. This can significantly affect the survival rate.
However, this can also be improved with the early-stage male breast cancer screening, diagnosis and cost-efficient therapy.
Let's examine in detail about male breast cancer (MBC):
- Prevalence in India
- Risk Factors
- Types of breast cancer in men
- Treatment and management
Prevalence in India
Worldwide, MBC accounts for only less than 1% cases and usually seen in elderly men. However, from the past few years, the incidences of MBC is increasing. In the United States and the United Kingdom, it accounts for 0.5 and 1 % of all breast cancers.
In India, the available three studies on MBC presents variable incidence results:
- Rai B et al. from north India have reported 0.5% of MBC cases.
- Chikaraddi SB et al. have revealed 0.4% MBC cases of all breast cancer.
- Shah P et al. Have reported relatively high MBC incidence in Kashmir i.e. 4.1%.
MBC in Indian male found at relatively early ages and aggressive in nature.
The most common symptoms of MBC, occur in 75% of the cases and also present in females patients are:
- Skin ulceration
- Painless palpable mass
- Nipple retardation
- Small bumps in armpits
- Rash or sore around the nipple
The incidences of discharge, ulceration and retraction is noticed up to 6, 6 and 9 percent. The painless palpable mass is mostly localized to subareolar regions in male patients. The left breast shows more involvement as compared to the right one.
Also, the Tumor-Node-Metastasis (TNM) system to diagnose the cancer spread may not be suitable for men patients.
The exact reason behind MBC is unknown. However, there are some of the risk factors which can significantly enhance the risk of breast cancer.
There are many risk factors which involved causing breast cancer, like, increasing age, increased oestrogen and testicular malfunction. Let's take a look on every aspect of risk factors associated with MBC:
Like women, risk of breast cancer enhances with first degree relatives having disease especially with early age during the diagnosis. There is a positive family history of breast cancer in 15–20% of cases of MBC. More uncommonly, men are observed to have brca1 or brca2 gene mutations, often the latter.
A male BRCA 2 carrier shows 6% lifetime risk of developing breast cancer as compared to 0.1% in the normal population. Males with Cowden syndrome and Klinefelter’s syndrome (XXY) reported high risk of breast cancer.
Prolonged exposure to the radiations also contributes in increasing the risk of converting normal cells into breast cancer cells. For instance, the patients with gynaecomastia treat with high doses of radiotherapy, which increases the risk of getting BMC seven-fold.
Workplaces like blast furnaces, steel and rolling mills are significantly associated with increased risk of MBC. Associations have also been seen with professions involving working with petrol, soap, exhaust fumes or perfume. The culprit carcinogens are polycyclic aromatic hydrocarbons (PAH), which can be found in exhaust emissions and tobacco smoke. Disclosure to electromagnetic fields has been also presumed as a risk factor, but the pieces of evidence for this is limited.
- The risk of getting MBC is also affected by estrogen/progesterone receptors balance. According to the outcomes of the National Cancer Institute’s SEER database, more than 90% MBC are estrogen (ER) positive. Similar outcomes have been noticed in Indian studies, where ER/PR positivity rate is around 80% in MBC cases.
- Testicular dysfunction also contributes to rising MBC risk by twelve-fold. It occurs as a result of infertility, testicular injury, mumps orchitis, and inguinal hernia.
- Obesity and liver disease associated with increased estrogen levels also can double the risk of MBC.
- Other than these, the high alcohol consumption is also associated with high MBC risk. For example, 10 g of daily alcohol consumption increases the risk of getting MBC by 16 percent.
These are the major risk factors which can significantly modulate the environment of your body suitable for the prognosis of MBC. By considering these factors, the risk of MBC can be decreased up to a great extent. However, talking about treatment options, the treatment might be dependent upon the MBC your body is suffering from. Let's explore the different types of breast cancer in little detail:
Types of breast cancer in men
In men, the types of breast cancers found are ductal carcinoma in situ dcis, invasive lobular carcinoma and invasive ductal carcinoma. However, the incidences of lobular carcinoma in situ in males are very rare due to lack of lobular development in males.
Basically, the breast cancer naming or type depends upon the extent of the cancer:
In situ breast cancer: When cancer has not spread.
Infiltrating or Invasive breast cancer: When cancer has spread to the surrounding tissues.
Treatment and management
The treatment and management needed in MBC is much more similar to those used for women breast cancer. The only difference is MBC is associated with less breast-conserving radiotherapy, surgery or chemotherapy.
Also, psychological support is also required in the management of MBC along with treatment to tackle concerns like body image.
Talking about treatment particularly, surgery, especially mastectomy is the mainstay of MBC treatment.
Endocrine therapy is the next choice to tackle this type of cancer. It is due to the significant relationship of MBC with estrogen receptors. Radiotherapy is recommended in MBC as postoperative treatment.
As compared to females, MBC are more likely:
- A hormone receptor positive type
- Nodal metastases (i.e. lymph vessels with breast cancer cells that spread cancer to other parts of the body, also known as metastatic breast cancer)
- Advanced stage disease
The incidence of MBC is rising. Currently, the same guidelines are used for treatment of MBC as used in treating female breast cancer.
The further research should be focused towards establishing accurate and new treatment guidelines to optimize the MBC treatment and management.
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