Dr. Jamin Brahmbhatt is a urologist and robotic surgeon at Orlando Health and past president of the Florida Urological Society
A few years ago, I had a male patient who came to me complaining of breast enlargement. At first we thought it was a side effect of one of his medications, but during the exam, something just didn’t feel right to me.
I decided to order a mammogram to get a closer look. The results showed an abnormal spot, which prompted him to see a specialist. The diagnosis for this man? breast cancer.
Breast cancer in men can be misdiagnosed or overlooked because it is so rare. Early detection can save lives.
The reality of breast cancer in men
When people think of breast cancer, most think of “pink” and women. But the truth is that men can also develop the disease.
Men account for about 1% of all breast cancer casesmeaning that 1 in 726 men will be diagnosed in their lifetime. The diagnosis is rare, but many men still get breast cancer.
One of the biggest challenges with male breast cancer is that it often goes unnoticed. Many men don’t realize they can develop the disease, and there are no routine screening guidelines like those for women.
In fact, more than 40% of male breast cancer cases are diagnosed in advanced stages (stage 3 or 4). As a result, the men receive more aggressive treatments compared to women due to delayed diagnosis.
Symptoms can be subtle—lumps, nipple discharge, skin changes, or swelling around the breast area. If you notice any changes in your man breasts, don’t ignore it. It’s always better to have a check-up.
The role of genetics in male breast cancer
Mutations in the BRCA1 and BRCA2 genes, which are most commonly associated with female breast and ovarian cancer, may increase a man’s risk of breast cancer.
About 0.2% to 1.2% of men with an inherited mutated change in BRCA1 and 1.8% to 7.1% with an inherited mutated change in BRCA2 will develop breast cancer by age 70. In contrast, about 0.1% of men in the general population will develop breast cancer at the same age.
Men with BRCA2 mutations have a 7% to 8% lifetime risk of developing breast cancer, much higher than the general male population.
Therefore, men with a family history of breast cancer, especially those with BRCA mutations, should consider genetic testing and be more sensitive to any changes in their breast tissue.
The link between BRCA and prostate cancer
These same BRCA mutations also increase the risk of prostate cancer in men.
A young patient recently came to my office with a concern that many would not expect at his age—prostate cancer. His mother and sister were diagnosed with breast cancer, and despite being in his 40s, he requested genetic testing for the BRCA gene and a prostate-specific antigen, or PSA, blood test.
While we waited for genetic test results, her PSA came back higher than expected. At this point, genetic testing became less meaningful. He underwent a biopsy, and the results confirmed that he had early-stage prostate cancer.
So, if you have a family history of breast cancer, it’s not just the women in the family who should be aware. The men in the family also need to be part of the conversation.
Comparing male and female breast cancer
Male and female breast cancers share similarities, but there are also some important differences.
Because men have less breast tissue, the cancer is usually closer to the chest wall, which can affect how it spreads.
The five-year survival rate for men with breast cancer is about 77.6%, compared with 86.4% in women, in part due to later diagnoses. However, the treatments—surgery, radiation, chemotherapy—are largely the same for men and women.
The big difference is awareness. There has been great work on breast cancer awareness in women, but men are often left out of the conversation. This needs to change.
Examining male breasts
There are no official guidelines for male breast self-examinations, but men can take proactive steps to monitor their breast health through suggested self-examination techniques. It is advisable to have these exams at the same time each month—perhaps at the same time as your monthly testicular exam.
Start by standing in your birthday suit (aka shirtless) in front of a mirror to inspect any abnormalities such as swelling, lumps, dimples, or nipple changes, both with your arms at your sides and raised above your head. .
For the manual exam, lie down with a pillow under your shoulder and the arm on the side you are examining behind your head. Use your opposite hand to gently press your fingers in small circles across the entire chest and armpit area, applying several pressures, and gently squeeze the nipple to check for discharge.
If you discover any changes or irregularities, consult your doctor. Remember, these self-examination steps are suggestions to help men identify potential problems early, as such detection can be crucial, especially for those at higher risk due to family history or genetic factors such as BRCA mutations.
From the seed to the next steps
If an abnormality is found, the next steps usually involve a mammogram or ultrasound to evaluate the lump in detail. If the imaging suggests anything suspicious, a biopsy will be done.
During a biopsy, breast tissue is analyzed under a microscope to determine whether it is benign or malignant. Based on the biopsy findings, your doctor may discuss appropriate treatment options, which may include surgery, radiation, or other therapies, depending on the stage and type of cancer found on the biopsy and staging imaging.
All of these treatments are similar to what is offered to women diagnosed with breast cancer.
Breaking mental and gender barriers
There is an unfortunate stigma associated with men with breast cancer. Many men are embarrassed or shocked by their diagnosis, which can make them hesitant to seek help early. But Cancer doesn’t care about gender, and neither should you.
Early detection is the best way to combat this disease, whatever your gender. The key is to be open about it. What Men Can Do Proactively The most important thing men can do is pay attention to their bodies.
If you notice any lumps, pain, swelling or changes in your chest or breast area, don’t ignore it. Talk to your doctor. And if you have a family history of breast or prostate cancer, consider genetic testing.
Breast cancer in men is rare, but that doesn’t mean it’s any less serious. By raising awareness during Breast Cancer Awareness Month, breaking stigmas and encouraging men to talk to their doctors, we can help detect cancer early and help men live longer.
