Breast Cancer in Men: Signs, Symptoms and Treatment Options

22 October 2024

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Male breast cancer is a rare condition, accounting for less than one percent of all breast cancer cases, but it's still important to be aware of its signs, symptoms, causes and treatment options should you or a loved one be impacted. As part of breast cancer awareness in October, we talk to Samer Hassan, M.D., a board-certified physician in internal medicine, oncology and hematology, with INTEGRIS Health Cancer Institute at Southwest Medical Center.

What does male breast cancer look like?

What to know: Like women, men have fatty tissue, ducts and breast cells that can turn cancerous. Breast cancer, which is more common in older men between the ages of 60 to 70, can present in a variety of signs and symptoms. A physical exam or a mammogram can help identify breast cancer.

Lumps or swelling are two of the most common symptoms among people with male breast cancer.

These lumps are usually painless, hard and have irregular edges but sometimes can also be tender or soft.
The lump is often located beneath the nipple or areola since men have less breast tissue than women.

Skin changes covering the breast, such as dimpling, puckering or scaling, can indicate male breast cancer.

The skin may also become red, swollen or exhibit a rash-like appearance, particularly in cases of inflammatory breast cancer.

Nipple alterations, such as inversion, retraction or a change in its position or shape, can be a warning sign.

Discharge from the nipple, which may be clear or blood-stained, is a tell-tale symptom that should prompt a visit to your doctor.

Pain or tenderness is typically uncommon, but some men experience this discomfort.

The pain can vary in intensity and nature, ranging from a persistent ache to a sharp pain.

Swelling or lumps in the lymph nodes can indicate that cancer has spread beyond the breast tissue.

Swollen lymph nodes can cause pain and discomfort in the chest wall or underarm.

Key takeaways: Contact your doctor if you experience any of these symptoms. While breast pain in men can indicate cancer, it can also be linked to various benign conditions, such as gynecomastia (enlarged breast tissue), infections or trauma.

Types of breast cancer in men

At a glance: There are five types of breast cancer men can develop. Of the five, infiltrating ductal carcinoma is the most common and inflammatory breast cancer and Paget’s disease of the nipple are increasingly rare.

Infiltrating ductal carcinoma (IDC) accounts for 80 to 90 percent of male breast cancer cases.

The cancer begins in the milk ducts, which are the tubes that carry milk from the lobules to the nipple.
The cancerous cells then break through the duct walls and invade the surrounding breast tissue.
It can also spread to other parts of the body through the lymphatic system and bloodstream.

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer confined to the lining of the milk ducts.

While this cancer hasn't spread to surrounding tissues, it can increase the risk of developing invasive breast cancer later on.
It's typically discovered via mammograms as it may not form a noticeable lump.

Invasive lobular carcinoma (ILC) starts in the lobules, the glands that produce milk, and can spread to nearby tissues.

However, this type of cancer is rare because men have few lobules.
It may be harder to detect on physical exams and imaging tests compared to IDC.

Inflammatory breast cancer (IBC) is an aggressive and fast-growing cancer that blocks lymph vessels in the skin of the breast.

IBC leads to redness, swelling and warmth in the breast, typically without a noticeable lump.
The skin might look pitted, resembling an orange peel.
Due to its fast progression, this cancer requires immediate and aggressive treatment.

Paget’s disease of the nipple starts in the ducts of the nipple and spreads to the nipple surface and areola.

Common symptoms include redness, flakiness and irritation of the nipple skin, occasionally paired with a burning sensation or discharge.
This condition is frequently linked to underlying DCIS or invasive cancer.

What causes male breast cancer?

The big picture: Male breast cancer can be influenced by several risk factors, including genetics, hormonal imbalances and lifestyle influences. Age and family history also play significant roles. While the exact mechanisms aren't fully understood, it’s important to know these risk factors so men can be aware and help with early detection.

Genetic mutations such as BRCA1 and BRCA2 significantly increase the risk of breast cancer in men, just as they do in women.

The genes produce proteins that help repair damaged DNA.
But when BRCA1 or BRCA2 genes are mutated, their ability to repair DNA is compromised.
Over time, this uncontrolled cell growth can result in cancer.

Hormonal imbalances involving estrogen and testosterone levels can promote breast cancer growth.

Men typically have a high amount of testosterone and low levels of estrogen, but either low levels of testosterone or high levels of estrogen increase the risk of cancer.
For example, obesity and liver disease increase estrogen production.

As men age, changes in DNA and hormones can heighten the risk of breast cancer.

The older you get, there is an accumulation of DNA damage due to the body’s inefficiencies in cell repair.
In addition, testosterone levels naturally decrease and estrogen levels can even increase over time, which leads to an imbalance and a greater chance of stimulating breast tissue.

Having close relatives with breast cancer, particularly female relatives such as mothers or sisters, can elevate breast cancer risk.

Men with a strong family history are more likely to carry BRCA1 or BRCA2 mutations.

Radiation exposure can break chemical bonds and directly damage DNA molecules, which makes cancer growth more likely.

Common sources of radiation exposure include medical treatment for other cancers and radiation in jobs such as nuclear power plants or certain medical fields.

Lifestyle factors play a role in affecting hormonal balance and overall health, both of which can lead to breast cancer.

A diet high in unhealthy fats, processed food can lead to fat accumulation, which is linked to higher estrogen levels.
Alcohol can raise estrogen levels and contribute to DNA damage.
A sedentary lifestyle can contribute to obesity and hormonal imbalances.

Male breast cancer treatment options

The bottom line: Treatment options include surgery, which often involves a mastectomy to remove the breast tissue, radiation therapy to destroy any remaining cancer cells post-surgery and chemotherapy to target cancer cells throughout the body.

Surgery, via a procedure called a mastectomy, removes cancerous tissue and protects against its spread.

In addition to excising breast tissue, the nipple and areola is also sometimes removed.
Lymph node removal or axillary lymph node dissection can also be performed to see if cancer has spread beyond the breasts.

Radiation therapy lowers the risk of recurrence by eliminating microscopic cancer cells that are not visible during surgery.

External beam radiation therapy and brachytherapy are the two options to treat male breast cancer.
External beam radiation therapy, either for the entire breast or partial breast, is the most common approach and uses high-energy X-rays to target cancer cells.
Meanwhile, brachytherapy uses radioactive material directly inside or next to the tumor for a more targeted approach.

Chemotherapy works in three ways, helping to shrink tumors, eliminate remaining cancer cells after surgery and to protect against the spread of cancer to other body parts.

Commonly used drugs include anthracyclines (doxorubicin), taxanes (paclitaxel), alkylating agents (cyclophosphamide) or antimetabolites (5-Fluorouracil).

Hormone therapy blocks the body’s natural hormones from fueling cancer growth.

This treatment is effective in cases in which cancer cells are hormone-receptor-positive, meaning they grow in response to hormones like estrogen or progesterone.
Tamoxifen and aromatase inhibitors are common hormone therapies that prevent or decrease estrogen production.

If you or someone you know has questions about male breast cancer, reach out to your primary care physician. Early consultation and intervention can make a significant difference. At INTEGRIS Health, our experienced oncologists and breast surgeons are ready to provide expert care and support tailored to your needs.