October is National Breast Cancer Awareness Month. With HIV considered the ultimate illness for gay men to worry about, along with the rise of every other STD, many forget that we are more than just our sex lives and can contract and inherit a host of other illnesses, just like the rest of the human population. One of these illnesses is cancer. Breast cancer, though very rare in the male population, does happen, and if it happens to you or someone you love, it will be the most critical health issue of your life.

We at GMJ are committed to discussing issues regarding the total healthcare of gay males, so let’s take a look at breast cancer, the risk factors, and what to do if you or someone you love might have, or be at risk for, the disease.

The knowledgeable people over at Cancer.org have a few pages on the topic that use a lot of medical jargon. Here are the basics you need to know and understand. Visit their site for more information about breast cancer or any other cancer.

  • Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Cells in nearly any part of the body can become cancerous and spread to other areas. To learn more about how cancers start and spread, see What Is Cancer?

  • Like all cells of the body, a man’s breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than a woman’s and because they usually have lower levels of female hormones that affect the growth of breast cells.

  • If the cancer cells have spread to these lymph nodes, there is a higher chance that the cells could have also gotten into the bloodstream and spread (metastasized) to other sites in the body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs as well. Because of this, finding cancer in one or more lymph nodes often affects the treatment plan. Still, not all men with cancer cells in their lymph nodes develop metastases to other areas, and some men can have no cancer cells in their lymph nodes and later develop metastases.

  • About 2,800 new cases of invasive male breast cancer will be diagnosed.

  • About 510 men will die from breast cancer each year!

  • Black men have a higher risk and tend to have a worse prognosis compared to white men. 

What the above means is that all humans have some breast tissue. Inside these tissues are cells that can cluster, grow, and spread to other areas of the body. Most males will not develop breast cancer because we lack the high concentration of female hormones that contribute to increased rates of cellar growth. Lymph nodes, if infected with cancerous cells, can speed the spread of cancer and cause it to spread throughout the body, leading to other cancers.

Breast cancer in males can be separated into five (5) types:

Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is considered non-invasive or pre-invasive breast cancer. In DCIS (also known as intraductal carcinoma), the cells lining the ducts have changed to look like cancer cells. The difference between DCIS and invasive cancer is that the cells have not spread (invaded) through the walls of the ducts into the surrounding breast tissue (or spread outside the breast). DCIS is considered a pre-cancer because some cases can go on to become invasive cancers. Right now, though, there is no good way to know for sure which cases will go on to become invasive cancers and which ones won’t. DCIS accounts for about 1 in 10 cases of breast cancer in men. It is almost always curable with surgery.

Infiltrating (or invasive) ductal carcinoma (IDC)

Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk duct of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may spread (metastasize) to other parts of the body through the lymphatic system and the bloodstream. At least 8 out of 10 male breast cancers are IDCs (alone or mixed with different types of invasive or in situ breast cancer). Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so they are more likely to spread to the nipple. This differs from Paget disease, as described below.

Infiltrating (or invasive) lobular carcinoma (ILC)

This type of breast cancer starts in the breast lobules (collections of cells that, in women, produce breast milk) and grows into the fatty tissue of the breast. ILC is very rare in men, accounting for only about 2% of male breast cancers. This is because men do not usually have much lobular tissue.

Paget disease of the nipple

This type of breast cancer starts in the breast ducts and spreads to the nipple. It may also spread to the areola (the dark circle around the nipple). The nipple skin is usually crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding. There may also be an underlying lump in the breast.

Paget disease may be associated with DCIS or with infiltrating ductal carcinoma. It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers.

Inflammatory breast cancer

Inflammatory breast cancer is an aggressive, but rare type of breast cancer. It makes the breast swollen, red, warm, and tender rather than forming a lump. It can be mistaken for a breast infection. This is very rare in men. This cancer is discussed in detail in  Inflammatory Breast Cancer.

Symptoms of Male Breast Cancer:

The most common clinical sign of breast cancer in men is a firm, usually painless mass located just under the nipple. There may not be other associated symptoms. The average size of breast cancer in men when first discovered is about 2.5 cm in diameter. The tumor may cause skin changes in the nipple area. These changes can include

Bloody or opaque discharge from the nipple may also occur. Less than 1% of cases are bilateral (occurring on both sides).

Risk Factors:

As a society and medical community, we are still trying to understand why and how cancer develops within the body, but here are a few of the known risk factors associated with male breast cancer.

  • Family history of cancer, specifically breast cancer, and the gene for it.
  • Abnormally high levels of estrogen.
  • Radiation exposure.
  • Cirrhosis of the liver from chronic alcohol abuse, chronic viral hepatitis, or rare genetic conditions that result in the accumulation of toxic substances within the liver.
  • Finasteride (Propecia, Proscar) usage. A drug that has been used to treat baldness, as well as benign prostatic hyperplasia (prostate enlargement) and to prevent prostate cancer, may be associated with an increased risk for male breast cancer.
  • Klinefelter’s syndrome is an inherited health condition affecting about one in 1,000 men. A normal man has two sex chromosomes (X and Y). He inherited the female X chromosome from his mother and the male Y chromosome from his father. Men with Klinefelter’s syndrome have inherited an extra female X chromosome, resulting in an abnormal sex chromosome makeup of XXY rather than the usual male XY. Affected Klinefelter’s patients produce high levels of estrogen and develop enlarged breasts, sparse facial and body hair, small testes, and the inability to produce sperm. Some studies have shown an increase in the risk of developing breast cancer in men with this condition. Their risk for the development of breast cancer is markedly increased, up to 50 times that of normal men.

Diagnosing Male Breast Cancer:

Like with all cancers, it will begin with a trip to the doctor to assess the size and area of the growth. This sets in motion a “Staging” of the possible cancer and how far it has possibly spread into the body. This is very important because it helps medical professionals develop a treatment plan.

Stage 0

Stage 0 refers to intraductal carcinoma or ductal carcinoma in situ, in which the cancer cells have not spread beyond the boundaries of the ducts.

Stage I

In Stage I breast cancer, the tumor is 2 cm or less in greatest diameter and has not spread to the lymph nodes or to other sites in the body.

Stage II

Stage II cancers are divided into two groups. Stage IIA cancer is either less than 2 cm in diameter with spread to the axillary lymph nodes, or the tumor is between 2 cm and 5 cm but has not spread to the axillary lymph nodes. Stage IIB tumors are either larger than 5 cm without spread to the lymph nodes or are between 2 cm and 5 cm in size and have spread to the axillary lymph nodes.

Stage III

Stage III is considered to be locally advanced cancer. Stage IIIA means the tumor is smaller than 5 cm but has spread to the axillary lymph nodes, and the axillary lymph nodes are attached to other structures; or the cancer is greater than 5 cm in diameter with spread to the axillary lymph nodes, which may be connected to other structures. Stage IIIB tumors have spread to surrounding tissues such as the skin, chest wall, or lymph nodes inside the chest wall.

Stage IV

Stage IV cancer refers to metastatic cancer, meaning it has spread to other parts of the body. With breast cancer, metastases (sites of tumor elsewhere in the body) are most often found in the bones, lungs, liver, or brain. It may also recur in and spread to involve areas of the chest wall, skin, and muscles, as well as more distant lymph nodes.

Treatment:

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Hormonal therapy
  • Targeted therapy

Prognosis:

Since men have less breast tissue than women, it is less common for breast cancers in men to be diagnosed at a very early stage and more likely to have spread beyond the breast when they are identified, resulting in a more advanced tumor stage at diagnosis.

Disease-specific five-year survival rates (meaning the percentage of patients who do not die of the disease for at least five years following diagnosis) reported for male breast cancer by stage are as follows:

  • Stage 0 – 100%
  • Stage I – 100%
  • Stage II – 91%
  • Stage III – 72%
  • Stage IV – 20%

These survival rates were calculated using historical data, and current treatments are likely to yield even higher survival rates for those recently diagnosed.

A man can be diagnosed with breast cancer at any age, but it is more common in men over the age of 50.

Unfortunately, because we don’t talk to men about breast cancer, they are more likely not to know the signs and seek out treatment later, thus reducing the chances for survival. Also, some insurance companies are known not to pay for male mammograms, which test for cancer. Even though male breast cancer is very rare, it is a killer of men. Knowing your body and regularly feeling for unusual lumps, bleeding from nipples, or other irregularities around the chest area is the best way to self-screen for this cancer.

For extra support, survivors’ stories, and assistance, we recommend The Male Breast Cancer Coalition.