COL Men get breast cancer, too
By Dr. Allen J. Douma
Tribune Media Services
Q: We hear much about women's problems with breast cancer, but it is my understanding that a significant number of men also get breast cancer. Can you give me some information on this? Should men have breast exams periodically? I would appreciate your comments.
A: Male breast cancer is a rare disease, accounting for only about 1 percent of breast cancers. Nevertheless, any incidence of breast cancer, in men or women, is too many. The average age for men to contract it is about 60, a little older than for women.
The cause is unknown but, as with women, hormonal influence may play a role. Also, increasing importance is being given to genetic factors. Cancer in the family is present in 10 percent of male breast cancer cases reported in the medical literature.
Gynecomastia, the glandular enlargement of the male breast, increases the risk of breast tumors in older men. This condition is most common in adolescent boys, but it can also occur in older men, especially when they have gained weight.
Symptoms of breast cancer usually include a hard, painless lump behind the nipple, sometimes together with nipple discharge, retraction or ulceration.
Until recently, breast cancer in men has been thought to be substantially different from that in women. As more becomes known about this relatively rare disease, the similarities between genders become more striking than the differences.
Examination of breast tissue biopsied by aspiration is the first step in diagnosis for both men and women, and male breast carcinoma is staged (assignment of degree of severity) similarly to female breast cancer.
Biopsy of the so-called sentinel lymph nodes in the underarm is now a widely used technique for evaluating the progress of early-stage breast carcinoma in both men and women. As in women, underarm lymph node status is the strongest predictor of treatment outcome in men.
Treatment is also similar and based on stage: simple, modified or radical surgery and surgical removal of underarm lymph nodes as necessary. This may be followed by adjunctive therapy that could include radiation, hormones and chemotherapy.
Management of advanced breast cancer in men should begin with tamoxifen and may require castration because of the hormonal influences. Castration in men is more effective in controlling breast cancer growth than the same operation in women.
There remains some discussion on the relative prognosis. Some researchers maintain that prognosis, stage for stage, is the same for men and women. Others report overall poorer survival in men, perhaps because men may wait longer before seeing a doctor.
Men at greatest risk -- that is, those who are around 60, have a family history of breast cancer and the appearance of gynecomastia -- would be well served by periodic breast self-exams. Of course, any evidence of a hard painless lump in the breast should be reported to a health care professional as soon as possible.
Write to Allen Douma in care of Tribune Media Services, 435 N. Michigan, Suite 1400, Chicago, IL 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.