The Health | MAy, 2019
22
men
Fighting cancer
Breast cancer in men
Yes, men can actually get
breast cancer. Dr Mastura
Md Yusof explains the causes
and chances of the cancer
developing in men
W
hile breast cancer in females is a
modern epidemic with wide recog-
nition of its increasing incidence
and high prevalence, male breast
cancer represents only about one
percent of all breast cancers and is
less known.
In addition, of all cancers diagnosed in males, breast
cancer accounts for less than one percent. In the Pen-
insular Malaysia National Cancer Registry, a total of
257 cases were reported between 2003 and 2005. It is
considered as a rare disease, and we don’t know much
about this condition as opposed to female breast cancer
that affects slightly more than 30 percent of Malaysian
women.
What causes it?
“We know so little about the disease and don’t really
know what causes breast cancer in men,” Dr Mastura
tells.
“The condition’s rarity has largely precluded large
data collection on its epidemiology, however it is
important to understand the risk factors for male
breast cancer. No men think about the possibility that
they’ll get diagnosed with it in their lifetime so they
don’t perform self-examination or seek a consultation
if they notice a lump.”
“There are no routine screening for male breast
cancer. The lack of awareness that men do get breast
cancer is not just by the public but also the health
professionals,” she adds.
This may contribute to more advanced stage at first
presentation and possibly worse outcome in men than
in women when it is first detected.
The signs of breast cancer in men
• A painless lump or thickening in the breast tissue
• Changes to the skin covering the breast, such as
dimpling, puckering, redness or scaling
• Nipple changes, such as redness or scaling, or a
nipple that begins to turn inward
• Nipple discharge. It can be bloody
• A lump in the armpit or above the collarbone
It causes rare stigma
Currently about 1 in 9 women will develop breast
cancer, which accounts for almost 30 percent of can-
cers in Malaysian women. For men, the average risk of
breast cancer is 1 in 1000 and breast cancer accounts
Even though breast cancer in men is significantly
rare, Dr Mastura stresses the need for the Malaysian
public to be aware and for men to go for a check-up
if any signs of the condition develops.
for less than 1 percent of cancers in men.
But for the ones who are unfortunate to develop it,
how are they reacting to it?
“Definitely men are ashamed to discuss it. It is
something difficult to talk about with a huge psycho-
logical impact but very little support. There is a sense
of vulnerability and a feeling of unfairness as they ask
themselves – if men are 100 times less likely to develop
the disease than women, then why me? Men with breast
cancer may experience anxiety and depression with
regards to their diagnosis and feel less masculine having
a cancer which is most often considered a ‘female
cancer’. Definitely men with breast cancer need just
as much support as their female counterparts to help
them cope and get the best outcome from this disease,”
explains Dr Mastura.
Is it any different than
breast cancer in women?
A joint effort by researchers in Europe found similarities
between male breast cancer and female breast cancer
as well as some differences. More than 90 percent of
male breast cancers were oestrogen receptor–positive,
whereas around 65 to 70 percent of female breast can-
cers are oestrogen receptor–positive and positivity of
both oestrogen receptor and progesterone receptor was
associated with better outcome in male breast cancers,
similar to female breast cancers.
“Since male breast cancer is a rare disease, treat-
ments are extrapolated from female breast cancer
studies so they don’t differ at all. Every process such as
triple assessment with clinical examination, imaging
and biopsy, staging, surgery, chemotherapy, hormone
and targeted therapy are offered similarly according
to the indications and stage per stage the survival of
male and female cancers are the same.” — The Health
Determinants of cancer development
Major determinants for breast cancer risk are
environmental factors while a small proportion has
genetic preponderance with some reporting having
family history of cancer. The factors are as follows:
1. Aging
Male breast cancer is most common in older men,
though it can occur at any age. The average age of
men diagnosed with breast cancer is about 68.
2. Hormones
Epidemiologic factors indicate a relationship between
high oestrogen level and male breast cancer. Men’s
breast tissue has slightly different structure and is less
developed compared to female breast. High oestrogen
levels may stimulate breast cell growth.
Men can have high oestrogen levels as a result of:
• Obesity or being overweight, which increases the
production of oestrogen.
• Taking hormonal medicines such as by transsexuals
to develop female characteristics.
• Having been exposed to other sources of hormones
or oestrogens in the environment.
• Being heavy users of alcohol, which can limit
the liver’s ability to regulate blood oestrogen
levels.
• Having liver disease or thyroid disorder, which
usually leads to lower levels of androgens (male
hormones) and higher levels of oestrogen (female
hormones). This increases the risk of developing
gynecomastia (enlarged male breasts) as well as
breast cancer.
3. Marital status – men who never married are at
higher risk
4. Previous breast conditions/ benign diseases
5. Gynecomastia (breast tissue growth that is
non-cancerous)
Gynecomastia is common, occurring to some
degree in around half of boys during adolescence. In
adulthood, there are several causes of gynecomastia
as well ranging from medications to liver disease to
obesity.
6. Family history of breast cancer occurs
in approximately 30% of male breast
cancer cases.
7. Familial form of breast cancer
Some men inherit abnormal (mutated) genes from
their parents that increase the risk of breast cancer.
Mutations in one of several genes, especially a gene
called BRCA2, commonly the BRCA2 mutation puts
men who inherit it have about a 6% lifetime risk of
breast cancer, which is 100-fold higher than in men
without the mutation.
Men with Klinefelter syndrome have a risk of breast
cancer that approaches that of females. This is a
trisomy of the sex chromosomes such as XXY (and
others) that carries a risk of male breast cancer of 1 in
100 men.
8. Previous cancer treatments
Radiation therapy to the chest (for example,
(Hodgkin’s disease), oestrogen therapy for prostate
cancer, and orchiectomy for testicular cancer may be
associated with an increased risk.
9. Undescended testicles
10. Mumps orchitis