Most people are aware that breast cancer is a major women’s health issue, affecting an average of 1 in 8 women. In fact, being female is the single greatest risk factor for the disease. However, you may be surprised to learn that breast cancer – and a number of other breast diseases – can also affect men. But, what does the average man need to know about their breast health? Gentlemen, look no further. Here’s what you need to live your “breast” life.
Take your lumps.
One of the most common symptoms men bring to the mammography suite is that of a newly discovered breast lump. New lumps and bumps can be alarming, especially when they occur in the breast, and all new breast lumps need to be evaluated with a mammogram. Sometimes a breast ultrasound is also needed to complete the evaluation. I’ve got good news, though: breast lumps in men are usually not cancer.
The incidence of breast cancer in men is extremely low, occurring in 1 out of every 100,000 men. Put into perspective, of all the breast cancers diagnosed in the U.S. over a year, less than 1% of these are diagnosed in men. Some have wondered whether or not men should be screened for breast cancer with mammograms. The answer is no, because the disease is so uncommon.
But male breast cancer does happen…… When? What? Who?
Yes, male breast cancer can develop, and a lump is usually the first sign. Male breast cancer is usually painless and non-tender, meaning that it does not hurt when touched or pressed. Nipple symptoms raise the concern for male breast cancer when a patient has them.
- asymmetric or recently developed nipple inversion
- nipple retraction
- nipple discharge, especially if it’s bloody
The average diagnosis age for men with breast cancer is 67. There are some groups of men at higher risk for breast cancer than others, including men with history of prior radiation to the chest, and men with testicular disease or undergoing estrogen supplementation. Men with Klinefelter Syndrome, liver disease, Ashkenazi Jewish heritage, family history of breast cancer (especially in first degree relatives), and men with BRCA 2 mutation are also at elevated risk.
OUCH. My breast hurts.
Breast pain is the other most frequent symptom that brings men to the mammography department. Oftentimes, breast pain in men is accompanied by a firm or rubbery lump deep to the nipple. The breast pain can be sharp, achy, or dull, or may occur as a burning sensation or hypersensitivity to light touch. Many men tell me their symptoms of pain are most noticeable when their shirt grazes against the nipple or when they strap on the seat belt in the car. Men with symptoms of a painful breast lump right behind the nipple usually have characteristic findings on the mammogram representing a phenomenon called gynecomastia.
Gynecomastia is an up-regulation of glandular tissue in the male breast. It can be painful, but, thankfully, symptoms usually dissipate within a year. Surgery is rarely required to remove the painful glandular tissue if symptoms fail to resolve on their own. Importantly, gynecomastia has not been shown to be associated with cancer.
All cases of gynecomastia can be caused by an imbalance between the hormones estrogen and androgen (i.e. testosterone). The treatment for gynecomastia is aimed at identifying and modifying the specific cause with the goal of restoring hormone balance.
Some causes of the hormonal imbalance can include:
- Numerous over-the-counter and prescription medications. For instance, nonprescription H2 blockers like Zantac for symptoms of reflux and androgen-deprivation medications prescribed for prostate cancer treatment are both common offenders.
- Lifestyle choices can also be contributory, with increased rates of gynecomastia observed in men who use marijuana or drink alcohol.
In summary, gynecomastia is by far the most common breast problem I see in men, and it is completely benign and usually treatable.
Anything else I need to know?
Yes! You should know that any breast disease that can happen in a woman can also happen in a man. I’ve given you information about the most common (gynecomastia) and most deadly (cancer) problems that can manifest in the male breast, but there are many other processes that can occur. A diagnostic mammogram is an important tool used to get to the bottom of any new breast symptoms. So don’t be anxious if you are referred to your local mammography department. It’s just your doctor performing due diligence, making sure you have no evidence of a rare cancer, and ensuring you are poised to live your “breast” life!