Men Can Get Breast Cancer Too, Say Cleveland Clinic, UH Specialists

The focus of Breast Cancer Awareness efforts are focused on women -- the ribbons are pink, after all. But men can get breast cancer too.

Patch sat down with a few local experts about male breast cancer: 

• Dr. Lyndsay N. Harris, the director of the Breast Cancer Program at the Seidman Cancer Center at University Hospitals Case Medical Center
• Dr. Katherine Lee, breast specialist in the Cleveland Clinic Breast Center

Patch: Why is it important to talk about male breast cancer?

Dr. Lee: It's important because men don't think they can get breast cancer. They don't think they can receive a mammogram screening. The discussion should be focused on breaking the myths and informing people on what is fact versus fiction. Men will say to me “men can't get breast cancer.” So they tend to show up late, when the lump has been there for several months, which is usually stage 2 or later. And that means that it has already spread to the lymph nodes because they have been waiting. I see this 50 percent of the time. If they never heard of male breast cancer, they think the lump will go away.

Patch: How common is breast cancer in men?

Dr. Harris: Male breast cancer is certainly less common, but it is a significant problem. Out of 100 cases 1 will be in men. The lifetime breast cancer risk rate is 1 in 1,000 for men. The average age is between 50-70 years old. So it is not often seen in younger men.

Patch: Is there a stigma related to male breast cancer?

Dr. Lee: Yes. There may be some stigma as it is widely a women's area. If a man goes to a breast center, it is predominantly female. The physician, the technician that takes the mammogram are mostly all women. So men may feel discomfort.

However, there are groups that are raising awareness among men. Take the NFL for example. The players, wearing pink socks and the pink ribbons this month, are bringing exposure to a venue that men watch. I think this is sparking a discussion for males. They are having conversations with their wives and girlfriends, and asking questions like “what is this.” This generation of awareness is the key, as men usually discover breast cancer when it is advanced. So knowing the issue is essential for survival.

Patch: What are the symptoms for male breast cancer?

Dr. Harris: Male breast cancer presents almost always as a lump in the breast. Usually there is an enlargement of the breast tissues, although it is not as dramatic as in women. However, there are men who are at higher risk. High risk patients produce more estrogen than normal. It's interesting because the cancerous tissue is almost always estrogen positive.

We typically see this in the setting of liver disease, alcoholism, obesity and there is a genetic syndrome Klinefelter. In that case a chromosomal abnormality results in an extra “X” chromosome. Another symptom could be hypogonadism, which results in impaired testicular function, and leads to a low or non-existent sex drive, or abnormal sexual functioning. In general anything that has affected the liver causing high estrogen, resulting in extremely low testosterone could put a man at risk for breast cancer.

Patch: When should men be screened for breast cancer or receive a mammogram?

Dr. Harris: Screening is recommended for men that carry the BReast CAncer gene 2 (BRCA2) or those who have already been found to be in the high risk category. Men should be screened for the BRCA2 gene if their mother, sister or relative was diagnosed with the gene or breast cancer. We recommend genetic testing for the BRCA2 gene if the mother was found to carry it, because it is likely for that person to develop breast cancer. So if a mother finds that she carries this gene than her son should at the very least should be tested for the gene, and if not tested then take a screened mammogram.

Dr. Lee: The question is why is he getting a screening mammogram? He should know something like he is high risk. The men we see in our center definitely have problems when the request a mammogram. So they receive a diagnostic mammogram, which is a more extensive mammogram compared to a screening mammogram.

Patch: Does family gene tendency matter if you're a man?

Dr. Lee: Yes. You should research your family tree as much possible to see if there is a genetic link. We find that men diagnosed with breast cancer carry the BRAC1 or BRAC2 gene. Usually if a mom has this gene every sibling has a 50/50 chance of inheriting it from their mother. A patient might see women in his family, sisters, moms, cousins, aunts, that have breast cancer or ovarian cancer. 

Patch: How common is male mastectomy?

Dr. Harris: Mastectomy is almost always the course of action because there is so little tissue. Some men also receive medical therapy such as chemotherapy or hormonal therapy in the form of anti-estrogen medication.

Patch: What type of examinations can males do at home and do doctors teach them this on visits like women?

Dr. Lee: They can self exam, but if a man is not at high risk I don't think they are taught to do the self exam compared to women who are taught this in routine doctor visits. But in the face of no high risk issues the men are not learning. Usually men discover they have breast cancer because they feel a lump when they are putting on their clothes, or maybe they experience discomfort in the area.