Breast cancer in men
Breast cancer in men is far less common than in women. In Germany, 1.5 out of 100,000 men are diagnosed with breast cancer every year. This means that every 800th man in Germany will develop breast cancer during his lifetime.
In 25% of cases, breast cancer in men is genetically predisposed, but obesity and radiation of the breast wall can also increase the risk of breast cancer in men. The diagnostic procedure is based on the scheme for female breast cancer. A doctor’s consultation, a physical examination, mammography and sonography are performed.
Since breast cancer in men is often of hereditary origin, genetic counselling should be offered, also to identify other persons at risk. As a rule, a mastectomy is performed as a surgical therapy and the sentinel lymph node is also removed and examined as in women. In the case of larger tumours (>2cm), lymph node infestation or negative hormone receptor status, follow-up radiation is always performed in men.
The operation is followed by an adjuvant systemic therapy. The recommendations for chemo- and immunotherapy are identical to those for women. Often, male breast cancer is also positive for the hormone receptor.
In this case, tamoxifen is given for 5 years in analogy to the woman. Aromatase inhibitors are rather untypical in men. Breast cancer is the most common type of cancer in women, which is why, statistically speaking, men have a much lower risk of developing breast cancer than women.
As breast cancer is considered a typical female disease, this type of tumour is often discovered late in life. For most men it is difficult to find out in retrospect what exactly caused the breast cancer. So far only a few factors are known to increase the risk of breast cancer in men.
These include so-called breast cancer genes, for example. There are some inherited or spontaneously occurring gene changes that increase the risk of breast cancer in both women and men (e.g. BRCA genes, breast cancer genes). However, these gene alterations are only found in a small number of patients.
Hormonal factors also play a role in the development of breast cancer. Men (like women) also produce the sex hormone oestrogen, but usually in much smaller quantities than women. Higher oestrogen levels occur, for example, in people who are very overweight or who have liver diseases such as cirrhosis or liver shrinkage.
Hormones that are taken by bodybuilders over a longer period of time are also suspected of increasing the risk of breast cancer. Men who have the so-called Klinefelter syndrome (one or more additional female X chromosomes) have a similarly high risk of breast cancer as women. Breast cancer in men manifests itself through palpable lumps.
However, fluid secretion from the nipple, small inflammations or wounds or a retraction of the skin or nipple are also considered warning signs of breast cancer. Ultrasound examinations and mammography (X-ray examination of the breast) are also used for men, but are not as meaningful as for women. Breast cancer is diagnosed by a biopsy (tissue sample) taken from the breast and examined.
The treatment of breast cancer in men is also little different from that for women. Areas suspected of having tumours as well as neighbouring lymph nodes from the armpit are removed surgically. Sometimes supportive measures are necessary after the operation to destroy tumour cells that may have remained in the body (e.g. radiotherapy of the breast wall, chemotherapy).
In men, anti-hormonal therapy is often indicated because the tumour grows in an estrogen-dependent manner. In men, painless lumps in the breast region are also a sign of breast cancer. Furthermore, whitish discharge from the nipple, changes and retractions of the nipple, as well as ulcers on the breast indicate malignant changes.
In early stages there are no general symptoms, later on there can be general fatigue and reduced performance. Metastases, scattering of the tumour in the body, can also lead to specific symptoms, depending on where they occur. For example, skeletal pain on bone metastases and swelling of the arm can occur with lymph node metastases in the armpit region.
