Lumps in the breast in men

Introduction

In men, due to the lack of awareness of breast disease, a lump is usually noticed late. Very few men carry out a self-examination regularly and then usually only because they have been advised of the danger of a tumor by their doctor due to a family history of breast cancer. For breast cancer in men really exists.

Although it is extremely rare, it is often diagnosed late because it is considered a typical disease in women. The 70,000 new cases of breast cancer per year in women in Germany are compared to about 600 new cases per year in men. However, due to the serious consequences, the attention of experts is also growing for the male patients.

Breast cancer genes such as BRCA (Breast Cancer Genes), which increase the probability of developing a breast tumour or other tumours (in women, for example, ovarian tumours), are assumed to be factors that promote disease in both men and women. Lifestyle also seems to determine the probability of both sexes becoming ill. For example, long-term or intensive exposure of the upper body to radiation, as may occur in the radiation therapy of earlier tumors, is considered to increase the risk. The hormone balance is also considered a possible risk factor.

For example, a metabolic condition such as that which can occur in overweight people leads to increased production of estrogen. In men this can increase the risk of breast cancer. The influence of hormones taken to improve performance is also being discussed.

Causes

Not every lump in a man’s breast means cancer. As with women, there are many benign causes for the formation of such a disturbing mass in men. It is however certain that also a finding with the man must be clarified by a physician and a malicious illness must be excluded.

Among the numerous causes of a knot in the man’s breast are breast cancer and a large number of benign masses such as cysts, lipomas and fibroadenomas or diseases such as gynecomastia and mastopathy. Gynecomastia is the term used to describe breast growth in men. The real gynecomastia, the benign proliferation of breast tissue, must be distinguished from the fake gynecomastia, which is caused by fat deposits in cases of severe overweight.

The most common causes of real gynecomastia are found in the hormonal balance and in the majority of cases are benign. A malignant cause, such as the presence of a testicular tumor, should be ruled out by a doctor. Occasionally a real gynecomastia is also caused by side effects of medication.

A frequent trigger is the blood pressure lowering drug spironolactone. As with women, cysts can also develop in the breast tissue of men. Due to a predisposition, these fluid-filled, mostly benign cavities can occur several times in a patient.

Using ultrasound, a cyst can be easily detected and distinguished from other causes. In unclear cases, advanced imaging measures or a biopsy of the breast can help to find a diagnosis. Lipomas can be another cause of lumps in the male breast.

Lipomas are benign fatty tissue tumors that occur in many people and usually do not require treatment. The exact origin of lipomas has not yet been conclusively clarified, but it is clear that it is an abnormal development of the fat tissue cells, as they can also occur in the breast. Fibroadenomas are frequent benign neoplasms of the mammary gland, which mostly occur in younger women.

Up to one third of women before menopause are affected. Fibroadenomas develop from the connective tissue in which the mammary glands are embedded. They can occur on one or both sides, as well as in several places in a breast simultaneously.

Their formation and growth are promoted by estrogens. Fibroadenomas are also a common cause of a palpable coarse lump in the breast in men. The term mastopathy is used in medicine to describe a variety of proliferative and degenerative remodelling processes in the breast.

The symptoms consist of palpable lump formation in the breast, breast pain (mastodynia) and discharge from the nipple. In men, mastopathy is usually based on a disturbance of the hormonal balance. A further cause in men is the formation of minute calcium deposits (microcalcifications) in the breast tissue with subsequent enlargement of the individual glandular lobules and reactive hardening of the surrounding connective tissue.While the complaints in women after the menopause usually subside, they can continue unabated in men. Here, too, the focus is on clarifying the type of tumor, since malignant diseases require immediate and intensive treatment.