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Breast cancer in men is rare. Around 400 men are diagnosed with the disease each year in the UK compared with around 50,000 women. However, the earlier breast cancer is found, the better the chance of beating it – so, you can see how important it is to look out for any unusual changes and get them checked by your doctor right away.
"I advise any man that finds a lump or who spots anything unusual about their nipple to get this checked out," says Andrew, pictured above.
"In November 2009, I hit my chest on a car door whilst opening it. Later that month, I noticed a slight lump to the right of the nipple – this was hard and sore. I visited the doctors in December but they said it was just bruising and swelling following the accident. In January, the lump was still just as hard and sore, so I saw another doctor who referred me to a breast clinic.
"After tests it was diagnosed as breast cancer. I had a full mastectomy, followed by chemotherapy and radiotherapy and, luckily, I am now on the road to recovery."
Signs and symptoms of breast cancer in men
Most breast tissue in men is concentrated in the area directly behind the nipple and the surrounding pigmented area, called the areola.
Most – though not all – breast cancers in men appear near the nipple as firm lumps.
Unusual changes to look out for include:
Fig. 1: a lump behind or near your nipple, or in your armpit
Fig. 2: a change in the appearance of your nipple or areola (including change in direction of nipple)
Fig. 3: nipple discharge or nipple sores (ulcers)
Men and boys can sometimes develop more breast tissue than normal due to a condition called gynaecomastia. This is not related to cancer.
If you notice any unusual changes to your breast tissue, check them with your doctor.
Your doctor will check your symptoms and may refer you for tests at a hospital clinic if needed. This is important because if you do have breast cancer, you can begin treatment right away, which gives you the best possible chance of beating it. Breast cancer in men is diagnosed using much the same approach as diagnosis in women, including imaging (a mammogram or ultrasound) and possibly a biopsy.
Risk factors for breast cancer in men
Breast cancer in men is rare but there are some things that can increase your risk of developing the disease. Breast cancer in men is thought to be caused by a combination of factors. We are still learning more about what can increase and decrease a man’s risk of developing the disease. Having particular factors that increase breast cancer risk doesn’t mean that you will definitely get breast cancer. Equally, not having many factors that increase breast cancer risk doesn’t mean that you won’t get the disease.
Even if you have a risk factor and are diagnosed with breast cancer, there’s no way of proving that the risk factor actually caused it.
Known risk factors for breast cancer in men are:
- Increasing age
- Genetics – breast cancer in the family
- Exposure to ionising radiation
- Hormone imbalances
- Prostate cancer
Your risk of breast cancer increases as you get older. Most men who develop breast cancer in England are over 60.
Genetics – breast cancer in the family
Faults in certain genes – such as BRCA1 and BRCA2 – are known to increase the risk of men and women developing breast cancer. Of every 100 men with a fault in BRCA2, about six to nine will develop breast cancer in their lifetime. The risk with BRCA1 is smaller, with about one in every 100 men who carry the genetic fault developing breast cancer.
These genes can be inherited, which is one of the reasons that breast cancer can run in families.
About three or four out of every 20 men with breast cancer have inherited faults in these genes. If you have a strong family history of breast cancer, it is possible you might carry these faulty genes.
People with a family history of breast cancer tend to have an unusually high number of close relatives (mother, sisters or daughters) on one side of the family with breast cancer and/or relatives who developed breast cancer at a young age. Other factors that contribute to a family history are cases of ovarian cancer, cancer in both breasts, male breast cancer, or having a certain geographical or ethnic background, such as Ashkenazi Jewish ancestry.
If you have concerns about any cancers in your family, see your doctor.
Men with the genetic condition Klinefelter’s Syndrome also have an increased risk of breast cancer. Men with this rare condition are born with an extra X chromosome, which decreases the levels of androgens (male hormones) in their body. Men with Klinefelter’s Syndrome have an approximately 20 times greater risk of developing breast cancer than men without it, although the risk is still low. More information on Klinefelter's Syndrome is available from the Klinefelter's Syndrome Association.
Exposure to ionising radiation
Radiotherapy treatment to the chest – for example to treat Hodgkin’s lymphoma – is known to increase breast cancer risk in women. There is some evidence that it may slightly increase risk in men too. If you have any concerns about previous chest radiotherapy, contact your specialist or doctor.
Men normally produce high levels of androgens – male hormones – such as testosterone, and low levels of the female hormone, oestrogen. Hormone imbalances where oestrogen levels are raised and androgen levels are decreased may slightly increase a man’s risk of developing breast cancer. This is because oestrogen can promote the growth of some breast cancers.
Here are some of the things that can cause hormone imbalances:
- Klinefelter’s Syndrome.
- Liver cirrhosis, which is scarring of the liver due to long-term damage.
- Obesity – Fat cells can convert male hormones into oestrogen. With a greater number of fat cells in their bodies, obese men produce more oestrogen.
- Oestrogen therapy used to treat some prostate cancers. While oestrogen therapy may increase the risk of male breast cancer, the risk is usually far outweighed by the benefits of treating prostate cancer.
Having prostate cancer may increase a man’s risk of developing breast cancer. The reasons for this link are not fully understood, but may relate to hormone levels. About one in six men with breast cancer will have prostate cancer in their lifetime too.
Reducing your risk
Most men’s risk of developing breast cancer is low. However, you may wish to take steps to reduce your risk, especially if you know you may be at higher risk, for example because of your family history.
Although many risk factors for breast cancer in men are things you cannot change, you can choose to watch your weight. Information on maintaining a healthy weight, including tools to assess your weight and advice on losing weight, can be found on the NHS Choices website.
Treatment of breast cancer in men
Many treatments for breast cancer in men are the same as those used in women. However, there are some differences. We explain the main types of treatment for male breast cancer below.
The aim of surgery is to remove cancerous tissue and to find out whether the cancer has spread to the lymph nodes in the armpit. Men with breast cancer commonly have a mastectomy, which removes the cancer, their breast tissue, and often nearby muscle and most or all of the lymph glands in the armpit. It is less common for men to have a lumpectomy (where the lump and a small margin of healthy tissue are removed) than women. This is because men have much less breast tissue than women and so their breast cancer can quite often invade the surrounding tissue unless caught early.
Radiotherapy is a common treatment for breast cancer in men. The aim of radiotherapy is to destroy any remaining cancer cells and reduce the chance of the cancer coming back.
There have been very few studies of drug treatments for breast cancer specifically in men. Therefore, drug therapy tends to be based on treatments known to work well in women. Most breast cancers in men are sensitive to hormones (known as hormone positive breast cancer). This means the cancer is stimulated to grow by the female hormones oestrogen and progesterone. Hormone therapies that block the action of these hormones can be effective in treating these breast cancers. The hormone treatment tamoxifen increases men’s survival when used with other treatment.
Men may also be offered chemotherapy (anti-cancer drugs). These are often given as a combination of different drugs, and the regimens used in men are the same as those used in women.
In addition, targeted therapies may be an option. These work by directly attacking cancer cells by latching on to proteins found specifically on these cells. They can have fewer side effects than chemotherapy. For example, the targeted therapy Herceptin (trastuzumab) latches on to breast cancer cells that express high levels of a protein called HER2 (known as HER2 positive breast cancers).
For more information on breast cancer in men, see Breast Cancer Care's Men with Breast Cancer guide.
Information last reviewed: 17 December 2012