Breast cancer represents less than 1% of all cancers in men, making it extremely rare. However, it tends to be diagnosed at later stages than breast cancer in men, possibly because of low awareness by both the general population and physicians. The overall incidence is one case per 100,000 men per year, while the median age at presentation is 65 to 71 years old. In the United States, male breast cancer is most common in African-American men, followed by non-Hispanic Caucasian men and Asian-Pacific Islanders, and lowest in Hispanic men.

It is estimated that we will see approximately 1,900 male breast cancer cases diagnosed this year and approximately 440 deaths.

Hormonal factors play a role in the development of breast cancer in men. Any process that causes an increase in estrogen in men will increase the risk of breast cancer. Medical conditions that cause increased estrogen levels in men include liver disease, testicular injury, orchitis (inflammation of the testicles from infection) and head injury causing hyperprolactinemia ( a condition in which a man has higher-than-normal levels of the hormone prolactin in his blood); boys being treated with chest irradiation for lymphoma and men exposed to nuclear fallout during WWII. Mutations in distinct genes, such as the BRCA1 and BRCA2 genes, account for 10% of male breast cancers. All men with breast cancer should be tested for the BRCA1 and BRCA2 gene mutations.

A family history of breast cancer is a risk factor in men. A mother or sister with breast cancer confers a 2.33 relative risk of developing breast cancer in men. This risk increases if the female first-degree relative developed breast cancer before the age of 45. Interestingly, 30% of men with breast cancer have a history of one or more first-degree relatives with breast cancer.

Conversely, men who carry the BRCA1 and BRCA2 mutations are also at increased risk to develop breast cancer. Men with a BRCA2 mutation have a 100 times increased risk for developing breast cancer, with a lifetime risk of 7%. Men with a BRCA1 mutation have less of a risk with a 1.2% lifetime risk of developing breast cancer.

According to the John W. Nick Foundation, the symptoms of male breast cancer may include:

• the presence of a hard, painless lump and nipple discharge (usually bloody).
• the nipple may also be inverted, and accompanied by local pain or itching.
• a firm mass directly beneath the nipple (the most common presentation of breast cancer in men).
• Swelling of the breast.
• Redness or scaling of the nipple or breast skin.
• A change in skin texture, such as dimpling or puckering.

Remember, these symptoms don’t necessarily mean you have breast cancer.

It is important to see your physician if you have any of these symptoms. The John W. Nick Foundation also recommends that if your doctor tells you there is nothing to worry about, you should get a second opinion because not all doctors are aware of male breast cancer.

In good health,
Anna Maria Voltura, M.D.

ABOUT DR. VOLTURA:
Anna Maria Voltura, M.D., is a Board-certified breast cancer surgeon and clinical director at Baptist Health Breast Center. Previously, she was medical director of the Christus St. Vincent Regional Medical Center’s Breast Institute in Santa Fe, New Mexico. She earned her medical degree from the University of New Mexico School of Medicine in Albuquerque, where she also completed her surgical residency. Dr. Voltura was a breast surgery fellow at Johns Hopkins University, specializing in the newest techniques for the diagnosis, surgical treatment and medical management of breast cancer. She is the author of breast cancer research articles published in medical journals.

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