Posted on October 24, 2024
Although breast cancer in males is rare, it is a topic worth shining a spotlight on this Breast Cancer Awareness Month. Today’s medical landscape has evolved, with genetic testing and advanced screening modalities empowering us to take charge of our health and apply this knowledge to implement proactive and informed strategies for optimal long-term outcomes.
The late actor Richard Roundtree, best known for his role in the Shaft movies, had breast cancer, as did Peter Criss from the rock band KISS; both used their platform to promote awareness of this disease. Knowledge of the condition, its risk factors, genetic predispositions, clinical presentations, diagnosis and treatment options is central to implementing strategies to minimise morbidity and mortality.
Breast cancer accounts for less than 1% of all cancer diagnoses in men, although studies indicate that the annual incidence of the disease is rising. The incidence of breast cancer in men increases over 60 years of age, with people of certain Jewish and African descent having a higher risk. Hormonal imbalances, particularly those leading to an increased oestrogen-to-testosterone ratio, increase the risk and can occur as a result of obesity, liver disease, testicular disorders and hormone therapy. Environmental and lifestyle risk factors include radiation to the chest, physical inactivity, excessive alcohol consumption, and exposure to certain occupational conditions such as high temperatures and petrochemicals.
Family history and genetic predisposition must also be taken into account and can be used pre-emptively. Among others, the breast cancer 2 (BRCA2) gene is most strongly associated with the disease. Actress Angelina Jolie brought significant public attention to the BRCA gene mutations and their associated cancer risks when she underwent a preventative double mastectomy in 2013, and later a complete hysterectomy. BRCA2 gene mutations increase the risk of breast cancer in females to 45 – 85% and ovarian cancer risk to 10 – 20%.
These genetic mutations are also associated with an increased risk of pancreatic cancer, prostate cancer and melanoma. Mathew Knowles, music executive and father of pop stars Beyoncé and Solange, was diagnosed with breast cancer in 2019. He had a family history of breast cancer and genetic testing identified a BRCA2 gene mutation. His was a success story, and as a breast cancer survivor, he continues to raise awareness about the risks associated with BRCA mutations, encouraging men to take genetic testing seriously and not to ignore symptoms.
The most common symptom of breast cancer in men is a one-sided painless lump, frequently located beneath the nipple. Other signs may include skin dimpling, nipple retraction or a discharge. Men are less likely to suspect a breast malignancy and delay seeking medical advice, often leading to advanced stages of the disease at the time of diagnosis. The differential diagnosis includes gynecomastia (bilateral, symmetrical breast enlargement in men), an increase in the fatty tissue of the breast, infections, lipomas, fibromatosis and metastatic tumours.
Diagnosis is usually made by biopsy of a suspicious lesion, ultrasonography and/or mammography. Most tumours are hormone-receptor-positive invasive ductal carcinomas, and are sensitive to oestrogen, progesterone or androgen. Staging is done to determine the tumour size, as well as the local and distant spread of the cancer. Depending on the histology and staging, treatment may include surgery, hormone blockers, radiation and/or various chemotherapies. Men with breast cancer appear to have a worse overall survival rate compared to their female counterparts, likely due to their delayed diagnosis, more aggressive tumour subtypes and poor compliance to the endocrine modulators.
Increasingly, evidence is pointing to a distinct disease process in men that differs from breast cancer in females, requiring further research for the establishment of its own diagnostic and management protocols. Early detection through tailored screening protocols and preventive strategies can significantly improve outcomes for men at higher risk, although no standardised screening protocols exist to date.
Increased public and professional awareness of the disease and minimising its social stigma may not only facilitate more rapid clinical interventions, but also decrease psychological distress stemming from the societal view of breast cancer as a female condition. Maintaining a healthy weight, limiting alcohol consumption and engaging in regular physical activity can reduce your breast cancer rise. Men undergoing hormone therapy should have their hormone levels monitored regularly.
Guys, the pink ribbon month is not only aimed at breast cancer awareness for the ladies in your life. If you have any lumps in your chest, a discharge from a nipple or a strong family history of cancer, please seek advice from an informed and current medical practitioner without delay.
Professor Joji Mercier of the Department of Physiology in the School of Medicine at the University of Pretoria. Prof Mercier is a practising clinician and leads a team that conducts cancer research at UP; she is also part of international collaborations.
Disclaimer: The opinions expressed in the article are solely those of the author and do not necessarily reflect the views of the University of Pretoria.
Copyright © University of Pretoria 2024. All rights reserved.
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