Breast Cancer in Men: The Warning Signs
By C.J. Clemmons
Breast cancer is traditionally thought of as an exclusively female-related disease. But like breast cancer in women, breast cancer in men is the uncontrolled growth of the cells of the breast tissue.
Breast cancer in men can be just as dangerous as breast cancer in women. More than 1,700 men are diagnosed with male breast cancer each year. But because men often wait to report the symptoms of male breast cancer, the disease is more likely to have spread, leaving many men with less hope that treatment will lead to recovery.
Breast cancer in men accounts for approximately one percent of cases of breast cancer and about 0.2 percent of all malignancies in men, according to The National Cancer Institute. In women, breast cancer represents 26 percent of all cancers. However, all of the types of breast cancer seen in women can also occur in men, although some are quite rare.
The National Cancer Institute estimates that breast cancer in men results in approximately 480 deaths in men compared to more than 40,000 women who die of breast cancer each year.
The survival rate for men is lower than for women. Men have very little breast tissue and do not typically receive mammograms.
Also, men are not taught to do regular breast self-examination. No one knows the exact cause of breast cancer, but risk factors include age, family history of breast cancer, changes in the appearance of the breast and race. Breast cancer is diagnosed more often in White women than Latina, Asian and African American women.
Since breast cancer is 100 times more common among women, the general public does not hear much about breast cancer in men. Many people are unaware that men can develop breast cancer, and neither individual men themselves nor their physicians regularly examine men’s breasts.
Furthermore, when men discover signs of breast cancer, they tend to delay before seeing a physician. This is the main reason why medical researchers have a hard time studying breast cancer in men and the effect it has on the male population. Men do not believe they are susceptible to the disease.
For instance, actor Richard Roundtree, the man who personified masculinity in the iconoclastic blaxploitaion film Shaft, discovered a lump in his right breast in the 1970s. It was cancer.
“When I got the news, I was shocked,” said Roundtree, who has worked with the Susan G. Komen Breast Cancer Foundation which raises breast cancer awareness among women and men, as well as funds for research. “I thought I couldn’t possibly have breast cancer. Men don’t get this,” Roundtree once said in a USA Today interview. The actor was fortunate to catch his cancer early and received chemotherapy, radiation treatments, and a mastectomy.
Another celebrity to have had male breast cancer is Peter Criss, a founding member of the rock band KISS, who calls himself “the luckiest man in the planet.” Criss said getting medical treatment early at the first sign of trouble saved his life.
“While some men feel embarrassed because of ‘this macho crap,’” Criss said surviving breast cancer was actually a blessing. He was treated before the tumor could spread and said he speaks out about breast cancer in men during National Breast Cancer Awareness month every October to raise the profile of this rare disease.
Criss, who played drums for KISS and was known as “Catman,” offered this advice to men who spot lumps in their breast: “Don’t sit around playing Mr. Tough Guy. Don’t say ‘It’s going to go away.’ It might not and you might not see life anymore and how beautiful that is.”
Most cases of breast cancer in men are detected in men between the ages of 60 and 70, although the condition can develop in men of any age. A man’s lifetime risk of developing breast cancer is about one-tenth of one percent, or one in 1,000.
However, men with breast cancer show the same racial disparities in survival as do women with the disease, according to a study conducted at Columbia University. Medicare-age African American men with breast cancer were three times more likely to die from the disease than White men. These findings parallel those of previous studies among women, which have shown higher breast cancer mortality rates for African American women at all ages, according to a 2009 study published in the Journal of Clinical Oncology.
Racial disparities in breast cancer outcomes between African American and White women have been reduced to access to health care, and other socioeconomic factors. Similar factors may contribute to the poor outcomes observed among African American men with breast cancer.
Among the findings related to African American men, the researchers reported that they were more likely to have later-stage disease and larger tumors than White men; African American men were 48 percent less likely to be referred to a medical oncologist and 56 percent less likely to receive chemotherapy than White men, though neither difference was significant. Five-year survival was about 90 percent among White patients but 66 percent among African American patients.
On the basis of the findings, the researchers concluded that part of the racial disparity in survival may be due to differences in treatment. Under treatment may account for the racial disparity in breast cancer survival among men.
Medical researchers have said further studies will be needed to explain clinical and biological factors contributing to racial disparities in male breast cancer. Because breast cancer in men is rare at less than one percent of cancers in men, obtaining large sample sizes has been a challenge. Most previous studies have been small, single center, retrospective series.
Early signs, however, indicate that the disease is more manageable and has higher successful treatable rates than when found in women. In many ways, the disease appears similarly in both sexes.
Symptoms of breast cancer
A painless lump, usually discovered by the patient himself, is by far the most common first symptom of breast cancer in men. Typically, the lump appears right beneath the breast, where breast tissue is concentrated.
A lump, however, is seldom the only symptom. Men are more likely than women to have nipple discharge (sometimes bloody) and signs of local spreading, including nipple retraction, fixation to the skin or the underlying tissues, and skin ulceration.
To improve the prognosis of breast cancer in men, broader efforts are needed to let men know that the disease exists and that, like other cancers, it can be cured or controlled if it is diagnosed and treated promptly.
Risk factors attributed to breast cancer.
The incidence of breast cancer in men, like in women, increases with age. The average age of men at diagnosis is close to 65, about five years older than the average age for women.
Breast cancer affects 14 African American men and eight White men in every million. Some studies also suggest that the prevalence is higher among Jewish males.
In Egypt, breast cancer in men represents six percent of all breast cancers, and in Zambia, it accounts for 15 percent. It has been suggested that one contributing factor might be an excess of estrogen produced by parasites. Others have proposed a link with liver disease caused by malnutrition.
– Socioeconomic Status
A recent study comparing male breast cancer patients from five metropolitan areas with men of comparable backgrounds who did not have breast cancer, found that the breast cancer patients were more likely to be college graduates and employed as professionals or managers.
Several researchers have reported two or more cases of breast cancer in men within a single family. Several of these reports have involved two brothers; one involved three brothers; and another described breast cancer in a man, his father and his uncle.
Abnormal hormonal activity, a factor that has been linked to the development of female breast cancer, could play a role in the development of male breast cancer as well. Several disorders with a hormonal component have been associated with an increased risk of male breast cancer, and numerous studies suggest that men with breast cancer display abnormal patterns of hormone metabolism and excretion.
The treatment for male breast cancer is generally similar to the treatment of female breast cancer. The basic therapy for cancer that shows no signs of distant spreading is surgery. In advanced stages, it is hormonal and chemotherapy. The small number of men who develop breast cancer makes it unlikely that large prospective trials can ever be undertaken to compare various therapies. It is possible, nonetheless, that institutions that see more than the usual number of cases could collaborate in developing a fund of reliable information. In the meantime, it is important that individual physicians and surgeons keep careful records to document the cases of the several hundred men who develop breast cancer each year in the U.S.
Clemmons is a contributing writer for Regal Black Men’s Magazine.