Dear [$fname],
When we think about breast cancer, we think about how it affects women, their families and what they have to face with a breast cancer diagnosis.
What many of us don't think about is how it can affect men diagnosed with this disease.
Male breast cancer accounts for only about 1% of all breast cancers. The American Cancer Society estimates that in 2008, about 1,990 new cases of
breast cancer in men were diagnosed causing approximately 480 deaths, compared to 40,000 women who die of breast cancer each year.
Most cases of male breast cancer are detected in men between the ages of 60 and 70, with a man's lifetime risk at about 1/10th of 1%, or one in 1,000.
The cause of male breast cancer include environmental influences and genetic (inherited) factors. Breast cancer risk in men is
increased by elevated levels of estrogen, previous radiation exposure, and a family history of breast cancer. When certain conditions result in abnormally
high levels of estrogen in men, they develop breast tissue behind the nipple (gynecomastia) which presents as a tender lump. High levels of
estrogens in men also increase the risk for developing male breast cancer.
In most cases, gynecomastia can be diagnosed by a physical examination. A careful medical history is also important, including medication and drug
use. As gynecomastia can often present as a hard lump behind the nipple, a mammogram is often recommended. An ultrasound to exclude a discrete lump
in this new tissue is often indicated. Further tests are usually suggested to help establish the cause of the elevated estrogen levels. These can include
blood tests to examine liver, kidney, and thyroid function and testicular ultrasound to exclude a rare testicular tumor. I see a lot of teenage boys with
gynecomastia due to the normal hormone imbalance that occurs at this age. Marijuana is also a very common cause of gynecomastia. There is nothing
like the threat of developing breasts to cure a Marijuana habit!
The most common symptom of breast cancer in men is finding a firm, non-painful mass behind the nipple. The average size of breast cancer in men when
first discovered is about 2.5 cm in diameter, about the size of a grape. The cancer may cause skin changes in the area of the nipple. These changes can
include ulceration of the skin, puckering or dimpling, redness or scaling of the nipple, or retraction (turning inward) of the nipple. Bloody or opaque
discharge from the nipple may also occur. If these symptoms are discovered, a call should be made and a complete examination should be done.
It is more common for breast cancers in men to have spread beyond the breast when they are identified, resulting in a more advanced tumor stage at diagnosis.
The reason for this is that men tend to delay seeking a medical opinion longer than women do and there is a very rich blood and lymphatic supply close to the nipple.
The treatment and prognosis of male breast cancer is considered similar to breast cancer in women. If it is found when 1.5cm or less and has not spread to lymph
nodes it is very curable.
Like breast cancer in women, catching it early is the key. If one of your loved ones is concerned about a breast lump, encourage them to
make an appointment with their physician to determine if further diagnostic evaluation is necessary.
Best regards,
Belinda Barclay-White, MD
www.AZBreastnet.com
