Male Breast Cancer: What Advocates Should Know
Bob Riter
I was delighted to be invited to write about male breast cancer in this issue of the AIS VOICE. It's been nearly 30 years since I was diagnosed, and I've closely followed the topic ever since. What I hope is to provide information useful to advocates who already know about breast cancer, but not much about male breast cancer.
Quick Facts
- Less than 1% of the total number of breast cancer cases in the United States occur in men.
- It's estimated there will be 2,800 new cases of male breast cancer in the United States and 510 deaths in 2025.
- Men are often diagnosed at a more advanced stage than women because they are less likely to be aware of and to report symptoms.
- Survival rates for men with breast cancer are lower than for women with breast cancer which is partly – but not compl
- etely – explained by the more advanced stage at time of diagnosis.
Biology
- Most men with breast cancer have Infiltrating Ductal Carcinoma which is Estrogen receptor positive and HER2 negative.
- Men with breast cancer are more likely to be ER+ than women with breast cancer.
- About 12% of men have HER2 positive breast cancer and are treated with the same drugs (e.g., Trastuzumab) as women.
- Men can also get other types of breast cancer, (e.g., lobular, DCIS, inflammatory), but they are rare.
- Men with breast cancer usually have germline genetic testing. BRCA2 mutations are common, especially when there is a family history and/or Ashkenazi ancestry. Other mutations (e.g., CHEK2 and PALB) are also identified.
- As in women, risk increases with age. In men, the median age at time of diagnosis is in the late 60s, a few years older than the median age for women.
Diagnosis
- Breast cancer in men typically presents as a painless lump under or near the nipple, or as a retracted nipple.
- Imaging (mammogram, ultrasound) may be performed. Since the lump is usually palpable and near the surface, it is common to have a fine-needle aspiration.
- Tender tissue behind both nipples is often a benign condition known as gynecomastia. This is especially common in teenage boys and in other men who are experiencing hormonal changes.
Treatment
- Men with breast cancer usually have a modified radical mastectomy, but breast conserving surgery is sometimes performed.
- Radiation and chemotherapy treatments are essentially the same as for women.
- Hormonal therapy is the most significant treatment difference between men with breast cancer and women with breast cancer. Post-menopausal ER+ women generally receive an aromatase inhibitor, but the standard of care for ER+ men continues to be tamoxifen. The ETHAN Trial is now underway to assess the effectiveness of different hormonal therapies in men.
Screening
- Because the incidence is so low, population screening for male breast cancer is not appropriate. (That is, you wouldn't routinely encourage mammograms for all men at any age).
- Men with a genetic mutation (e.g., BRCA2) or a strong family history of breast cancer should discuss specific screening recommendations with their physician and/or genetic counselor.
Psychosocial Considerations
- In general, men with breast cancer are more open about sharing their diagnosis than they were 30 years ago, but it's still largely thought of as a women's disease.
- Because it's relatively rare, it's unusual for men with breast cancer to find a male breast cancer support group or even to meet other men with breast cancer. Most connections are made virtually through the Male Breast Cancer Global Alliance or other organizations.
Things to Consider
- Historically, breast cancer was categorized as breast cancer, whether in women or in men. Today, researchers and clinicians are beginning to think of male breast cancer as a distinct disease. Our thinking will continue to evolve as we better understand the molecular underpinnings of breast cancer and share data across institutions and countries.
When the Man You Love Gets Breast Cancer: A Wife's Perspective
A conversation with Patty Singer.
Her husband, Michael Singer, was diagnosed with breast cancer fifteen year ago.
1. Do you remember your reaction when Michael was initially diagnosed?
I certainly remember my reaction when Michael was first diagnosed with breast cancer. My chest became tight, my heart was racing in my chest, and I thought I was going to be a widow within a year. Michael's sister Jo-Ann was diagnosed barely 2 years before my husband's diagnosis and was gone in a year. Jo-Ann lived with us during her disease. It was a heartbreaking ordeal. I believed I was going to go through this again.
2. I suspect when you go as a couple to a breast cancer appointment or event, people assume you're the one with breast cancer. Is this correct?
When we go, as a couple, for our annual mammograms most think it's just for me until they see Michael gown up. Then there's a curious look on the "women's" faces. They don't allow Michael to sit with me, they put him separate from the women like an outcast. When we attend events, we make certain to wear male breast cancer attire.
3. Do you think your experience as a woman supporting a man with breast cancer is different than the experience of a man supporting a woman with breast cancer?
My experience as a woman supporting my husband with breast cancer is definitely different than a man supporting a woman with breast cancer. Society is still not aware that men get breast cancer
too. Unfortunately, it is not in the media like all the pink washing we are fed. Part of my support is making people or organizations aware of the 1% of men with breast cancer by attending cancer events and speaking about my husband's breast cancer experience.
4. What advice would you give to a woman whose spouse or partner is a man newly diagnosed with breast cancer?
My advice to a wife/partner to a man diagnosed with breast cancer is to be present. Education is so important and finding out all that you can about their diagnosis. There are many support groups out there to help. Bring a list of questions to their doctor appointments, along with paper and a pen to write down information given. Try to use all the resources available. If you're not comfortable with what the doctor is saying or if the doctor has never had a male patient, get a second opinion.
More Resources on Male Breast Cancer
- Listen to our Coffee Chat on Male Breast Cancer featuring Michael Singer and Dr. Jose Pablo Leone
- Read as Kathy Giller shares the powerful story of her husband Lee's experience with male breast cancer —from an unexpected diagnosis to his advocacy—highlighting the urgent need to raise awareness that breast cancer affects men too.
- Check out our Komen.org content on male breast cancer
Originally published in the AIS Voice of the Susan G. Komen Foundation