YOUNGSTOWN, Ohio – Breast cancer is rare in men, but that doesn’t diminish the risks, local surgeons maintain.
Fewer than 1% of breast cancers occur in men, according to the American Cancer Society. ACS estimates that 2,670 men will be diagnosed with invasive breast cancer in 2026, and about 530 men will die from the disease.
“It’s pretty rare,” Dr. Nicole Reyes of the Joanie Abdu Comprehensive Breast Care Center acknowledges. By comparison, an estimated 300,000 new breast cancer diagnoses are expected in women this year.
On average, Reyes treats no more than two men each year.
The average age of diagnosis of breast cancer in men is 70, Reyes says. As with women, the biggest risk factor for men is increasing age, she and Dr. Penelope Mashburn, a general surgeon with Sharon Regional Health System who handles breast cancer cases, agree.
“The older you get, the more increased risk you are at for getting pretty much any type of cancer, but a really big risk factor in men is a genetic mutation in the BRCA-2 gene,” Reyes says. “That puts men at significantly higher risk of getting breast cancer – also women, but specifically men as well.”
“As you get older, you have more of a chance of mutations,” Mashburn affirms.
Genetics also come into play – if a man’s mother and sister had breast cancer, he is at a higher risk of developing it as well, she says.
“If men have a really strong family history of breast cancer, it’s something maybe they should just be more aware of,” Reyes agrees.
Other factors that increase the risk for men include anything that increases estrogen, including taking exogenous estrogen, Reyes says.
Both physicians also point to obesity as a risk factor. Extreme obesity increases estrogen levels and decreases testosterone levels because fatty cells will convert into estrogen. Heavy alcohol consumption can lead to cirrhosis, and other liver conditions can increase estrogen in men.
“Obviously, any man who has had any radiation or prior cancer will be at an increased risk,” Mashburn says. Additionally, men who have gynecomastia – overgrowth of breast gland tissue in boys caused by an imbalance of testosterone and estrogen – also are at higher risk for breast cancer.
“Obviously, smoking is bad for any form of cancer,” she adds.
LACK OF AWARENESS
One risk factor specific to men is that they and their physicians don’t generally consider them candidates for the disease, Reyes says.
Men often don’t consider it because of lack of awareness, because it is a disease primarily associated with women. They also might be embarrassed or uncomfortable having a discussion about the possibility if they find something in their breast.
“I think that also goes along with healthcare providers too,” she continues. “I think there’s some bias in healthcare providers because it’s not the first thing they think of when they see a man with a breast mass.”
The disease often isn’t caught early because men don’t undergo regular breast cancer screenings as women do, Mashburn says. Most of the time, when men identify it, there already is a hard lump in the breast.
Delays in identifying breast cancer in men contributes to about half of diagnoses being made when breast cancer is in the advanced stage, Reyes says. Usually when men come in to see her they have a mass and some sort of imaging has been done. Men often are sent to her to differentiate whether they have gynecomastia or an actual mass.
“There’s certain things that I look for on the physical exam or look for on the imaging, and usually I’ll follow them to make sure it doesn’t get any bigger or at least it stays stable,” she says. The main thing she looks for is a specific mass in the subareolar region, when associated with any nipple retraction or bloody nipple discharge.
“They’re the big signs of breast cancer,” she says.
“The disease is not caught early because men don’t have routine mammograms like women, and most of the times when men find a breast cancer [mass], there’s already a hard lump in the breast,” Mashburn says.
Sometimes men report they have had a lump for about a year or more and it just keeps growing. “At that point in time, it’s invading down to the muscle or even invading lymph nodes,” she says.
If caught early, breast cancer is very treatable in men, as with women, which is why Reyes emphasizes raising awareness. Detection of abnormalities should be looked at immediately.
“If it’s caught early, the survival rate is very, very good,” she remarks. “If it’s caught in its early stages when it’s just localized to the breast, five-year survival can be upwards of 95%.”
Treatment when cancer is early involves removing the entire breast, not just the cancerous mass, because a man’s breast is so much smaller than a woman’s, Mashburn says. She usually does a biopsy of the sentinel lymph node – located underneath the axilla – to determine if the cancer has spread.
“Most of the time it gets found at a later stage,” Mashburn says. “But I have had primary care doctors send me patients early enough that I’ve gotten it all at stages one and two, and you always want to catch everything at the first stage or even the second stage.”
Beyond surgical intervention, treatment – as with women – involves radiation, chemotherapy if needed, and endocrine therapy, Reyes says.
“Any abnormal finding in a man’s chest or breast is not something to be ignored. It should always be looked at, no matter what,” Reyes advises.
Pictured at top: Dr. Nicole Reyes emphasizes that any abnormal finding in a man’s breast should be evaluated promptly.
