Breast cancer (male)

Breast cancer is often thought of as a condition that only affects women, but men can also develop it.

It's much less common in men than women.

The cancer develops in the small amount of breast tissue men have behind their nipples. The most common symptom is a hard, painless lump in one of the breasts.

However, the vast majority of breast lumps are caused by a condition called gynaecomastia. This is a common non-cancerous condition where male breast tissue becomes enlarged.

Breast cancer in men can also cause nipple problems, such as the nipple turning in on itself (retraction) or nipple discharge.

Read more about the symptoms of male breast cancer

When to speak to your GP

You should always talk to your GP if you notice a lump in your breast or you have problems affecting your nipples, such as discharge.

While these symptoms are unlikely to be caused by breast cancer, they should be investigated further. 

Why it happens

The cause of male breast cancer is unclear, but factors known to increase your chances of developing the condition include:

• age – most cases affect men over the age of 60
• having a family history of breast cancer (male or female)
• obesity – a body mass index (BMI) of 30 or more

Read more about causes of breast cancer in men

Treating breast cancer in men

In most cases, surgery is used to remove the cancer, along with a section of the breast. This may be followed by a long-term course of hormone-blocking therapy using medication, usually a drug called tamoxifen.

Tamoxifen helps block the effects of hormones known to stimulate the growth of cancerous cells in breast tissue. It should help prevent the cancer returning.

In some cases, radiotherapy or chemotherapy may be used for the same purpose.

Read more about treating breast cancer in men

Outlook

The outlook for breast cancer is not as good in men as in women. This is because there's reduced awareness of the condition and it may take longer to diagnose.

The survival rates for breast cancer in men largely depend on how far the cancer has spread before it's diagnosed.

Breast cancer diagnosed at an early stage can often be treated successfully, but effective treatment is more difficult if the cancer has spread beyond the breast tissue.

Unfortunately, many cases are diagnosed after the cancer has already started to spread.

Read more about diagnosing breast cancer in men.

Reducing your risk

The most effective way of reducing your risk of developing breast cancer, as well as other serious health conditions, is to:

• drink alcohol in moderation 
• maintain a healthy weight – through a combination of eating a healthy diet and exercising regularly

Read more about preventing cancer

The main symptom of breast cancer in men is a hard lump in one of your breasts. The lump is almost always painless.

The lump is usually located underneath the nipple and areola (the circle of dark-coloured skin surrounding the nipple).

However, the vast majority of breast lumps are caused by a condition called gynaecomastia. This is a common non-cancerous condition where male breast tissue becomes enlarged.

Less common symptoms of male breast cancer include:

• the nipple beginning to turn in on itself (nipple retraction)
• the nipple becoming hard and inflamed, and looking sore (nipple ulceration)
• fluid leaking from the nipple (nipple discharge)

Advanced symptoms

Additional symptoms usually only develop if the cancer spreads from the breast to other parts of the body, such as the bones, liver or lungs. This is known as metastatic breast cancer.

Symptoms of metastatic breast cancer include:

• bone pain
• swelling of the lymph nodes (glands), usually in or around the armpit
• shortness of breath
• feeling unusually tired all the time
• feeling sick (nausea)
• itchy skin with yellowing of the skin and whites of the eyes (jaundice)

When to seek medical advice

You should always visit your GP if you notice a lump in your breast or you have problems affecting your nipples, such as retraction, ulceration or discharge. 

These problems are unlikely to be of the result of breast cancer, but they should be investigated further.

It's not clear exactly what causes breast cancer in men, although a number of things can increase your risk of developing the condition.

Age

Like many cancers, men have an increased risk of developing breast cancer as they get older. Most cases are diagnosed in men aged 60 to 70. It's rare for young men to develop the condition.

Genetics and family history

A genetic mutation is a permanent alteration in the DNA sequence that makes up a gene. The result is that one or more of the body's processes may not work in the way they should.

There are a number of genetic mutations known to increase your risk of developing breast cancer. The most significant mutation identified is known as the BRCA2 mutation. 

There's also evidence that breast cancer can run in families, especially in men who have a first-degree relative who has developed breast cancer, such as a mother or sister.

Routine testing for the faulty genes that cause breast cancer in men isn't usually carried out on the NHS, unless specifically requested by a specialist. However, some private clinics may offer gene testing. Tests can be expensive, with prices ranging from around £2,000 to £3,000.

Oestrogen

There's evidence that high levels of the hormone oestrogen, or prolonged exposure to it, can increase the risk of breast cancer in men.

Compared with women, men tend to have low levels of oestrogen, but there are circumstances that can increase the levels of oestrogen in men. These include:

• hormone treatments – man-made (synthetic) versions of oestrogen are often used to treat prostate cancer, and are also given to transgender patients undergoing a male to female sex change
• obesity – obese men have higher levels of oestrogen than normal
• cirrhosis – this is scarring of the liver, often caused by long-term alcohol misuse

There is also a rare genetic condition affecting males called Klinefelter syndrome. This is a congenital condition that boys are born with that means those who are affected produce less of the hormone testosterone than usual.

As testosterone usually helps to limit the effect of oestrogen, men with Klinefelter syndrome are more likely to develop breast cancer than the general male population.

Occupational risks

There's some evidence men who work in hot environments are twice as likely to develop breast cancer compared with men who work in cooler environments.

Environments linked to an increased risk of breast cancer in men include:

• blast furnaces
• steelworks
• rolling mills – a factory where metal (usually steel) is shaped using rollers
• car manufacturing plants

One hypothesis to help explain the link between working environment and the increased risk of developing breast cancer is that excessive heat may damage the testicles, which could lead to an increase in oestrogen levels.

Another hypothesis is that working in hot environments usually involves exposure to certain chemicals that may increase the risk of developing breast cancer in men.

Rates of breast cancer are also unusually high in men who manufacture perfumes and soaps. They are 7 times more likely to develop breast cancer than the male population at large.

The reason for this increased risk is still unclear. Exposure to certain chemicals seems to be an obvious possibility, but this hasn't yet been proven.

Radiation

Exposure to radiation has been linked to an increased risk of developing breast cancer in men.

Research has found men who received a course of radiotherapy – where high energy X-rays are used to kill cancerous cells – directed at the upper chest were seven times more likely to develop male breast cancer compared with the population at large.

However, even a seven-fold increase means the chance of developing breast cancer is still very low.

If you have symptoms of breast cancer, such as a hard, painless lump in one of your breasts, your GP will carefully examine you.

During the examination, they'll also look for other possible signs of male breast cancer, such as swollen lymph nodes (glands).

It's likely your GP will refer you for further tests if there's a possibility you may have breast cancer. 

Mammogram

A mammogram is a type of X-ray used to help determine whether there are any changes in breast tissue that could be the result of cancer.

During the mammogram procedure, a radiographer (a specialist in taking X-rays) will compress one of your breasts between two X-ray plates. This shouldn't be painful, but you should tell the radiographer if you find it uncomfortable.

Once your breast has been correctly positioned, an X-ray will be taken that produces a clear image of the inside of your breast. The procedure will then be carried out on your other breast.

Ultrasound

An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your breasts, in the same way an unborn baby can be seen in the womb.

An ultrasound probe or sensor will be placed over your breasts to create an image of the inside of your breasts on a screen. The image will highlight any lumps or abnormalities that may be present in your breasts.

Biopsy

A biopsy may be recommended if a mammogram or ultrasound scan highlight any lumps or abnormalities in your breasts.

A biopsy is a test that can either confirm or rule out a diagnosis of breast cancer in men. It involves taking a sample of suspected cancerous tissue and examining it in a laboratory for the presence of cancerous cells.

A type of biopsy known as a core biopsy is usually recommended for the diagnosis of breast cancer in men. This type of biopsy can usually indicate whether the cancer has started to spread from the breast into the surrounding area.

During a core biopsy, a local anaesthetic will be used to numb your breast. A hollow needle will then be used to remove a number of small tissue samples from the breast lump.

If cancer is found, it's also possible to check whether there are special proteins, known as oestrogen receptors, on the surface of the cancerous cells.

This is important, because if oestrogen receptors are found – and they are in more than half of cases – it's possible to treat the cancer with hormone therapy.

Read treating breast cancer in men for more information.

Staging

After breast cancer has been diagnosed, your care team should provide information about the stage of the cancer. Staging is a system used to describe how far a cancer has spread at the point of diagnosis.

A cure may be possible if breast cancer is diagnosed at an early stage. However, treatment can only be used to control symptoms and slow the spread of the cancer if it's diagnosed at a later stage. Unfortunately, more than 40% of breast cancers in men are diagnosed at a late stage.

In some cases, men are diagnosed with a type of breast cancer called ductal carcinoma in situ (DCIS). This means there are cancer cells in the breast, but they're contained within the breast ducts and can't spread.

If left untreated, DCIS can lead to invasive breast cancer over a period of time.

Coping with a diagnosis

Being told you have breast cancer can cause a wide range of emotions, such as shock, fear, confusion and, in some cases, embarrassment.

Most people assume breast cancer only affects women, so it can be difficult to come to terms with the diagnosis.

Feelings of isolation and being alone are common in men with breast cancer. This may be because there's little in the way of advice and support for men with breast cancer, particularly when compared with the support available for women with the condition.

Sometimes men who find themselves in this situation can become depressed. You may be depressed if you've felt very down and no longer interested in doing activities you used to enjoy during the past month.

If you think you may be depressed, visit your GP. There is a range of effective treatments, such as medication and counselling, that can help relieve feelings of depression.

You may also find it useful to talk to other men affected by the condition. Breast Cancer Now is a breast cancer charity that provides an online forum for anyone diagnosed with breast cancer. Cancer Research UK also provides Cancer Chat, an online forum for anyone affected by cancer.

Screening for breast cancer in men

As breast cancer is rare in men, routine screening for the condition isn't recommended, even for men in high-risk groups, such as those with a family history of breast cancer or those who have had radiotherapy.

Treatment for breast cancer in men largely depends on how far the cancer has spread.

Most hospitals use multidisciplinary teams (MDTs) to treat men with breast cancer. These are teams of specialists who work together to make decisions about the best way to proceed with your treatment.

Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the ideal treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you'd like to ask the specialist. For example, you could ask about the advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan depends on how far the cancer has spread. If the cancer hasn't spread significantly beyond your breast, a complete cure may be possible.

In these cases, surgery to remove the affected breast is usually recommended. This is often followed by radiotherapy, hormone therapy, or chemotherapy to help prevent the cancer returning.

If the cancer has spread beyond your breast into other parts of your body, such as your lungs, a complete cure won't be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms and slow down the spread of the cancer.

More information about these treatments can be found below.

Surgery

An operation called a mastectomy is usually recommended as the first treatment for breast cancer.

A mastectomy involves removing the entire breast, sometimes with the nipple and lymph nodes (glands) in the armpit. A procedure known as a sentinel lymph node biopsy may also be performed.

In some cases, part of the muscle under the breast may also be removed if there's a risk the cancer has spread to this area.

Once surgery has been completed, there will be a straight scar across your chest where your nipple used to be and possibly an indentation around the area where the breast tissue used to be.

After surgery

Most men are well enough to leave hospital 1 to 3 days after surgery.

After the operation, it's likely you'll feel very tired and it may take a few weeks before you're well enough to start carrying out relatively strenuous activities, such as lifting objects or driving. Your specialist nurse will be able to offer more specific advice about this.

The wound takes about 2 to 3 weeks to heal. It's important to keep the wound clean during this time.

You should look for any signs that the wound may have become infected, such as redness and swelling around the wound or a discharge of pus. Inform your MDT as soon as possible if you suspect an infection.

It's difficult to predict when you'll feel able to return to work. Some people choose to remain off work until other treatments, such as radiotherapy, have been completed.

Others prefer to return to work in between treatments. Your MDT will be able to advise you, but the final decision will be yours.

It can take several weeks to fully recover from the effects of a mastectomy. A structured exercise programme, where the intensity and amount of time spent exercising is gradually increased, will probably be recommended.

Your treatment team will be able to provide you with more advice or refer you to a physiotherapist (a specialist with training in rehabilitation using exercise).

Complications of surgery

After surgery, you may experience numbness or tingling at the site of the scar and in your upper arm. This is common, and is caused by nerve damage during surgery.

The numbness and tingling should pass within a few weeks or months, although it can occasionally be permanent.

Another possible complication is painful swelling in the arms. This is called lymphoedema, which is caused by the disruption of the lymphatic system (a series of channels and lymph nodes normally responsible for removing excess fluid from tissue).

If many lymph nodes are surgically removed, it can disrupt the lymphatic system's ability to drain fluid, which can lead to swelling.

There's no cure for lymphoedema, but it's possible to control the symptoms using a combination of different techniques, such as massage and compression garments.

See treating lymphoedema for more information

Radiotherapy

Radiotherapy is a type of treatment involving a machine that releases high-energy waves to destroy cancerous cells. It can be given a few weeks after surgery to prevent the cancerous cells returning.

A typical course of radiotherapy involves 2 to 5 sessions a week over the course of 3 to 6 weeks. The sessions are short and usually only last for 10 to 15 minutes.

Radiotherapy isn't usually painful, although you'll probably experience some side effects. This is because the energy released during radiotherapy can also damage healthy cells.

Common side effects of radiotherapy can include:

• extreme tiredness (fatigue)
• feeling sick (nausea)
• sore, red and irritated skin on the breast similar in appearance to sunburn

The side effects of radiotherapy should pass after your course of treatment has finished, although some men experience prolonged fatigue for several months.

Radiotherapy can also be used in cases of advanced breast cancer to slow down the spread of the cancer and relieve the symptoms of pain. This is known as palliative radiotherapy.

Palliative radiotherapy is usually given in just 1 or 2 doses and doesn't usually cause any side effects.

Hormone therapy

Up to 90% of cases of breast cancers in men are oestrogen receptor positive, or ER+. 'E' is used because the American spelling of oestrogen is 'estrogen'.

This means the cancerous cells require oestrogen to grow. Oestrogen is a type of hormone found in low levels in men and much higher levels in women.

The aim of hormone therapy is to block the effects of oestrogen on the breast tissue to prevent the cancer recurring after surgery. It can also be used in cases of advanced breast cancer to slow down the spread of the cancer.

Tamoxifen

Tamoxifen is one of the hormone-blocking medications widely used for breast cancer. It's available in tablet or liquid form, and prevents oestrogen entering the breast tissue cells.

The ideal length of treatment with tamoxifen is unclear. Studies in women with breast cancer suggest a five-year course of treatment is the most effective for preventing the return of cancer and extending survival rates. However, it's unclear if this also applies to men.

Tamoxifen can also cause unpleasant side effects, which will be taken into consideration when your treatment team is deciding which treatments to recommend. You can discuss the pros and cons of long-term treatment with tamoxifen with your doctors.

Side effects of tamoxifen can include:

• reduced interest in sex (loss of libido)
• inability to obtain or maintain an erection (erectile dysfunction)
• headache
• feeling sick – taking your medication with food may help reduce this side effect
• changes in mood, such as feeling irritable or depressed

You should inform your team if you experience side effects that become particularly troublesome, as alternative medications are available.

Aromatase inhibitors

Aromatase inhibitors are an alternative type of hormone medication. They may be used if tamoxifen proves unsuccessful or the side effects of tamoxifen are particularly troublesome. Aromatase inhibitors can also be used to slow the spread of advanced breast cancer.

In men, oestrogen is created when a protein called aromatase converts another hormone called androgens. Aromatase inhibitors block the effects of aromatase, which in turn lowers the amount of oestrogen in the body.

Aromatase inhibitors are usually given in tablet form and taken daily for two to five years. As with tamoxifen, there's little available evidence about the most effective length of dosage in men, compared with female breast cancer.

Side effects of aromatase inhibitors can include:

• joint pain
• lack of energy
• hot flushes
• skin rashes
• feeling sick
• being sick
• thinning of the hair

However, it's unlikely you'll experience any or all of these side effects.

Chemotherapy

Chemotherapy is used to treat cases of breast cancer where hormone therapy would be largely ineffective because the cancerous cells are not oestrogen receptor positive (ER+).

It's usually given after surgery to help prevent the cancer returning, or it's used to treat the symptoms of incurable cancer.

Chemotherapy for breast cancer involves taking a combination of cancer-killing medications. Treatment is usually given every 2 to 3  weeks over the course of 6 months.

You may be given chemotherapy tablets (oral chemotherapy), chemotherapy injections (intravenous chemotherapy), or a combination of both.

The side effects of chemotherapy can include:

• feeling sick
• being sick
• diarrhoea
• loss of appetite
• mouth ulcers
• tiredness
• skin rashes
• infertility
• hair loss

The side effects should resolve once your treatment has finished. Your hair should grow back about 3 to 6 months after treatment.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. It's important to tell your MDT about any symptoms of a potential infection, such as:

• a high temperature of 38C (100.4F) or above
• flu-like symptoms, such as chills or joint pain
• a general sense of feeling unwell

You should also avoid close contact with people known to have an infection.

If you're sexually active, you should use a condom for 48 hours after receiving a dose of chemotherapy medication. This is because the medication used in chemotherapy could pass into your semen and cause irritation in the tissue of your partner's genitals.

You should avoid having children while receiving chemotherapy as many of the medications can damage your sperm and increase your chances of having a baby with a birth defect. Again, using a reliable method of contraception, such as a condom, is recommended

Depending on the medications used, it may be several months after your course of chemotherapy has ended before you can safely have children. Your MDT will be able to give you a more detailed recommendation.

Biological therapy

Biological therapy uses medication to block the effects of a protein called human epidermal growth factor receptor 2 (HER2) in cases where HER2 is contributing to breast cancer.

Biological therapies are sometimes referred to as targeted therapies because they are designed to target biological processes that cancers rely on to grow and reproduce.

If you have high levels of the HER2 protein and are able to have biological therapy, you'll probably be prescribed a medicine called trastuzumab. Also known by the brand name Herceptin, it is usually used after radiotherapy or chemotherapy to prevent cancerous cells returning.

Trastuzumab

Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in the body and are created by the immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells designed to respond to the HER2 protein.

Trastuzumab is given through a drip, directly into a vein (intravenously). You'll receive the treatment in hospital. Each treatment session takes up to 1 hour, and the number of sessions you need depends on whether your breast cancer is in its early or more advanced stages.

On average, for early breast cancer you'll need to have a session once every 3 weeks, and for more advanced cancer you'll need to have weekly sessions.

Trastuzumab can cause side effects, including heart problems. This means it's not suitable if you have a heart problem, such as angina, uncontrolled high blood pressure (hypertension), or heart valve disease.

If you need to take trastuzumab, you'll need to have regular tests on your heart to ensure it's not causing any problems.

Other side effects of trastuzumab can include:

• an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever
• diarrhoea
• tiredness
• aches and pains