Manuel A. Torres-Salichs MD,FACS Surgical Oncology, Breast Surgeon

Edileidis Tarrio, ARNP-BC, OCN





"Any men who has a lump that presents in the breast, particularly behind the nipple, which is the most common presentation of male breast cancer should not ignore it and should seek immediate evaluation by a medical professional."

Male Breast Cancer

Every person, male and female is born with breast tissue. Women develop more breast tissue during puberty due to the effect of female hormones. The growth and development in boys is restricted due to the presence of male hormones and the absence of high levels of estrogen. The male breast is primarily composed of fatty tissue, connective tissue and few branching ducts. Lobules are usually absent from the male breast.

Breast cancer affects men as well as women. Breast cancer is about 100 times more common in women than in men. Breast cancer represents only .6% of all breast carcinomas and less than 1.5% of all malignancies in men. It affects approximately 1 in 100,000 men in the United States. The American Cancer Society estimates that approximately 1,450 men were diagnosed with breast cancer in the United States in 2009 and about 450 men died from the disease.
Male patients tend to be older at the time of presentation. They also may have a more advanced stage of the disease and greater lymph node involvement at the time of diagnosis. This is somewhat ironic since breast tumors in men are easier to feel than they are in women. The reason may be that men assume they are experiencing a benign condition known as gynecomastia where there is growth of benign breast tissue. The delay in diagnosis may also be related to better screening in women and lack of public education regarding male breast cancer and self-examinations.
Breast cancer usually affects men in their sixth decade. The tumors are predominantly ductal in origin and generally have a higher rate of estrogen/progesterone positivity than breast cancer in women. Overall, stage by stage men have the same chances of survival of breast cancer as women.
The prevalence of bilateral breast cancer in men is less than in women, with an incidence of approximately 1.5% of males diagnosed with a first breast malignancy.
A single causative factor for male breast cancer remains unproven. Men with Klinefelter's sydrome, a rare chromosomal disorder, have a high risk of developing the disease. The risk is estimated to be 20 times higher than in males without this condition. In this syndrome, atrophic testicles are associated with decreased testorenone levels and a relative hypersetrogenism. Also, men with a deleterious mutation of the BRCA2 gene are at a higher risk of developing breast cancer.

Risk Factors

Older Age:
• Breast cancer usually affects males in their sixth decade

Radiation Exposure:
• A history or radiation therapy to the chest at an early age increases the risk of breast cancer

Occupational Factors:
• Wood Machining
• Exposure to Petroleum and Combustion Products
• Exposures to High Temperatures
• Exposure to Electromagnetic Fields
• Aviators

Hormonal Factors:

There is some evidence that may implicate estrogen in the etiology of male breast cancer, yet the number of cases of breast cancer following estrogen therapy is relatively small, considering the number of patients who receive estrogen therapy. These are some conditions that increase hormone levels:

• Men receiving Estrogen for Prostate Carcinoma
• Alcohol Consumption and Liver Disease
• Liver damage Secondary to Schistosomiasis
• History of Mumps Orchitis

Medical Conditions

• Obesity
• Diabetes Mellitus
• Hypertension
• Hypercholesterolemia
• Prostate Cancer


• Family with Hereditary Breast Cancer
• BRCA2 Deleterious Genetic Mutation

Clinical Presentation

• Most tumors occur in the central areolar region followed by the upper outer quadrant
• It usually presents as a small painless lump behind the nipple
• Nipple retraction or ulceration
• Nipple discharge
• Solitary axillary mass

Surgical Treatment

The vast majority of male breast cancers are treated with a mastectomy. Breast conservation is usually not an option. Men have a small amount of breast tissue under the areola. This poses a great challenge in obtaining negative margins while preserving the nipple-areolar complex and an acceptable cosmetic outcome.

Modified radical mastectomy
Mastectomy with sentinel node biopsy in patients with clinically negative axillary lymph nodes

Adjuvant Radiation Therapy

The decision to give radiation therapy depends on the size of the primary tumor or presence of cancer cells in the lymph nodes.

Adjuvant Radiation Therapy

Most of male breast cancers are ductal in origin and have a high rate of hormone receptors expression. Hormonal therapy has been the mainstay of treatment in male breast cancer, with tamoxifen being the front-line drug. Tamoxifen occasionally causes hot flashes, decreased libido, and erectile dysfunction.

Primary or Adjuvant Chemotherapy

The rarity of male breast cancer has precluded major progress in the understanding and treatment of the disease. Treatment is often extrapolated from female breast cancer despite distinct features between the two diseases. Treatment with chemotherapy depends on several factors. These include size of the tumor, the presence of cancer cells in the lymph nodes and the presence or absence of tumor biomarkers (estrogen or progesterone receptors, HER2 protein).