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Jan31
Breast Cancer in Men
Introduction

Breast cancer is often thought of as a condition that only affects women, but men can also develop it.
However, breast cancer in men is much less common than breast cancer in women.
The most common symptom of breast cancer in men is a hard, painless lump that the develops on one of the breasts.

When to see Dr. B C Shah

You should always visit Dr. B C Shah if you notice a lump in your breast, or you have symptoms that affect your nipples, such as retraction or discharge.
While these symptoms are unlikely to be the result of breast cancer, they should be investigated further.

Treating breast cancer in men

In most cases of breast cancer, surgery is used to remove a section of the breast. This is usually followed by a long-term course of hormone therapy using a medication called tamoxifen.
Tamoxifen helps to block the effects of hormones on breast tissue that are known to stimulate the growth of cancerous cells. It should help to prevent the cancer from returning.
In some cases, radiotherapy and/or chemotherapy may be used for the same purpose.

Causes

The causes of breast cancer in men are unclear, but a number of risk factors for the condition have been indentified. These include:
Age – most cases of male breast cancer affect men who are over 70 years of age
Having a family history of breast cancer (both male or female)
Obesity - a body mass index (BMI) of 30 or more
Alcohol consumption

Who is affected?

The average age of diagnosis is 71 years of age.

Outlook

The outlook for breast cancer in men is less favourable than for breast cancer in women. This is because there is less awareness of the condition, so it often takes longer to diagnose.
Healthcare professionals assess the outlook for cases of cancer by measuring how many people survive for five years following the initial diagnosis. This is known as ‘the five year survival rate’. However, many men who are diagnosed with breast cancer survive for much longer than five years.
The estimated five year survival rate for:
Stage 1 breast cancer is 75-100%
Stage 2 to 3 breast cancer is 50-80%,
Stage 4 breast cancer is 30-60%

Symptoms of breast cancer in men

The most common symptom of breast cancer in men is usually a hard, painless lump in one of your breasts. However, in around 1 in 20 cases, the lump can be painful.
The lump is usually located underneath the nipple and areola (the circle of dark coloured skin that surrounds the nipple).
Less common symptoms of male breast cancer usually affect the nipple. These can include:
the nipple begins to turn in on itself (nipple retraction)
the nipple becomes hard, inflamed, and ‘sore looking’ (nipple ulceration)
fluid leaking from the nipple (nipple discharge)
Additional symptoms usually only develop if the cancer spreads from your breast to other parts of the body, such as your 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) near your breast; usually in, or around, the armpit
Shortness of breath
Feeling unusually tired all the time
Feeling sick (nausea)
Itchy skin

When to seek medical advice

You should always visit Dr. B C Shah if you notice a lump in your breast or if you have symptoms that affect your nipples, such as retraction, ulceration or discharge. While symptoms such as these are unlikely to be of the result of breast cancer, it is important that they are investigated further.

Causes of breast cancer in men

Cancer begins with an alteration to the coding information in cells that tells them when to grow and replicate. The code is read from the deoxyribonucleic acid (DNA) that is found in all human cells. A change in the code is called a mutation and can alter the instructions that control cell growth.
If a mutation occurs, the cells carry on growing instead of stopping when they should. The cells reproduce in an uncontrollable manner, producing a lump of tissue that is known as a tumour.

How cancer spreads

Left untreated, cancer can quickly grow and spread to other parts of your body. There are two ways that breast cancer can spread:
Directly - where the cancer spreads outs of the breast tissue into surrounding muscle and skin

Indirectly - where cancer cells spread via the blood or lymphatic system (see below) to more distant parts of the body, such as the lungs and liver

The lymphatic system is a series of glands (or nodes) that are distributed throughout your body in a system that is similar to the blood circulation system. The glands produce many of the specialised cells that are needed by your immune system.

Risk factors for breast cancer in men

It is not clear exactly what causes the DNA inside the cells of the male breast to behave in this manner. However, a number of risk factors that can increase your risk of breast cancer developing have been identified (see below).

Due to the rarity of breast cancer in men, even if you had most of the risk factors outlined below (with the exception of having Klinefelter's syndrome), your risk of developing the condition would still be very small.

Genetics and family history

A genetic mutation is where the instructions that are carried in all living cells become scrambled in some way which means that one or more of the body’s processes do 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 to date is known as the BRAC2 mutation. One study that was carried out in the UK found that 1 in 20 men with breast cancer have the BRAC2 mutation.
There is also evidence that breast cancer can run in families, as 1 in 5 men who develop breast cancer, have a first-degree relative, such as a mother or sister, who also has a history of breast cancer.

Oestrogen exposure

There is evidence that prolonged exposure to the hormone oestrogen can increase the risks of breast cancer in men.
Compared to women, men tend to have low levels of oestrogen, but there are a number of 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 transsexuals who are undergoing a male to female sex change
Obesity – obese men have higher levels of oestrogen than normal
There is also rare genetic condition called Klinefelter's syndrome where baby boys are born with much higher levels of oestrogen than normal. It is estimated that 1 in every 1,000 people are affected by Klinefelter's syndrome.
Klinefelter's syndrome is a major risk factor for breast cancer in men. Men who have the condition are 20 times more likely to develop breast cancer than the male population at large.

Occupational risks

There is evidence that men who work in hot environments are twice as likely to develop breast cancer compared with men who work in cooler environments. Environments that have been linked to an increase risk of breast cancer in men include:
Blast furnaces
Steel works
Rolling mills – a factory where metal (usually steel) is shaped using rollers
Car manufacturing plants
One theory 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 theory is that working in hot environments usually involves exposure to certain chemicals which may increase a 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 seven times more likely to develop breast cancer than the male population at large. The reason for this increased risk is still unclear, although exposure to certain chemicals seems to be an obvious, although as yet unproven, factor.

Radiation

Exposure to radiation has been linked to an increased risk of developing breast cancer in men.
Research has found that 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 to the population at large.
However, it is important to put the increase risk in context. Even a seven-fold increase means that the chances of developing breast cancer is still very low at around 1 in 14,285.

Breast cancer in men – Diagnosis

If you have symptoms which might indicate breast cancer, such as a hard, painless lump in one of your breasts, Dr. B C Shah will carefully examine your breasts. During the examination, they will also be looking for other possible signs of male breast cancer, such as swollen lymph nodes (glands).
It is likely that your Dr. B C Shah will refer you for further tests. There are three tests that are used to help diagnose male breast cancer. These are:
A mammogram,
An ultrasound
A biopsy

Mammogram

A mammogram is a type of X-ray that can 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 should not 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 which will produce a clear image of the inside of your breast. The procedure will then be carried out on your other breast.

Ultrasound

Ultrasound uses high frequency sound waves to produce an image of the inside of your breasts (in the same way that 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 an 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 male breast cancer. 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 that is 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, which is known as invasive breast cancer.
During a core biopsy, a local anaesthetic will be used to numb your breasts. A hollow needle will then be used to remove a number of small tissue samples from the breast lump.
If cancer is found, it will also be 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 (they are in an around 90% of cases), it is possible to treat the cancer using a medication called tamoxifen.

Staging

After breast cancer has been diagnosed, your care team should be able to provide information about what stage your cancer is at.
Staging is a system that is used to describe how far a cancer has spread at the point of the diagnosis. The higher the stage, the more advanced the cancer and the further it has spread. The staging system for male breast cancer is outlined below.
Stage 1 - the cancerous tumour is less than 2cm (three quarters of an inch) across and there are no signs that the cancer has spread to the lymph nodes near the armpit.
Stage 2 - the cancerous tumour is 2-5cm (three quarters to two inches) across and/or there are signs that the cancer has spread to the lymph nodes near the armpit.
Stage 3 - the cancerous tumour is larger than 5cm (2 inches) across and has started to move into surrounding tissues, such as skin and muscle. Near-by lymph nodes are also affected but there is no sign that the cancer has spread beyond the breast and armpit.
Stage 4 - there are signs that the cancer has spread to other parts of the body, such as the lungs or bones. This is known as secondary, or metastatic, cancer.
A cure may be possible in cases of stage 1, 2 and 3 male breast cancer. In cases of stage 4 breast cancer, a cure is unlikely but it may be possible to control the symptoms and slow the spread of the cancer.

Coping with a diagnosis

Being told that you have breast cancer can cause a wide range of emotions, such as shock, fear, confusion and, in some cases, embarrassment.
Most people assume that breast cancer only affects women, so it can be difficult for many men 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 is little in the way of advice and support for men with breast cancer, particularly when compared to the support that is available for women with the condition.
Sometimes, men who find themselves in this situation can become depressed. You may be depressed if during the past month you have felt very down and you are no longer interested in doing activities that you used to enjoy. If you think that you may be depressed, you should visit your Dr. B C Shah. There are a range of effective treatments, such as medication and counselling, that can help relieve feelings of depression.

Treating breast cancer in men

Many hospitals use multidisciplinary teams (MDTs) to treat breast cancer in men. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Members of your MDT may include:
A surgeon
A clinical oncologist (a specialist in the non-surgical treatment of cancer)
A pathologist (a specialist in diseased tissue)
A radiologist (a doctor who specialises in analysing the results of imaging tests such as X-rays and ultrasound scans)
A dietitian
A social worker
A psychologist
As well as having a specialist MDT, you may also be assigned a key worker who will usually be a specialist nurse. They will be responsible for co-ordinating your care.
Deciding what treatment is best for you can often be confusing. Dr. B C Shah will recommend what he think is the best 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 that you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan will depend on how far the cancer has spread. If the cancer has not spread significantly beyond your breast (stage 3 or below), a complete cure may be possible.
Surgery to remove the affected breast is usually recommended followed by radiotherapy, hormone therapy and /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 (stage 4 breast cancer), a complete cure will not be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms, slow down the spread of the cancer and prolong lifespan.

Surgery

Surgery is the first treatment option that is often recommended for breast cancer and usually involves an operation called a modified radical mastectomy. This is where Dr. B C Shah removes the entire breast as well as the lymph nodes (glands) in the armpit.
Once surgery has been completed there will be a scar where your nipple used to be and an indentation in your chest where the breast tissue was.
It is possible to have reconstructive surgery after having a modified radical mastectomy. Tissue can be taken from other parts of your body, such as your lower abdomen or buttocks, and be used to recreate the shape of the breast.
An alternative option is to use breast implants that are similar to those that are used in cosmetic surgery. However, they are obviously much smaller. In many cases, reconstructive surgery can be carried out immediately after a mastectomy has been performed.
It is also possible to restore the appearance of a nipple by having a tattoo on your chest. ‘Nipple tattoos’ can be created in around 30 to 40 minutes and have a very realistic appearance.
You should discuss the various options for reconstructive surgery with Dr. B C Shah.

See more at: http://drbcshah.com/breast-cancer-in-men/


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