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Breast Cancer in Men - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Breast Cancer in Men. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Breast cancer in men is rare, accounting for less than 1% of all breast cancers. Although breast cancer in men occurs less frequently than breast cancer in women, the diseases are similar in many ways.

About the breast

The breast is mostly made up of fatty tissue. Within this tissue is a network of lobes, which are made up of tiny, tube-like structures called lobules that contain milk glands. Tiny ducts connect the glands, lobules, and lobes to the nipple, located in the middle of the areola, which is the darker area that surrounds the nipple of the breast. Blood and lymph vessels run throughout the breast; blood nourishes the cells, and the lymph system drains bodily waste products. The lymph vessels connect to lymph nodes, the tiny, bean-shaped organs that help fight infection.

About breast cancer

Cancer begins when normal cells in the breast change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.

Breast cancer spreads when breast cancer cells move to other parts of the body through the blood vessels and/or lymph vessels. This is called metastasis. Breast cancer most commonly spreads to the regional lymph nodes. The lymph nodes can be located under the arm, called the axillary lymph nodes, under the sternum or breast bone, called the mediastinal lymph nodes, or just above the collarbone, called the supraclavicular lymph nodes. When it spreads further through the body, it most commonly spreads to the bones, lungs, and liver. Less commonly, breast cancer may spread to the brain. The cancer can also come back after treatment locally in the skin, in the same breast, other tissues of the chest, or elsewhere in the body.

Types of breast cancer

The main types of breast cancer are the same for men and women. Most breast cancers start in the ducts or lobes. Almost 75% of all breast cancers begin in the cells lining the milk ducts and are called ductal carcinomas. Approximately 25% breast cancers in men are lobular carcinoma, which begins in the lobules.

A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating carcinoma. The majority of men with breast cancer have infiltrating ductal carcinomas (IDC).

Disease that has not spread is called in situ, meaning "in place." Ductal carcinoma in situ (DCIS) is the most common type of in situ breast cancer, but it is uncommon in men.

Other types of breast cancer include Paget's disease of the nipple, which begins in the ducts but spreads to the skin of the nipple. Paget’s disease is more common in men than in women. Another type is inflammatory breast cancer, which makes up about 1% to 5% of all breast cancers; this type is rare in men. Less common subtypes of breast cancer include medullary, mucinous, tubular, or papillary.

Breast cancer in men is found the same way as breast cancer in women is—through self-examination, clinical examination, or through an x-ray of the breast called a mammogram. Changes in the breast may be easier to detect because, in general, men have less breast tissue. However, the awareness of breast cancer in men is much lower than it is in women; therefore, men may not perform regular breast self-examinations or talk with their doctor about the disease.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available as a PDF) that offers an easy-to-print introduction to breast cancer.
  • ASCO Answers Guide: This 52-page booklet (available as a PDF) helps newly diagnosed patients better understand their disease and treatment options, as well as keep track of the specifics of their individual cancer care plan.
  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in breast cancer that provides basic information and areas of research.

To continue reading this guide, use the menu on the side of your screen to select another section.

Breast Cancer in Men - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 2,360 men in the United States will be diagnosed with breast cancer. An estimated 430 men will die of breast cancer this year.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. Breast cancer in men and women has similar survival rates. For the earliest stages of breast cancer, stages 0 and I, the five-year survival rate is 99%. Men with breast cancer that has spread to the local lymph nodes have an 84% five-year survival rate, and men with cancer that has spread to other parts of the body have a 24% five-year survival rate. Even if the cancer is found at a later stage, new treatments help many people with breast cancer maintain their quality of life for some period of time.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a man how long he will live with breast cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2014.

Breast Cancer in Men - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor can help you make more informed lifestyle and health care choices.

A man’s average risk for breast cancer is low; out of 1,000 men with an average risk of the disease, one will develop breast cancer. Generally, most breast cancers are sporadic, meaning they develop from damage to a person’s genes that occur by chance after they are born and there is no risk of passing on the gene to a person's children. Inherited breast cancers are less common and occur when gene changes, called mutations, are passed within a family from one generation to the next (see below). The following factors can raise a man’s risk of breast cancer:

Family history of breast disease or presence of a genetic mutation. About one out of five men who develop breast cancer has a family history of the disease. Men with breast cancer gene (BRCA) gene mutations may be at increased risk for breast cancer and prostate cancer. Men with BRCA2 gene mutations have a 6 in 100 chance of developing breast cancer, whereas men with BRCA1 gene mutations have a 1 in 100 chance of developing breast cancer. Learn more about BRCA gene mutations and hereditary breast cancer risk in a separate article on this website.

Age. The average age for men to be diagnosed with breast cancer is 65.

Elevated estrogen levels. Certain diseases, conditions, or treatments can increase the levels of female hormones such as estrogen, which contributes to the development of breast cancer.

  • Klinefelter’s syndrome, a rare genetic condition in which men are born with an extra X chromosome, may increase the risk of breast cancer because men with Klinefelter’s syndrome have higher levels of estrogen and lower levels of male hormones called androgens.
  • Liver disease, such as cirrhosis, can change hormone levels and cause low levels of androgens and higher levels of estrogens.
  • Low doses of estrogen-related drugs that are given for the treatment of prostate cancer may slightly increase the risk of breast cancer.

Radiation. High doses of radiation may increase the risk of breast cancer. An increased risk of breast cancer has been seen in long-term survivors of atomic bombs, people with lymphoma who received radiation therapy to the chest, people who have had many x-rays for conditions such as tuberculosis, residual thymic disease, or acne, non-cancerous conditions of the spine, and in children who received radiation therapy for ringworm.

Lifestyle factors. As with other types of cancer, studies continue to show that various lifestyle factors may contribute to the development of breast cancer.

  • Being obese or even overweight increases the risk of breast cancer.
  • Lack of exercise may increase the risk of breast cancer because exercise lowers hormone levels, alters metabolism, and boosts the immune system. Increased physical activity is associated with a decreased risk of developing breast cancer.
  • Drinking two or more alcoholic drinks per day may raise the risk of breast cancer. However, this risk factor has not been studied in men.

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk. Learn more about weight management, physical activity, and alcohol consumption in the Prevention and Healthy Living section of this website. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

Regular self-examinations, clinical breast examinations performed by a doctor or other health care professional, and mammography are important ways to find breast cancer early, when it is easier to treat. Men should be familiar with the feel of their breast tissue, so they can talk with their doctor if they notice any lump or change. During an annual physical examination, your doctor will perform a clinical examination of the breast. Mammograms are not routinely offered to men and may be difficult to perform because of the small amount of breast tissue. A doctor may recommend regular mammography for men with a strong family history of breast cancer or for those with a genetic mutation that increases the risk of developing the disease.

To continue reading this guide, use the menu on the side of your screen to select another section.

Breast Cancer in Men - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Men with breast cancer may experience the following symptoms. Sometimes, men with breast cancer do not show any of these symptoms or signs. Or, these symptoms may be caused by a medical condition that is not cancer.

  • A lump or swelling in the breast tissue. Because men generally have small amounts of breast tissue, it is easier to feel small lumps.
  • Any new irregularity on the skin or nipple, such as redness, scaliness, puckering, or a discharge from the nipple

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, supportive care, or palliative care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide. 

Breast Cancer in Men - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also help the doctor decide which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose breast cancer in men:

Clinical breast examination. During this procedure, the doctor will feel for lumps in the breast tissue and under the arm.

Diagnostic mammography. If a lump or suspicious area is found, the doctor will recommend a diagnostic mammogram. Diagnostic mammography is similar to screening mammography except that more images of the breast are taken.

Ultrasound. An ultrasound uses high-frequency sound waves to create an image of the breast tissue. An ultrasound can distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

Nipple discharge examination. Fluid from the nipple can be examined under a microscope to look for cancer cells.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. There are different types of biopsies that are named by the technique and/or size of needle used to collect the tissue sample.

  • A fine needle aspiration biopsy uses a thin needle to remove a small sample of cells.
  • A core needle biopsy uses a wider needle to remove a larger sample of tissue. This is usually the preferred biopsy technique for finding out whether an abnormality on a physical examination or an imaging test is cancer. A vacuum-assisted biopsy removes several large cores of tissue. Local anesthesia, medication to block pain, is used to lessen a patient’s discomfort during the procedure.
  • Image-guided biopsy is used when a distinct lump cannot be felt, but an abnormality is seen with an imaging test, such as a mammogram. During this procedure, a needle is guided to the location with the help of an imaging technique, such as mammography, ultrasound, or MRI. A stereotactic biopsy is done using mammography to help guide the needle. A small metal clip may be put into the breast to mark where the biopsy sample was taken, in case the tissue is cancerous and more surgery is needed. This clip is usually titanium so it will not cause problems with future imaging tests, but check with your doctor before you have additional imaging tests. An image-guided biopsy can be done using a fine needle, core, or vacuum-assisted biopsy (see above), depending on the amount of tissue being removed. Imaging tests may also be used to help do a biopsy on a lump that can be felt, in order to help find the best location.
  • A surgical biopsy removes the largest amount of tissue. This biopsy may be incisional, which is the removal of part of the lump, or excisional, which is the removal of the entire lump. Because surgery is best done after a cancer diagnosis has been made, a surgical biopsy is usually not the recommended way to diagnose breast cancer. Most often, non-surgical core needle biopsies are recommended to diagnose breast cancer. This means that only one surgical procedure is needed to remove the tumor and to take samples of the lymph nodes.

If cancer is diagnosed, surgery is needed to remove the cancer in the breast. It is also needed to evaluate the lymph nodes for cancer in a procedure called a sentinel lymph node biopsy. Sometimes, treatment may be given before surgery, called neoadjuvant therapy, to shrink the cancer; see Treatment Options. The goal of surgery is to achieve clear surgical margins, which means that there are no cancer cells at the edge of the tissue removed during surgery. If there is cancer in the lymph nodes, the cancer is called lymph node-positive breast cancer or node-positive; if there is no cancer in the lymph nodes, the cancer is called lymph node-negative breast cancer or node-negative. More information about lymph node evaluation can be found in Stages.

Tumor features. Examination of the tumor under the microscope determines if it is invasive or in situ; ductal or lobular; how different the cancer cells look from healthy cells, called the grade; and whether the cancer has spread to the lymph nodes. The margins (edges) of the tumor are also examined and their distance from the tumor is measured.

Molecular testing of the tumor

Your doctor may recommend other laboratory tests on your tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help your doctor recommend treatment.

Estrogen receptor (ER) and progesterone receptor (PR) tests. Breast cancer cells with these receptors depend on the hormones estrogen and/or progesterone to grow. The presence of these receptors helps determine both the risk of recurrence and what kind of treatment will be most likely to lower the risk of recurrence. Generally, hormonal therapy (see Treatment Options) works well for ER-positive or PR-positive tumors, but chemotherapy is also used in specific situations. Breast cancer in men is more likely to have receptors for estrogen and progesterone, which means that hormonal therapy is likely to work well. Read about ER and PR testing.

HER2 tests. About 20% to 25% of breast cancers have an increase in the number of copies of a gene called the human epidermal growth factor receptor (HER2). This is called HER2-positive cancer. The gene makes a protein which is found on the cancer cell and is important in tumor cell growth; these types of cancers usually grow more quickly. The HER2 status helps determine whether a certain type of drug, such as trastuzumab (Herceptin), lapatinib (Tykerb), pertuzumab (Perjeta), or trastuzumab emtansine (Kadcyla, also known as T-DM1) might help treat the cancer. In addition, about 50% of HER2-positive tumors also have other positive hormone receptors and can benefit from both types of therapy. Read about HER2 testing for breast cancer.

If test results show a tumor is negative for all three factors outlined above -- ER, PR, and HER2 -- the disease is called triple-negative.

Ki67. How quickly a cell divides into two cells, called tumor proliferation, can be measured in a tumor sample and is referred to as Ki67 or MIB1. How well chemotherapy works to treat a tumor has been linked with how quickly tumor cells grow and divide. Hormone receptor-positive cancers are most commonly slow-growing with a low risk of recurrence if they are treated with hormonal therapy, but some are more rapidly growing with a higher risk of recurrence. In these cancers, chemotherapy may play an important role in reducing the risk of recurrence. In contrast, most HER2-positive and triple-negative cancers are fast-growing and are treated with chemotherapy, with HER2 targeted therapy for a cancer that is also HER2-positive. In some situations, Ki67 may be used to help to plan treatment or to help estimate a patient’s chance of recovery, but it is not used in many hospitals because the results are highly variable. Ki67 results depend on the laboratory doing the testing, the method of testing, and what part of the tumor is tested. Standardization of the testing methods and training appear to improve the results, so there is increasing interest in measuring tumor proliferation more routinely.

Genetic testing of the tumor. Tests that look at the biology of the tumor are commonly used to understand more about a breast cancer, particularly for cancers that have not spread to other organs. The tests below look at the genes in the tumor sample, not the genes a person inherits, to help predict the risk of cancer recurrence and to help choose treatment. They are usually done after surgery (see Treatment Options). A person with a higher risk of recurrence will likely need chemotherapy, while a person with a lower risk of recurrence can possibly avoid these treatments and their potential side effects. For more information about genetic tests, what they mean, and how the results might affect your treatment plan, talk with your doctor.

  • Oncotype Dx™ is a test that evaluates 16 cancer-related genes and five reference genes to estimate the risk of the cancer coming back in a place other than the breast and nearby lymph nodes, within 10 years after diagnosis of stage I or stage II (see Stages), node-negative, ER-positive breast cancer treated with hormonal therapy alone. It is mainly used to help make decisions about whether chemotherapy should be added to a person’s treatment. Recent research suggests that this test might be useful to decide about use of chemotherapy in node-positive disease in some situations.
  • Mammaprint™ is another, similar test using information about 70 genes to predict the risk of the cancer coming back for early-stage, low-risk breast cancer. It is approved by the U.S. Food and Drug Administration (FDA) for estimating the risk of recurrence in early-stage breast cancer, but it is not yet known if this test can predict if chemotherapy will work. 
  • Additional tests are widely available with unknown impact on treatment choice and are being studied. Talk with your doctor about any test you are considering

Blood tests

The doctor may also need to do several types of blood tests to learn more about the cancer.

Complete blood count. A complete blood count (CBC) is used to measure the number of different types of cells, such as red blood cells and white blood cells, in a sample of a person’s blood. It is done to make sure that your bone marrow is functioning normally.

Serum chemistry. These tests are often done to look at minerals in your blood, such as potassium and calcium, called electrolytes and specialized proteins called enzymes that can be abnormal if cancer has spread. However, many noncancerous conditions can cause changes in these tests, and they are not specific to cancer.

  • Alkaline phosphatase is an enzyme that can be associated with disease that has spread to the liver, bone, or bile ducts.
  • Blood calcium levels can be high if cancer has spread to the bone.
  • Total bilirubin count and the enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) evaluate liver function. High levels of any of these substances can indicate liver damage, a sign that the cancer may have spread to that organ.

Hepatitis tests. These may be used to check for evidence of prior exposure to hepatitis B and/or hepatitis C. If you have evidence of an active hepatitis B infection, you may need to take a special medication to suppress the virus before you receive chemotherapy. Without this medication, the chemotherapy can help the virus to grow and cause damage to the liver.

Blood tumor marker tests. A serum tumor marker, also called a biomarker, are proteins found in a person's blood that can be associated with cancer. High levels of a serum tumor marker may be due to cancer or a noncancerous condition. Tumor marker testing is not recommended for early-stage breast cancer because the markers are not usually high, but they may be useful to monitor the growth of recurrent or metastatic disease along with symptoms and imaging tests. Tumor markers should not be used to monitor for a recurrence, as it does not appear to improve a patient’s chance of recovery. Learn more about tumor markers for breast cancer.

Additional tests

The tests your doctor recommends to evaluate whether the cancer has spread and its stage depends on your medical history, symptoms, how much the disease has grown in the breast and lymph nodes, and the results of your physical examination. Read Stages for more information. Many of these tests may not be done until after surgery. These tests are generally only recommended for patients with later-stage disease.

  • An x-ray is a way to create a picture of the structures inside the body, using a small amount of radiation. A chest x-ray may be used to look for cancer that has spread from the breast to the lungs.
  • A bone scan may be used to look for spread to the bones. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein, and then the scan is performed several hours later using a special camera. The tracer collects in areas of the bone that are healing, which occurs in response to damage from the cancer cells. The areas where the tracer collects appear dark, compared to healthy bone, which appears gray. However, some cancers do not cause the same healing response and will not show up on the bone scan. Also, areas of advanced arthritis or healing after a fracture will also appear dark.
  • A computed tomography (CT or CAT) scan may be used to look for tumors in organs outside of the breast, such as the lung, liver, bone, and lymph nodes. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size and if it is shrinking with treatment. A contrast dye may be injected into a patient’s vein before the scan to provide better detail.
  • A positron emission tomography (PET) scan may also be used to determine whether the cancer has spread to organs outside of the breast. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy because they are actively dividing. Because cancer cells tend to use energy actively, they absorb more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Areas that are most active appear as bright spots, and the intensity of the brightness can be measured to better describe these areas. A combination PET/CT scan may also be used to measure the size of tumors and to more accurately determine the location of the bright spots. A PET/CT scan will also show any abnormalities in the bone, similar to the bone scan.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Breast Cancer in Men - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, how much it has grown, and if or where it has spread. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

The most commonly used tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes, and if so, how many nodes are involved? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero), which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (one through four), which are used for invasive breast cancer. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

There are two types of TNM staging for breast cancer. First, the clinical stage is based on the results of tests done before surgery, such as a physical examination, x-rays, and CT and MRI scans. Then, the pathologic stage is assigned based on the pathology results from the breast tissue and any lymph nodes removed during surgery. It is usually determined several days after surgery. In general, more importance is placed on the pathologic stage than the clinical stage.

Here are more details on each part of the TNM system for breast cancer:

Tumor. Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe the tumor in even more detail.

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of cancer in the breast.

Tis: Refers to carcinoma in situ. The cancer is confined within the ducts or lobules of the breast tissue and has not spread into the surrounding tissue of the breast. There are three types of breast carcinoma in situ:

Tis (DCIS): DCIS is a noninvasive cancer, but if not removed it can later develop into an invasive breast cancer. DCIS means that cancer cells have been found in breast ducts and have not spread past the layer of tissue where they began.

Tis (LCIS): Lobular carcinoma in situ (LCIS) describes abnormal cells found in the lobules or glands of the breast. LCIS is not cancer, but it increases the risk of developing invasive breast cancer.

Tis (Paget’s): Paget’s disease of the nipple is a rare form of early, noninvasive cancer that is only in the skin cells of the nipple. Sometimes Paget’s disease is associated with another invasive breast cancer. If there is also an invasive breast cancer present, it is classified according to the stage of the invasive tumor.

T1: The invasive part of the tumor in the breast is 20 millimeters (mm) or smaller in size at its widest area. This is a little less than an inch. This stage is then broken into three substages depending on the size of the tumor:

  • T1a is a tumor that is larger than 1 mm, but 5mm or smaller
  • T1b is a tumor that is larger than 5 mm, but 10 mm or smaller
  • T1c is a tumor that is larger than 10 mm, but 20 mm or smaller.

T2: The invasive part of the tumor is larger than 20 mm but not larger than 50 mm.

T3: The invasive part of the tumor is larger than 50 mm.

T4: The tumor falls into one of the following groups:

  • T4a means the tumor has grown into the chest wall.
  • T4b is when the tumor has grown into the skin.
  • T4c is cancer that has grown into the chest wall and the skin.
  • T4d is inflammatory breast cancer.

Node. The “N” in the TNM staging system stands for lymph nodes. Lymph nodes located under the arm, above and below the collarbone, and under the breastbone are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. As explained above, if the doctor evaluates the lymph nodes before surgery, based on other tests and/or a physical examination, a letter “c” for “clinical” staging is placed in front of the “N.” If the doctor evaluates the lymph nodes after surgery, which is a more accurate assessment, a letter “p” for “pathologic” staging is placed in front of the “N.” The information below describes the pathologic staging.

NX: The lymph nodes cannot be evaluated.

N0: No cancer was found in the lymph nodes.

N0(i+): When very small areas of “isolated” tumor cells are found in a lymph node under the arm, called the axillary lymph nodes. This is usually less than 0.2 mm or less than 200 cells. In this stage, the nodes are still called N0, but an “i+” is also listed.

N1mic: Cancer in the axillary lymph nodes is larger than 0.2 mm but less than 2 mm in size and can only be seen through a microscopic.

N1: The cancer has spread to one to three axillary lymph nodes under the arm. This category can include positive internal mammary lymph nodes if they are found during a sentinel lymph node procedure and not otherwise clinically detected. The internal mammary lymph nodes are located under the sternum or breastbone.

N2: The cancer within the lymph nodes falls into one of the following groups:

  • N2a is when the cancer has spread to four to nine axillary, or underarm, lymph nodes.
  • N2b is when the cancer has spread to or to internal mammary lymph nodes without spread to the axillary nodes.

N3: The cancer falls within one of the following groups:

  • N3a is when the cancer has spread to 10 or more lymph nodes under the arm or to those located under the clavicle, or collarbone.
  • N3b is when the cancer has spread to the internal mammary nodes and the axillary nodes.
  • N3c is when the cancer has spread to the lymph nodes located above the clavicle, called the supraclavicular lymph nodes.

If there is cancer in the lymph nodes, knowing how many lymph nodes are involved, and where they are helps doctors to plan treatment. The pathologist can find out the number of axillary lymph nodes that contain cancer after they are removed during surgery. It is not common to remove the supraclavicular or internal mammary lymph nodes during surgery. If there is cancer in these lymph nodes, treatment other than surgery, such as radiation therapy, chemotherapy, and hormonal therapy, is used to control the disease.

Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Distant spread cannot be evaluated.

M0: The disease has not metastasized.

M0 (i+): There is no clinical or radiographic evidence of distant metastases, but microscopic evidence of tumor cells is found in the blood, bone marrow, or other lymph nodes that are no larger than 0.2 mm in a patient without other evidence of metastases.

M1: There is evidence of metastasis to another part of the body, meaning there are breast cancer cells growing in other organs.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. Most patients are anxious to learn the exact stage of the cancer. However, it is important to keep in mind that tumor biology, including the diagnostic markers outlined above, has a significant impact on the type of treatment that is recommended, as well as on the prognosis. Your doctor will generally confirm the stage of the cancer when the testing after surgery is finalized, usually about five to seven days after surgery. When treatment is given before surgery, called neoadjuvant therapy, the stage of the cancer will be determined from other tests.

Stage 0: Stage zero (0) describes disease that is only in the ducts and lobules of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called noninvasive cancer (Tis, N0, M0).

Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes (T1, N0, M0).

Stage IB: Cancer has spread only to the lymph nodes, and is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller (T0 or T1, N1mic, M0).

Stage IIA: Any one of these conditions:

  • There is no evidence of a tumor in the breast, but the cancer has spread to the axillary lymph nodes but not to distant parts of the body. (T0, N1, M0).
  • The tumor is 20 mm or smaller and has spread to the axillary lymph nodes (T1, N1, M0).
  • The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes (T2, N0, M0).

Stage IIB: Either of these conditions:

  • The tumor is larger than 20 mm but not larger than 50 mm and has spread to one to three axillary lymph nodes (T2, N1, M0).
  • The tumor is larger than 50 mm but has not spread to the axillary lymph nodes (T3, N0, M0).

Stage IIIA: The cancer of any size has spread to four to nine axillary lymph nodes, but not to other parts of the body (T0, T1, T2 or T3, N2, M0). Stage IIIA may also be a tumor larger than 50 mm that has spread to one to three lymph nodes (T3, N1, M0).

Stage IIIB: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to the lymph nodes under the arm, but it has not spread to other parts of the body (T4; N0, N1 or N2; M0).

Stage IIIC: A tumor of any size that has not spread to distant parts of the body but has spread to 10 or more axillary lymph nodes or the lymph nodes in the N3 group (any T, N3, M0).

Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall (any T, any N, M1). Metastatic cancer spread is found when the cancer is first diagnosed about 5% to 6% of the time. Most commonly, metastatic breast cancer is found after a previous diagnosis of early-stage breast cancer.

Recurrent: Recurrent cancer is cancer that has come back after treatment, and can be either local or distant or both. If there is a local recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan. The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Breast Cancer in Men - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat men with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, read the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

The biology and behavior of a breast cancer affects the treatment. Some tumors are small but grow fast, while others are large and grow slower. When planning the treatment for breast cancer, the doctor will consider many factors, including:

  • The stage of the tumor
  • The tumor’s hormone receptor status (ER, PR) and HER2 status (see Diagnosis)
  • Other markers, such as Oncotype DX™ and Mammaprint™ (if appropriate)
  • The patient’s age, general health, and preferences
  • The presence of known mutations in inherited breast cancer genes, such as BRCA1 or BRCA2

Even though the doctor will specifically tailor the treatment for each patient and the breast cancer, there are some general steps for treating breast cancer.

For both DCIS and early-stage invasive breast cancer, doctors generally recommend surgery to remove the tumor. To make sure that the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor. Although the goal of surgery is to remove all of the visible cancer, microscopic cells can be left behind, either in the breast or elsewhere. For larger cancers, or those that are growing more quickly, doctors may recommend treatment with chemotherapy before surgery, called neoadjuvant therapy. Neoadjuvant hormonal therapy may also be recommended in other specific situations.

The next step in the management of early-stage breast cancer is to lower the risk of recurrence and to get rid of any remaining cancer cells. This is called adjuvant therapy. Adjuvant therapies include radiation therapy, chemotherapy, hormonal therapy, and/or targeted therapy. See below for more information on these types of treatment. Whether adjuvant therapy is needed depends on the chance that any cancer cells remain in the breast or the body and the chance that a specific treatment will work to treat the cancer. Although adjuvant therapy lowers the risk of recurrence, it does not completely get rid of the risk.

Along with staging, other tools can help estimate prognosis and help you and your doctor make decisions about adjuvant therapy. The website Adjuvant! Online (www.adjuvantonline.com) is a tool that your doctor can access to interpret a variety of prognostic factors. This website should only be used with the interpretation of your doctor. In addition, other tests that can predict the risk of recurrence for your specific tumor, such as Oncotype Dx, and Mammaprint (see Diagnosis), may also be used to better understand whether chemotherapy may work.

When surgery to remove the cancer is not possible, chemotherapy, radiation therapy, hormonal therapy, and/or targeted therapy may be given to shrink the cancer.

The treatment of recurrent cancer and metastatic cancer depends on how the cancer was first treated and the characteristics of the cancer mentioned above, such as ER, PR, and HER2.

Descriptions of the most common treatment options for breast cancer in men are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. Surgery is also used to examine the nearby underarm or axillary lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The types of surgery include the following:

  • A lumpectomy is the removal of the tumor and a small, cancer-free margin of healthy tissue around the tumor. Because men do not have much breast tissue, a lumpectomy is generally not an option.
  • A mastectomy is the surgical removal of the entire breast.

Lymph node removal and analysis

Cancer cells can sometimes be found in the axillary lymph nodes in some patients. It is important to find out whether any of the lymph nodes near the breast contain cancer, as part of treatment planning.

Sentinel lymph node biopsy. The sentinel lymph node biopsy procedure allows for the removal of one to a few lymph nodes, avoiding the removal of multiple lymph nodes in an axillary lymph node dissection (see below) procedure for patients whose sentinel lymph nodes are free of cancer. The smaller lymph node procedure helps patients lower the risk of swelling of the arm called lymphedema and decreases the risk of numbness, as well as arm movement and range-of-motion problems, which are long-lasting issues that can severely affect a person’s quality of life.

In a sentinel lymph node biopsy, the surgeon finds and removes about one to three sentinel lymph nodes from under the arm that receive lymph drainage from the breast. The pathologist then examines these lymph nodes for cancer cells. To find the sentinel lymph node, the surgeon injects a dye and/or a radioactive tracer into the area of the cancer and/or around the nipple. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. The surgeon can find the node when it turns color if the dye is used or gives off radiation if the tracer is used.

If the sentinel lymph node is cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer and no further surgery is needed. If the sentinel lymph node shows that there is cancer, then the surgeon may perform an axillary lymph node dissection to remove more lymph nodes to look for cancer, depending on the stage of the cancer, the features of the tumor, and the amount of cancer in the sentinel lymph nodes. It is recommended that patients with signs of cancer in the axillary lymph nodes receive an axillary lymph node dissection, regardless of whether a sentinel lymph node biopsy is done. Find out more about ASCO's recommendations for sentinel lymph node biopsy.

Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm, which are then examined by a pathologist for cancer cells. The actual number of lymph nodes removed varies from person to person. If cancer is found in the sentinel lymph node, whether more surgery is needed to remove additional lymph nodes varies depending on the specific situation.

Most patients with invasive cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection. A sentinel lymph node biopsy may not be done if there is obvious evidence of cancer in the lymph nodes before any surgery. In this situation, a full axillary lymph node dissection is preferred.

Summary of surgical options

To summarize, surgical treatment options include the following:

  • Removal of cancer in the breast: Usually a removal of the cancer and all of the breast tissue
  • Lymph node evaluation: Sentinel lymph node biopsy and/or axillary lymph node dissection

Talk with your doctor about the specific surgery recommended for you and the possible side effects of that surgery, including how side effects will be managed. The most significant side effect of surgery is lymphedema, which can occur when lymph nodes are removed or damaged during surgery. Because the lymph nodes are part of the channels that drain the lymphatic fluid from the arm, damage to the area may hold back the flow of lymphatic fluid and cause it to back up in the arm. The use of sentinel node biopsy has been shown to reduce the risk of developing lymphedema.

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using a probe in the operating room, it is called brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove, although this approach is rare. Adjuvant radiation therapy is recommended for some men after a mastectomy depending on the size of their tumor, the number of cancerous lymph nodes under the arm, and the width of the tissue margin around the tumor removed by the surgeon.

Radiation therapy can cause side effects, including fatigue, swelling of the breast, redness and/or skin discoloration/hyperpigmentation and pain in the skin where the radiation was aimed, sometimes with blistering or peeling. Rarely, a small amount of the lung can be affected by the radiation, causing pneumonitis, a radiation-related swelling of the lung tissue. In the past, with older equipment and techniques of radiation therapy, patients who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from the effects of radiation.

Many types of radiation therapy may be available to you with different. Talk with your doctor about the advantages and disadvantages of each option.

Types of radiation therapy

Several approaches to radiation therapy have been studied in women, but have not been studied in very many men with breast cancer. Talk with your doctor for more information.

  • Hypofractionated radiation is giving a higher daily dose of radiation over a shorter time, usually 3 to 4 weeks instead of 6 to 7 weeks.
  • Partial breast irradiation (PBI) is radiation therapy that is given directly to the tumor area, usually after a lumpectomy, instead of the entire breast, as is usually done with standard radiation therapy. Targeting radiation directly to the tumor area more directly usually shortens the amount of time that patients need to receive radiation therapy.
  • Intensity-modulated radiation therapy (IMRT) is a more advanced way to give external-beam radiation therapy to the breast. The intensity of the radiation directed at the breast is varied to better target the tumor, spreading the radiation more evenly throughout the breast. The use of IMRT lessens the radiation dose and the possible damage to nearby organs, such as the heart and lung, and lower the risks of some immediate side effects

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, which work usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

Chemotherapy may be given before surgery to shrink a large tumor and reduce the risk of recurrence, called neoadjuvant chemotherapy. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy. Chemotherapy is also commonly given if a patient has a metastatic breast cancer recurrence.

A chemotherapy regimen (schedule) consists of a specific treatment schedule of drugs given at repeating intervals for a set period of time. Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every two weeks (also called dose-dense), once every three weeks, or even once every four weeks. Common drugs for breast cancer include:

  • Capecitabine (Xeloda)
  • Carboplatin (Paraplatin)
  • Cisplatin (Platinol)
  • Cyclophosphamide (Neosar)
  • Docetaxel (Docefrez, Taxotere)
  • Doxorubicin (Adriamycin)
  • Pegylated liposomal doxorubicin (Doxil)
  • Epirubicin (Ellence)
  • Eribulin (Halaven)
  • Fluorouracil (5-FU, Adrucil)
  • Gemcitabine (Gemzar)
  • Ixabepilone (Ixempra)
  • Methotrexate (multiple brand names)
  • Paclitaxel (Taxol)
  • Protein-bound paclitaxel (Abraxane)
  • Vinorelbine (Navelbine)

A patient may receive one drug at a time or combinations of different drugs at the same time. Research has shown that combinations of certain drugs are sometimes more effective than single drugs for adjuvant treatment. The following drugs or combinations of drugs may be used as adjuvant therapy to treat breast cancer:

  • AC (doxorubicin and cyclophosphamide)
  • AC or EC (epirubicin and cyclophosphamide) followed by T (doxorubicin and cyclophosphamide, followed by paclitaxel or docetaxel, or the reverse)
  • CAF (cyclophosphamide, doxorubicin, and 5-FU)
  • CEF (cyclophosphamide, epirubicin, and 5-FU)
  • CMF (cyclophosphamide, methotrexate, and 5-FU)
  • EC
  • TAC (docetaxel, doxorubicin, and cyclophosphamide)
  • TC (docetaxel and cyclophosphamide)

Trastuzumab, pertuzumab, and lapatinib are HER2-targeted therapies that may be given with chemotherapy for HER2-positive breast cancer (see Targeted therapy, below). Bevacizumab (Avastin) is another targeted therapy that has been used in combination with chemotherapy for the treatment of metastatic breast cancer, but is no longer approved for the treatment of breast cancer.

The side effects of chemotherapy depend on the individual, the drug(s) used, and the schedule and dose used. These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects can often be prevented or managed during treatment, and they usually go away once treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor, oncology nurse, or pharmacist is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Hormonal therapy

Hormonal therapy, also called endocrine therapy, is an effective treatment for most tumors that test positive for either estrogen or progesterone receptors (ER-positive or PR-positive; see Diagnosis) for both early-stage and metastatic cancer. Because most men with breast cancer have ER-positive disease, hormonal therapy is often part of the treatment plan. This type of tumor uses hormones to fuel its growth. Blocking the hormones usually slows the growth of the tumor.

Hormonal therapy after surgery may be used by itself or after chemotherapy. Hormonal therapy options for men include:

  • Tamoxifen (Nolvadex, Soltamox) is the primary hormonal therapy used for men with breast cancer. It blocks estrogen from binding to cancer cells. It is a pill taken daily, usually for many years.
  • Aromatase inhibitors decrease the amount of estrogen made by the body. This type of treatment is effective in treating breast cancer in women, but there is not much information on their use for men with breast cancer, although research has shown that they could be effective. Caution is urged in using aromatase inhibitors in men who still have their testicles (testes), as these treatments could cause androgen levels to increase.
  • Fulvestrant (Faslodex) is a drug that is given by injection once a month. It stops estrogen from helping a cancer grow in a way that is different from tamoxifen. Like aromatase inhibitors, there is not much information on its use for men, but research has shown that it may be effective.
  • Megesterol (Megace) is a progesterone-like drug used to treat a hormone receptor-positive tumor. It is rarely used for men with breast cancer.

Side effects of hormonal therapy can include hot flashes, decreased sexual desire or ability, and mood swings.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments.

The first approved targeted therapies for breast cancer were hormonal therapies. Then, HER2 targeted therapies were been approved to treat HER2-positive breast cancer. Most recently, a drug that targets a protein called mTOR, which contributes to cancer growth, was approved in combination with hormonal therapy for the treatment of metastatic breast cancer. Targeted therapy is also used to prevent growth of cancer that has spread to the bone and to maintain bone health. Talk with your doctor about possible side effects of specific medications and how they can be managed.

HER2 targeted therapy

  • Trastuzumab is approved for both the treatment of advanced breast cancer and as an adjuvant therapy for early-stage HER2-positive breast cancer. Currently, one year of trastuzumab is recommended for the treatment of early-stage breast cancer. For metastatic cancer, trastuzumab is given in combination with different types of chemotherapy. Patients receiving trastuzumab have a small (2% to 5%) risk of heart problems. This risk is increased if a patient has other risk factors for heart disease or receives chemotherapy that also increases the risk of heart problems at the same time. These heart problems do not always go away, but they are usually treatable with medication.
  • Pertuzumab is approved for the treatment of advanced breast cancer, and is being studied as a treatment for early-stage disease. Research shows that adding pertuzumab to trastuzumab and the chemotherapy drug docetaxel for advanced breast cancer not yet treated with either chemotherapy or trastuzumab increases the effectiveness of treatment and lengthens lives with few additional side effects. Based on this data, the combination of trastuzumab, pertuzumab, and either docetaxel or paclitaxel has become the standard of care for the treatment of untreated advanced breast cancer. Pertuzumab is also approved as neoadjuvant treatment for breast cancer in the United States, in combination with trastuzumab and docetaxel or paclitaxel.
  • Lapatinib is commonly used for HER2-positive metastatic breast cancer when trastuzumab and pertuzumab in combination with docetaxel are no longer effective at controlling the cancer’s growth. The combination of lapatinib and the chemotherapy capecitabine is approved to treat advanced or metastatic HER2-positive breast cancer when a patient has already received chemotherapy and trastuzumab. Lapatinib is also used in combination with trastuzumab for patients whose cancers were growing on trastuzumab. Lapatinib is being studied for early-stage breast cancer in combination with trastuzumab. The recent approval of ado-trastuzumab emtansine (see below) has changed the use of lapatinib, as this drug was shown to be more effective than the combination of lapatinib and capecitabine. Lapatinib is now more commonly used following treatment with T-DM1 (see below).
  • Ado-trastuzumab emtansine or T-DM1 is approved for the treatment of metastatic breast cancer for patients who have previously received trastuzumab and chemotherapy with either paclitaxel or docetaxel. T-DM1 is made up of trastuzumab linked to a type of chemotherapy. Research shows that treatment with this drug caused fewer side effects and controlled tumor growth better than the combination of lapatinib and the capecitabine. T-DM1 is given by vein every three weeks. Studies are now testing T-DM1 as a treatment for early-stage breast cancer

mTOR inhibitor therapy

  • Everolimus (Afinitor) and similar drugs are being researched in combination with hormonal therapy for metastatic and early-stage breast cancer.

Osteoclast targeted therapy (drugs that block bone destruction)

  • Bisphosphonates are drugs that block the cells that destroy bone, called osteoclasts. Bisphosphonates are commonly used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones. For breast cancer that has spread to bone, higher doses of bisphosphonates have been shown to reduce the side effects of cancer in the bone, including broken bones and pain. Pamidronate (Aredia) and zoledronic acid (Zometa) are two intravenous bisphosphonates used to treat breast cancer bone metastasis.
  • Denosumab (Xgeva) is another osteoclast-targeted therapy called a RANK ligand inhibitor. Recent studies have shown that denosumab works well to treat breast cancer bone metastases, and may be better than bisphosphonates at controlling the symptoms of bone metastases. Denosumab is also effective at treating osteoporosis and is being studied as a cancer treatment in early-stage breast cancer.

Learn more about drugs that block bone destruction.

Getting care for symptoms and side effects

Cancer and its treatment cause symptoms and side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called supportive or palliative care, and it includes supporting the patient with his physical, emotional, and social needs.

Supportive or palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Metastatic breast cancer

If cancer has spread to another location in the body, it is called metastatic cancer or metastatic recurrent cancer. Symptoms of metastatic breast cancer may be related to the location of metastasis and may include changes in vision, changes in energy levels, feeling ill, or extreme fatigue.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

The treatment of metastatic or recurrent breast cancer depends on the previous treatment(s), the time since the original diagnosis, and the characteristics of the tumor, such as ER, PR, and HER2. Your health care team may recommend a treatment plan that includes a combination of systemic therapies, such as chemotherapy, hormonal therapy and targeted therapy, which are generally the primary treatment for recurrent metastatic cancer. Radiation therapy and surgery may be used in certain situations for men with a distant metastatic recurrence. Often radiation is used to treat cancer that has spread to the bone. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions after treatment for early-stage breast cancer are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return, and will help you make decisions about your treatment. Learn more about coping with the fear of recurrence.

If the cancer does return after treatment for early-stage disease, it is called recurrent cancer. It may come back in the breast (a local recurrence); in the chest wall (a regional recurrence); or in another part of the body, including distant organs such as the lungs, liver, and bones.

A local recurrence is frequently considered curable with further treatment. A metastatic (distant) recurrence is generally considered incurable, but it is often treatable. Some patients live years after a metastatic recurrence of breast cancer.

Generally, a recurrence is found when a person has symptoms or an abnormal finding on a physical exam. These symptoms depend on the site of the recurrence and may include:

  • A lump under the arm or along the chest wall
  • Bone pain or fractures, a possible sign of bone metastases
  • Headaches or seizures, a possible sign of brain metastases
  • Chronic coughing or trouble breathing, possible signs of lung metastases
  • Abdominal pain or a yellowing of the skin and eyes called jaundice, which may be associated with liver metastases

If a man has a recurrence, a cycle of testing will begin to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. A biopsy of the recurrent site is often recommended to be certain of the diagnosis and to check for ER, PR, and HER2 status, because this may have changed from the time of the original diagnosis. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Breast Cancer in Men - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat men and women with breast cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating breast cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with breast cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options, so that the person understands the standard treatment, and how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for breast cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Breast Cancer in Men - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about breast cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • New surgical methods that save tissue or prevent scarring are being tested in clinical trials.
  • Improved radiation therapy to lower the risk of side effects
  • New therapies and combinations of therapies, including chemotherapy, hormonal therapy, and targeted therapy are being studied in clinical trials.
  • Clinical trials are underway to find better ways of reducing symptoms and side effects of current breast cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding breast cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Breast Cancer in Men - Coping With Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for breast cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with breast cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care.

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Breast Cancer in Men - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for breast cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO’s recommendations for breast cancer follow-up care include regular physical examinations and mammograms, among other recommendations. In addition, ASCO offers cancer treatment summaries and a survivorship care plan to help keep track of the breast cancer treatment you received and develop a survivorship care plan once treatment is completed. In some instances, patients may be seen at survivorship clinics that specialize in the post-treatment needs of people with cancer.

Breast cancer can come back in the breast or other areas of the body. The symptoms of a cancer recurrence include a new lump in the breast, under the arm, or along the chest wall; bone pain or fractures; headaches or seizures; chronic coughing or trouble breathing; extreme fatigue; and/or feeling ill. Talk with your doctor if you have these or other symptoms. The possibility of recurrence is a common concern among cancer survivors; learn more about coping with fear of recurrence.

After surgery for treat breast cancer, the chest may be scarred and may have a different appearance than before surgery. If lymph nodes were removed as part of the surgery or affected during treatment, lymphedema may occur, and this is a life-long risk for patients.

Some patients experience breathlessness, a dry cough, and/or chest pain two to three months after finishing radiation therapy because the treatment can cause swelling and hardening or thickening of the lungs, called fibrosis. These symptoms are usually temporary. Talk with your doctor if you develop any new symptoms after radiation therapy or if the side effects are not going away.

Patients who received trastuzumab or certain types of chemotherapy called anthracyclines may be at risk of heart problems. Talk with your doctor about the best ways to check for heart problems.

In addition, men recovering from breast cancer have other symptoms that may persist after treatment. Learn about ways of coping with cancer-related fatigue, a drop in cognitive function that is sometimes called "chemobrain", and other late effects of cancer treatment.

Men recovering from breast cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level and may lower the risk of cancer recurrence. Your doctor can help you create a safe exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Breast Cancer in Men - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of breast cancer that I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage of my cancer?
  • Should I see a genetic counselor?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Who will be part of my health care team, and what does each member do?
  • Who is going to help coordinate my treatment and follow-up care?
  • What are the possible side effects of this treatment, both in the short term and the long term?How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What are the chances that the cancer will come back?
  • What is my prognosis?
  • How can I keep myself as healthy as possible during treatment?
  • What follow-up tests will be needed, and how often will I need them?
  • What support services are available to me? Are there support services specifically for men with breast cancer? What about support for my family?
  • Whom should I call for questions or problems?

For additional questions, see the Guide to Breast Cancer.

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Breast Cancer in Men - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Breast Cancer in Men. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

- Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with cancer.

- Find out more about clinical trials as a treatment option.

- Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

- Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for men with breast cancer.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Breast Cancer in Men. Use the menu on the side of your screen to select another section to continue reading this guide.