Breast Cancer - MaleLast Updated: January 26, 2012 This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/10 Overview
Breast cancer in men is rare, accounting for less than 1% of all breast cancer cases. Although breast cancer in men occurs less frequently than breast cancer in women, the diseases are similar in many ways. Cancer begins when normal cells in the breast begin to change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). The breast is mainly composed 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 (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, which are tiny, bean-shaped organs that normally help fight infection. The main types of breast cancer are the same for men and women. Most breast cancer cases 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% of male breast cancers are lobular carcinoma (cancer that 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 male breast cancer cases are 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. Inflammatory breast cancer makes up about 1% to 5% of all breast cancers. Paget's disease of the nipple begins in the ducts, but spreads to the skin of the nipple. Paget’s disease is more common in men than in women. Other, less common subtypes of breast cancer include medullary, mucinous, tubular, or papillary. Cancer may begin as a single, genetically abnormal cell. As this one cell divides, it eventually becomes a tumor and develops a blood supply to nourish its continued growth. At some point, cells may break off from the primary mass and move to other parts of the body in a process called metastasis. Breast cancer spreads when breast cancer cells move to other sites in the body through the blood vessels and/or lymph vessels. A common site of spread is the regional lymph nodes. The lymph nodes can be axillary (located under the arm), mediastinal (under the sternum or breast bone), or supraclavicular (located just above the collarbone). The most common sites of distant metastasis are the bones, lungs, and liver. Less commonly, breast cancer may spread to the brain. The cancer can also recur (come back after treatment) locally in the skin, in the same breast (if it was not removed as part of treatment), other tissues of the chest, or elsewhere in the body. Breast cancer in men is detected the same way as breast cancer in women is—through self-examination, clinical examination, or mammography (x-ray of the breast). Changes in the breast may be easier to detect because 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 on Cancer.Net:
Find out more about basic cancer terms used in this section. Statistics
This year, an estimated 2,190 men in the United States will be diagnosed with breast cancer. An estimated 410 men will die of breast cancer this year. 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 (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) 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 23% five-year survival rate. Even if the cancer is found at a more advanced stage, new therapies enable many people with breast cancer to experience the same quality of life as before their diagnosis. 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. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2012. Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can 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 communicating them to your doctor can help you make more informed lifestyle and health care choices. The following factors can raise a man’s risk of breast cancer: Family history of breast disease or presence of a genetic mutation. About 20% of breast cancers in men occur in those who have a family history of the disease. Men with breast cancer gene 2 (BRCA2) gene mutations may be at increased risk for breast cancer or other types of cancer. Learn more about the genetics of breast cancer. Age. The average age for men to be diagnosed with breast cancer is 65. Elevated estrogen levels. The presence of certain diseases, conditions, or treatments can increase estrogen (female hormones) levels.
Radiation. High doses of radiation may increase the risk of breast cancer. An increased risk of breast cancer has been observed in long-term survivors of atomic bombs, people with lymphoma treated with radiation therapy to the chest, people undergoing large numbers of x-rays (such as for tuberculosis or to treat residual thymic disease or acne), non-cancerous conditions of the spine, and children treated with 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.
Currently, there is no proven method for preventing male breast cancer. A person’s best chance of surviving breast cancer is early detection through regular self-examinations, clinical breast examinations (breast exam performed by a doctor or other health care professional), and mammography (an x-ray of the breast). Men should be familiar with the feel of their breast tissue normally, so they can bring any lump or change to their doctor’s attention. During an annual physical examination, the health care professional 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 the presence of a genetic mutation that increases their risk of developing the disease. Symptoms
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. If you are concerned about a symptom or sign on this list, please talk with your doctor.
Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized. Some tests may also find out which treatments may be the most effective. For most types of cancer, a biopsy (the removal of a small amount of tissue for examination under a microscope) 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 metastasized. Your doctor may consider these factors when choosing a diagnostic test:
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 methodically feel for lumps in the breast tissue and under the arm. Diagnostic mammography. If a lump or suspicious area is found, the doctor will order a diagnostic mammogram. Diagnostic mammography is similar to screening mammography except that more views (pictures) of the breast are taken. Ultrasound. An ultrasound uses high-frequency sound waves to create an image of the breast tissue. An ultrasound may distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is not usually 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 from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). A biopsy is specified by the technique and/or size of needle used to collect the tissue sample.
If cancer is diagnosed, surgery is needed to remove the cancer in the breast and evaluate the lymph nodes for the presence of cancer (discussed in Treatment). The goal is to achieve clear surgical margins (no cancer cells at the edge of the tissue removed during surgery). If lymph nodes show evidence of cancer, the cancer is called lymph node-positive breast cancer (or node-positive, for short); if the lymph nodes do not show evidence of cancer, the cancer is called lymph node-negative breast cancer (or node-negative, for short). Additional information about lymph node evaluation can be found in Staging. Testing the tissue The pathologist tests the tissue from the biopsy and the surgery for the following to help guide treatment decisions: Tumor features. Examination of the tumor under the microscope determines if it is invasive or in situ; ductal or lobular; grade (how different the cancer cells look from healthy cells); and whether the cancer has spread to the lymph nodes. The margins (edges) of the tumor are also examined. Estrogen receptor (ER) and progesterone receptor (PR) tests. Breast cancer cells with these receptors depend on the hormones estrogen and progesterone to grow. The presence of these receptors helps determine both the patient’s prognosis (chance of recovery) and whether the cells are likely to respond to hormone therapy. Generally, ER-positive or PR-positive tumors respond to hormone therapy. Read ASCO’s recommendations for ER and PR testing. HER2 tests. There is too much of the protein HER2 in about 25% of breast cancers. The HER2 status helps determine whether a drug targeting HER2, such as trastuzumab (Herceptin), might be useful for treating breast cancer. Read ASCO’s recommendations for HER2 testing for breast cancer. Testing a tumor’s genes Tests that look at the biology of the tumor are becoming more common to understand more about a person’s breast cancer. The tests below look at the expression of genes in a tumor sample to predict the risk of cancer recurrence. A person with a higher risk of recurrence will likely receive additional treatment, while a person with a lower risk of recurrence can avoid extra treatment and its possible side effects. For more information about these tests, what they mean, and how it might affect your treatment plan, talk with your doctor.
Blood tests The doctor may also need to do blood tests to learn more about the cancer. A serum chemistry panel is frequently done to evaluate blood electrolytes (minerals in your body, such as potassium and calcium) and enzymes (specialized proteins) that can be abnormal if cancer has spread. However, it is important to note that many noncancerous conditions can cause variations in these tests, and they are not specific to cancer.
Blood tumor marker tests A serum tumor marker (also called a biomarker) is a substance found in a person's blood that can be associated with the presence of cancer. An elevated serum tumor marker may indicate an abnormal process in the body, which could be due to cancer or a noncancerous condition. Tumor marker testing is not usually recommended in early-stage breast cancer, but these markers may be useful in the follow-up care of recurrent (disease that comes back after treatment) or metastatic disease. Common tumor markers in breast cancer include CA27.29, CA15-3, and CEA. Learn more about tumor markers for breast cancer. Additional tests The doctor may order additional tests (depending on the individual’s medical history and results of the physical examination) to evaluate the stage of the cancer. Read Staging for more information. These tests are generally only recommended for patients with more advanced stage disease.
Learn more about what to expect when having common tests, procedures, and scans. Find out more about common terms used during a diagnosis of cancer. Staging
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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. There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the size of the tumor itself, the presence of cancer in the lymph nodes around the tumor, and whether the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero), which is non-invasive ductal carcinoma in situ (DCIS), and stages I through IV (one through four), which represent invasive breast cancer. The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
There are two types of 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, CT scans, and MRI tests. Then, the pathologic stage is assigned based on information found during surgery, plus the laboratory results (pathology) of the breast tissue and any lymph nodes removed during surgery. In general, more importance is placed on the pathologic stage than the clinical stage. 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 (cancer) in situ. In this case, the cancer is confined within the ducts and 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 non-invasive cancer, but if not removed it can later develop into an invasive type of breast cancer. A designation of 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, non-invasive cancer that is confined to the skin cells of the nipple. Sometimes Paget’s disease is found to be associated with an underlying 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 dimension. This stage may be broken into three substages called T1a, T1b, and T1c, depending on the size of the tumor. T1mi: Microinvasion, or micrometastases, means a few cancer cells have spread to surrounding tissue, but none larger than 1 mm. 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 has extended into the chest wall (called T4a) and/or to the skin (called T4b). If there are signs of both, it is called T4c, and inflammatory breast cancer is referred to as T4d. 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. 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 deposits of “isolated” tumor cells are found in a lymph node (less than 0.2 mm or less than 200 cells), the nodes are still designated N0, but an “i+” is listed after the designation. N1: The cancer has spread to one to three axillary lymph nodes under the arm. This category can include positive internal mammary lymph nodes (found under the sternum or breastbone) if detected during a sentinel lymph node procedure and not otherwise clinically detected. N1mic: This designation is used when the cancer in the lymph nodes is greater than 0.2 mm but less than 2 mm in size (microscopic). N2: The cancer has spread to four to nine lymph nodes under the arm (called N2a), or to clinically apparent internal mammary lymph nodes (lymph nodes under the sternum [breastbone] on the inside of the chest, called N2b) without spread to the axillary nodes. N3: The cancer has spread to 10 or more lymph nodes under the arm or to the infraclavicular lymph nodes (located under the clavicle, or collarbone); this is called N3a. Or, the cancer has spread to the internal mammary nodes with axillary node involvement (N3b) or to the supraclavicular (located above the clavicle) lymph nodes (N3c). If there is cancer in the lymph nodes, it also helps doctors to plan treatment to know how many lymph nodes are involved. The pathologist can determine the number of axillary lymph nodes affected by cancer. It is not common to remove the supraclavicular or internal mammary lymph nodes at the time of surgery. Rather, if involvement of these nodal groups is suspected or confirmed, they are included in radiation treatment fields when planning treatment. 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 are 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 metastasis to another part of the body. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage 0: Stage zero (0) describes disease that is confined within the ducts and lobules of the breast tissue and has not spread into 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: The tumor is confined within the ducts and lobules of the breast tissue and has not spread into the surrounding tissue of the breast, or it is smaller than 20 mm, with microscopic spread to the lymph nodes (T0 or T1, N1mic, M0). Stage IIA: Any one of these conditions:
Stage IIB: Any one of these conditions:
Stage IIIA: This stage describes a cancer of any size that 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 IIA 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 distant sites in the body, usually the bones, lungs or liver, or chest wall (any T, any N, M1). Metastatic cancer spread is found at the time of breast cancer diagnosis about 5% to 6% of the time. Most commonly, metastatic breast cancer is the result of a recurrence many months to years following the original cancer diagnosis and treatment. Recurrent: Recurrent cancer is cancer that comes back after treatment. 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. Treatment
The treatment of male breast cancer depends on the size and location of the tumor, whether the cancer has spread, and the man’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. Male breast cancer may be treated with surgery, radiation therapy, chemotherapy, and hormone therapy. Each option is described below. This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, read the Clinical Trials section. Overview of breast cancer treatment 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:
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 ensure that the entire tumor is removed, the surgeon will also remove a small area of tissue around the tumor. Although surgery aims to remove all of the visible cancer, it is known that many times microscopic cells can be left behind, either in the breast or elsewhere. The next step in the management of early-stage breast cancer is to lower the risk of recurrence (return of the cancer) and to get rid of any hidden remaining cancer cells. This is called adjuvant therapy. Adjuvant therapies include radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy (see below for more information on these types of treatment). The need for adjuvant therapy is determined based on an estimate of the chance of residual cancer in the breast or the body. Although adjuvant therapy lowers the risk of recurrence, it does not necessarily eliminate it. Along with staging, other sophisticated tools can help determine prognosis and help you and your doctor make decisions about adjuvant therapy. The website Adjuvant! Online (www.adjuvantonline.com) is one such 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 (such as Oncotype Dx, and Mammaprint; see Diagnosis) may be used to find out whether your doctor recommends adjuvant chemotherapy. When surgery to remove the cancer is not possible, chemotherapy, radiation therapy, hormone therapy, and/or targeted therapy may be used as the primary treatment. 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 status). Additional descriptions of the most common treatment options for breast cancer are listed below. Surgery Surgery is performed to remove the tumor in the breast and to evaluate the surrounding axillary (underarm) lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The types of surgery include the following:
Because men do not have much breast tissue, a lumpectomy, which remove only the tumor, is generally not an option. Lymph node removal and analysis Lymph nodes can trap cancer cells traveling away from the original tumor site. It is important to find out whether any of the lymph nodes near the breast contain evidence of cancer. In an axillary lymph node dissection, the surgeon removes many of the lymph nodes from under the arm, which are then examined by a pathologist for cancer cells. The actual number of nodes removed varies. Sentinel lymph node biopsy The sentinel lymph node biopsy procedure allows for the removal of one to a few lymph nodes, reserving a bigger axillary lymph node dissection procedure for patients whose sentinel lymph nodes show evidence of cancer. The smaller lymph node procedure helps patients lower the risk of lymphedema (swelling of the arm) and decreases arm mobility and range-of-motion problems. Learn more about preventing lymphedema after breast cancer treatment. In this procedure, the surgeon finds and removes the sentinel (first) lymph node (as a practical matter, one to three nodes) that receives drainage from the breast. The pathologist then examines it for cancer cells. To identify 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 emits radiation (if the tracer is used). If the sentinel node is cancer-free, research has shown that there is a good possibility that the subsequent nodes will also be free of cancer and no further surgery of the lymph nodes is performed. If the sentinel lymph node shows cancer is present, then the surgeon will perform an axillary lymph node dissection, removing additional lymph nodes to look for the presence of more cancer. Find out more about ASCO's recommendations for sentinel lymph node biopsy. Most patients with invasive cancer will undergo either sentinel lymph node biopsy or an axillary lymph node dissection. For those with sentinel nodes that indicate cancer, an axillary lymph node dissection is still considered the standard procedure. If there is obvious evidence of cancer in the lymph nodes before any surgery, then the preferred approach is a full axillary lymph node dissection without a sentinel lymph node biopsy. Summary To summarize, surgical treatment options include the following:
The most significant side effect of surgery is lymphedema (arm swelling), 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 incidence of lymphedema. Read more about preventing lymphedema. Learn more about cancer surgery. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill 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 implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a specific time. The lowest risks of cancer recurrence in the breast after lumpectomy are associated with the use of radiation therapy. Early randomized clinical trials showed, in general, recurrence rates of 30% or more without radiation therapy, compared with 10% recurrence rates with radiation therapy. After surgery, adjuvant radiation therapy is given regularly for a number of weeks after a lumpectomy to eliminate any remaining cancer cells near the tumor site or elsewhere within the breast. Adjuvant radiation therapy is also recommended for some patients after a mastectomy depending upon the size of their tumor, number of cancerous lymph nodes under the arm, and width of the tissue margin around the tumor removed by the surgeon. Adjuvant radiation therapy is effective in reducing the chance of breast cancer returning in both the breast and the chest wall. 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. Radiation therapy can cause side effects, including fatigue, swelling of the breast, and skin changes. A small amount of the lung can be affected by the radiation, although the risk of pneumonitis, or a radiation-related inflammation of the lung tissue is rare. In the past, with older equipment and techniques of radiation therapy, patients treated for left-sided breast cancers had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from radiation damage. Although exposure to radiation is thought to be a risk factor for cancer after many years, less than one in 500 survivors will develop a different kind of cancer other than a breast cancer (usually a type of cancer called sarcoma) within the area that was treated. Clinical trials comparing lumpectomy and adjuvant radiation therapy with mastectomy have not shown a difference in the number of patients developing or dying of other cancers within a 20-year time span. The most common type of radiation treatment is called external beam radiation therapy, which is radiation therapy given from a machine outside the body. Many types of radiation therapy may be available to you; talk with your doctor about the options, advantages, and disadvantages of these options. Radiation therapy schedule Standard radiation therapy after a lumpectomy is external-beam radiation therapy given daily for five days per week (Monday through Friday) for six to seven weeks. This usually includes radiation therapy to the whole breast first for four-and-a-half to five weeks, followed by a more focused treatment to the site of the tumor bed in the breast for the remaining treatments. This focused part of the treatment, called a boost, is standard for patients with invasive breast cancer to reduce the risk of a recurrence in the breast. If there is evidence of cancer in the underarm lymph nodes, radiation therapy may also be given to the lymph node areas in the neck or underarm near the breast or chest wall. Usually, patients who undergo mastectomy do not require radiation therapy. However, for patients with large cancers, many involved lymph nodes, or extension of cancer into the skin or chest wall, radiation may still be recommended after a mastectomy. Standard radiation therapy after a mastectomy is given to the chest wall for five days a week (Monday through Friday) for five to six weeks. Newer approaches to breast radiation therapy Several newer radiation treatment approaches are being studied in women, but have not been studied in very many men with breast cancer. Talk with your doctor for more information.
Learn more about radiation therapy. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Most people with breast cancer receive chemotherapy in their doctor's office or outpatient clinic. An adjuvant chemotherapy regimen consists of a specific treatment schedule of drugs given at repeating intervals for a specific number of times. Chemotherapy may be given intravenously (injected into a vein) or occasionally orally (by mouth), and is usually given in cycles. Chemotherapy may be given before surgery to both shrink a large tumor and reduce the risk of recurrence or adjuvant therapy given after surgery to reduce the risk of recurrence. Chemotherapy is also commonly given at the time of a metastatic breast cancer recurrence. Patients in clinical trials may be offered new drugs or new combinations of existing drugs. The side effects of chemotherapy depend on the individual and the drug and the dose used, but can include fatigue, hair loss, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers, but studies have shown that these side effects do not shorten a patient’s survival time. Different drugs are useful for different cancers, and research has shown that combinations of certain drugs are more effective than individual ones. The most common combinations for male breast cancer include:
Other chemotherapy that may be prescribed includes paclitaxel, docetaxel, vinorelbine (Navelbine), gemcitabine (Gemzar) and capecitabine (Xeloda). Trastuzumab (see Targeted therapy below) is used to treat HER2-positive breast cancer (see Diagnosis). Trastuzumab and lapatinib (Tykerb) are HER2-targeted therapies that may be given with chemotherapy in HER2-positive metastatic breast cancer. Bevacizumab (Avastin), a blood vessel blocking drug (called anti-angiogenic), is another targeted therapy approved in combination with chemotherapy in the treatment of metastatic breast cancer. (See the Targeted Therapy section below.) Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor 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. Hormone therapy Hormone therapy helps manage a tumor that tests positive for either estrogen receptors (ER) or progesterone receptors (PR) for both early-stage and metastatic cancer. Because more than 75% of breast cancers in men have estrogen receptors, hormone therapy is often part of the treatment plan. This type of tumor uses hormones to fuel its growth. Blocking the hormones usually limits the growth of the tumor. If it is determined that the tumor is hormone receptor-positive (uses estrogen or progesterone to grow [see Diagnosis]), then adjuvant hormone treatment may be used alone or after chemotherapy. Hormone therapies for men include:
Side effects of hormone therapy can include hot flashes, decreased sexual desire or ability, and mood swings. Targeted therapy Targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Currently the two main classes of biologically targeted therapy approved in breast cancer treatment are targeted to the HER2 molecule (HER2 targeted therapy) and the blood vessels in the area of the tumor (anti-angiogenic therapy). Learn more about targeted treatments. HER2 targeted therapy
Anti-angiogenic targeted therapy (blood vessel blocking therapy)
Anti-osteoclast targeted therapy (drugs that block bone destruction)
Learn more about bisphosphonates for breast cancer. Recurrent and metastatic breast cancer Breast cancer is called recurrent if the cancer has come back after it was first diagnosed and treated. 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 is frequently treatable. Some patients live years after a metastatic recurrence of breast cancer. The goal of treatment for advanced disease is to prolong survival and/or improve quality of life. Generally, a recurrence is detected when a person has symptoms. These symptoms depend on the site of the recurrence and may include:
Other symptoms may be related to the location of metastasis and may include changes in vision, changes in energy levels, feeling ill, or extreme fatigue. 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. 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 status).
Find out more about common terms used during cancer treatment. Clinical Trials Resources
Doctors and scientists are always looking for better ways to treat patients with breast cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a new approach to radiation therapy or surgery, a new method of treatment or prevention, ways to help patients manage symptoms, or improve a patient’s quality of life. Patients who participate in clinical trials are 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. 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 finding new drugs and other therapies is 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. Learn more about Clinical Trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for breast cancer, learn more in the Current Research section. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, infection, fatigue, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors and nurses also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your doctor which side effects are most likely to happen (and which are not), which need to be reported right away, when side effects are likely to occur, and how they will be addressed by the health care team if they do happen. Also, be sure to communicate with the doctor and nurses about side effects you experience during and after treatment. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them In addition to physical side effects, you may experience psychosocial (emotional and social) effects as well. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
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 (mastectomy or lumpectomy) to treat breast cancer, the breast may be scarred and may have a different shape or size than before surgery. If lymph nodes were removed as part of the surgery or affected during treatment, lymphedema (swelling of the hand and/or arm) may occur, and this is a life-long risk for patients. Read more about preventing lymphedema after breast cancer treatment 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 fibrosis (hardening or thickening) of the lungs. 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 (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 healthy living after cancer. Find out more about common terms used after cancer treatment is complete. Current Research
Research about breast cancer in men is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
Looking for More about Current Research? If you would like additional information about the latest areas of research regarding breast cancer in men, explore these related items:
Or, choose “Next” (below, right) to continue reading this detailed section. Questions to Ask the Doctor
Regular communication with your health care team is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
For additional questions, see the Guide to Breast Cancer. Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
