Breast cancer in male

Breast cancer has long been perceived as a disease exclusive to women. Consequently, many people do not recognize that men can also develop breast cancer.

A recent report indicates that the incidence of male breast cancer has increased by 26% over the past 25 years and continues to show an upward trend. In Vietnam, a growing number of cases have also been reported.

Male breast cancer is often overlooked

Male breast cancer may be misdiagnosed as other breast-related conditions such as gynecomastia, breast abscess, metastatic lesions to the breast, or other primary non-breast malignancies.

Unlike breast cancer, gynecomastia typically presents with bilateral, symmetrical breast enlargement, poorly defined margins, no invasion into the chest wall, and no associated axillary lymphadenopathy.

Male breast cancer is less common than in females and usually occurs between the ages of 50 and 60, approximately 10 years later than in women, but tends to be more aggressive. Due to the underdeveloped male breast tissue, malignant cells can rapidly invade distant organs such as the liver, lungs, and bones.

In fact, male breast cancer can often be detected at an earlier stage compared to females. The most characteristic clinical sign is a firm mass located beneath the areola, sometimes in the upper outer quadrant of the breast, often associated with tenderness on palpation.

However, due to the misconception that men cannot develop breast cancer, abnormalities in the male breast are frequently overlooked, and routine breast screening is rarely performed.

By the time symptoms such as nipple retraction, skin ulceration, cutaneous invasion, fixation to the chest wall, or axillary lymphadenopathy appear, the disease is often already at an advanced stage. In more severe cases, metastasis may occur to the bones, liver, brain, and lungs.

Management of male breast cancer

The management of male breast cancer in early stages generally follows the same principles as in female breast cancer, including the following modalities:

Surgery: This is the primary treatment when the tumor is small and localized. The standard procedure is radical mastectomy without breast reconstruction or conservation. This differs from early-stage breast cancer management in women, as men have minimal breast tissue and tumors are typically located centrally.

Radiotherapy: In female breast cancer with nodal involvement, postoperative radiotherapy to the chest wall improves survival outcomes. In male patients, radiotherapy is particularly important due to the high rate of nipple and skin invasion, especially in those with more than four positive axillary lymph nodes or locally advanced disease.

Chemotherapy: Extensive data from female breast cancer demonstrate the benefits of systemic chemotherapy in improving treatment outcomes, and similar principles are applied in male patients.

Adjuvant radiotherapy or chemotherapy following surgery may last from 1 to 9 months, depending on the extent of disease. Hormonal therapy has also shown favorable outcomes in selected cases.

Male breast cancer tends to have a more aggressive clinical course and a poorer prognosis compared to female breast cancer. Overall survival rates are lower, particularly in older patients and those diagnosed at advanced stages.

Prognostic factors include age at diagnosis, disease stage, and the presence of lymph node metastasis.

In most cases, no clear risk factors are identified. However, some are associated with hormonal imbalances, a history of testicular disorders, family history of breast cancer, prior chest irradiation, or exposure to ionizing radiation.

Additionally, smoking, obesity, diabetes mellitus, and excessive alcohol consumption are associated with an increased risk. Therefore, maintaining a healthy lifestyle and undergoing regular health check-ups, including breast cancer screening in men, are key to early detection and improved outcomes.

Note: The information provided is for reference purposes only and does not replace professional medical diagnosis or treatment.

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