Male Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all

breast cancers occur in men. In 2005, when 211,400 women
were diagnosed with breast cancer in the United States, 1,690
men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they
get breast cancer? The truth is that boys and girls, men and
women all have breast tissue. The various hormones in girls'
and women's bodies stimulate the breast tissue to grow into full
breasts. Boys' and men's bodies normally don't make much of
the breast-stimulating hormones. As a result, their breast tissue
usually stays flat and small. Still, you may have seen boys and
men with medium-sized or big breasts. Usually these breasts
are just mounds of fat. But sometimes men can develop real
breast gland tissue because they take certain medicines or
have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available

to study. Most studies of men with breast cancer are very small.
But when a number of these small studies are grouped
together, we can learn more from them.

The Risk Factors for Male Breast

Cancer
It's important to understand the risk factors for male breast
cancer—particularly because men are not routinely screened
for the disease and don't think about the possibility that they'll
get it. As a result, breast cancer tends to be more advanced in
men than in women when it is first detected.

A number of factors can increase a man's risk of getting breast

cancer:

• Growing older: This is the biggest factor. Just as is the

case for women, risk increases as age increases. The
median age of men diagnosed with breast cancer is about
67. This means that half the men who are diagnosed are
over 67, and half are under.
• High estrogen levels: Breast cell growth—both normal
and abnormal—is stimulated by the presence of estrogen.
Men can have high estrogen levels as a result of:
o Taking hormonal medicines.
o Being overweight, which increases the production of
estrogen.
o Having been exposed to estrogens in the
environment (such as estrogen and other hormones
fed to fatten up beef cattle, or the breakdown
products of the pesticide DDT, which can mimic the
effects of estrogen in the body).
o Being heavy users of alcohol, which can limit the
liver's ability to regulate blood estrogen levels.
o Having liver disease, which usually leads to lower
levels of androgens (male hormones) and higher
levels of estrogen (female hormones). This increases
the risk of developing gynecomastia (breast tissue
growth that is non-cancerous) as well as breast
cancer.
• Klinefelter syndrome: Men with Klinefelter syndrome
have lower levels of androgens (male hormones) and
higher levels of estrogen (female hormones). Therefore,
they have a higher risk of developing gynecomastia
(breast tissue growth that is non-cancerous) and breast
cancer. Klinefelter syndrome is a condition present at birth
that affects about 1 in 1,000 men. Normally men have a
single X and single Y chromosome. Men with Klinefelter
syndrome have more than one X chromosome (sometimes
as many as four). Symptoms of Klinefelter syndrome
include having longer legs, a higher voice, and a thinner
beard than average men; having smaller than normal
testicles; and being infertile (unable to produce sperm).
• A strong family history of breast cancer or genetic
alterations: Family history can increase the risk of breast
cancer in men—particularly if other men in the family
have had breast cancer. The risk is also higher if there is a
proven breast cancer gene abnormality in the family. Men
who inherit abnormal BRCA1 or BRCA2 genes (BR stands
for BReast, and CA stands for CAncer) have an increased
risk for male breast cancer. This risk of developing breast
cancer by age 70 is approximately 1% with the BRCA1
gene and 6% with the BRCA2 gene. Overall, that's about
 80 times greater than the lifetime risk of men without
BRCA1 or BRCA2 abnormalities. Still, the majority of male
breast cancers happen in men who have no family history
of breast cancer and no inherited gene abnormality.
• Radiation exposure: Having radiation therapy to the
chest before age 30, and particularly during adolescence,
may increase the risk of developing breast cancer. This
has been seen in young people receiving radiation to treat
Hodgkin's disease. (This does NOT include radiation
therapy to treat breast cancer.)

One study found that male breast cancer is on the rise, with a
25% increase over the 25 years from 1973 to 1988. But it's still
rare. It's unclear whether the reported rise means the disease
is slowly becoming more common, or whether men better
understand the symptoms and report their symptoms, leading
to diagnoses that might have been missed in the past.

If you notice any persistent changes to your breasts, you should

contact your doctor. Here are some signs to watch for:

• a lump felt in the breast

• nipple pain
• an inverted nipple
• nipple discharge (clear or bloody)
• sores on the nipple and areola (the small ring of color
around the center of the nipple)
• enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts

(not just on one side) is usually NOT cancer. The medical
term for this is gynecomastia. Sometimes the breasts can
become quite large. Non-cancer-related enlargement of
the breasts can be caused by medications, heavy alcohol
use, weight gain, or marijuana use.

A small study about male breast cancer found that the

average time between first symptom and diagnosis was
19 months, or over a year and a half. That's a very long
time! This is probably because people don't expect breast
cancer to happen to men, so there is little to no early
detection.
 Earlier diagnosis could make a life-saving difference. With
more research and more public awareness, men will learn
that—just like women—they need to go to their doctor
right away if they detect any persistent changes to their
breasts.

Diagnosis of Male Breast Cancer

After an abnormality of the breast is found, tests are performed
to see if the problem is cancer. One or all of these tests might
be done:

• Mammogram: A mammogram is an X-ray picture of the

breast. Two pictures are taken of the breast after it is
compressed between two glass plates. One image is shot
from the top and the second picture is taken from the side.
A radiologist will look at the pictures and determine if
anything looks abnormal. He or she may then decide to
get other pictures of a certain area. These are called spot
or magnification views.
• Ultrasound: Ultrasound sends high-frequency sound
waves through your breast and converts them into images
on a viewing screen. Ultrasound complements other tests.
If an abnormality is seen on mammography or felt by
physical exam, ultrasound is the best way to find out if the
abnormality is solid (such as a benign fibroadenoma, or
cancer) or fluid-filled (such as a benign cyst). Ultrasound
cannot determine whether a solid lump is cancerous.
• Nipple discharge examination: If you have nipple
discharge, some of the fluid may be collected and
examined under a microscope to see if any cancer cells
are present.
• Biopsy: A biopsy is necessary to distinguish normal tissue
from cancer tissue. If cancer is present, the biopsy also
helps your doctors zero in on the size, type, and kind of
breast cancer. Biopsies are performed on any kind of
abnormality that your doctor can feel or that looks
suspicious. (Because most breast cancers in men are
discovered by feeling something abnormal, it's highly
unusual to find an abnormality only by mammography or
another imaging modality.) Various techniques are used to
biopsy tissue, and it's likely that your surgeon will try to
 use the least invasive procedure possible while making
sure that enough tissue is removed to make a clear
diagnosis.
• Needle biopsy of palpable lesions (lesions that can be
felt) is least invasive. It can be done in the doctor's office.
Results are often available in 24 hours. A long, thin, hollow
needle is placed in the palpable abnormality. The tissue is
then sent off to pathology for analysis. If the lesion is only
seen by mammography or another test, then your doctor
may need the help of this test to guide the needle to the
right place. Cells are extracted through the center of the
needle. A collapsible hook at the end of the needle keeps
the needle in place until the surgery is done. X-rays verify
that the abnormal area seen on the original X-rays is the
same area into which the surgeon inserts the needle. This
biopsy technique has the highest risk of a "false
negative"—a biopsy result that says "normal," even
though a cancer is present. The reason for this is probably
that the needle doesn't always pick up the cancer cells.
• Stereotactic needle biopsy: (core biopsy) removes
multiple pieces of a lesion. If the lesion can't be felt, the
needle is guided to the area of concern with the help of
mammography or ultrasound. If a cancer is only found by
MRI (magnetic resonance imaging), then needle biopsy
may be guided by that technique. A small metal clip may
be inserted into the breast to mark the site of biopsy in
case the biopsy proves cancerous and additional surgery
is required. But since most men diagnosed with breast
cancer have mastectomy, a clip is usually unnecessary
since the whole breast is removed.
• Incisional biopsy: is more like regular surgery— it
removes a bigger piece of tissue than a fine needle biopsy
or a core biopsy. Often, incisional biopsies are done when
needle biopsies are inconclusive or if the lump is too
extensive or too big to be removed easily. The purpose of
this procedure is to make a diagnosis. Because it only
takes out part (not all) of the cancer, it is not a treatment.
In men, once a breast cancer diagnosis is made,
mastectomy is usually done.
• Excisional biopsy: is the most involved kind of biopsy. It
attempts to remove the entire suspicious lump of tissue
from the breast. This is the surest way to establish the
 diagnosis without missing the cancer tissue (winding up
with a false negative). Removing the entire lump may also
provides you some peace of mind until the final treatment
plan is put in place. Both incisional and excisional biopsies
can be done in an outpatient center or hospital, using local
anesthesia. The purpose of this procedure is to make a
diagnosis. Even if the lumpectomy takes out all of the
cancer in the breast with clear margins, if breast cancer is
diagnosed, mastectomy is usually done.

If a cancer diagnosis is made, your doctor might recommend

more tests. For example, an MRI can show how much cancer is
in the affected breast relative to the normal tissue right under
and next to the breast cancer. This information may help the
surgeon plan the extent of surgery. Plus, an MRI can help
evaluate the other breast to see if it's OK. Other tests, such as
blood work, chest X-ray, and bone scan, might be done to see if
the cancer has spread to other parts of the body.

Research News on Male Breast Cancer

Men less likely to survive early breast cancer
Last Updated: 2007-05-09 16:39:58 -0400 (Reuters Health)

NEW YORK (Reuters Health) - While breast cancer is far more

common in women than in men, men may be more likely to die
from early-stage breast tumors, a new study suggests.

Male breast cancer is rare, accounting for less than 1 percent of

all breast cancers. But unlike the case with breast cancer in
women, there have been no improvements in survival the past
30 years in men with this disease.

The rarity of breast cancer in men has prevented clinical trials,

and treatment is based on what's known about female breast
cancer.

But the new findings, published in the journal Cancer, suggest

that there may be biological differences in male and female
breast cancers that affect survival. Specifically, men with
relatively small tumors or tumors that had not yet spread to the
lymph nodes had a shorter survival time than their female
counterparts.

Among men whose breast cancer had not spread to the lymph
nodes, the typical survival time was 6 years, compared with
nearly 15 years among women.

The difference suggests a need for better understanding of

male breast cancer, and improved treatments, according to Dr.
Zeina A. Nahleh and her colleagues at the University of
Cincinnati.

The researchers based their findings on a large cancer registry

maintained by Veterans' Affairs. They reviewed the records of
612 men treated for breast cancer and compared them with
2,413 women treated for the disease.

While Nahleh's team found no difference in survival times of

men and women with more-advanced breast cancer, they did
find one among patients with earlier-stage tumors.

When it came to treatment, men had lower rates of both

chemotherapy and radiation than women did, but they were as
likely as women to receive hormone therapy.

Hormonal therapies for breast cancer, such as the drug

tamoxifen, block the ability of estrogen to fuel tumor growth. As
in women, men's breast tumor cells often have receptors for
estrogen, which means hormone therapy can be helpful.

However, Nahleh and her colleagues write, it's possible that

men's breast tumors do not respond well to standard therapy
with tamoxifen.

"A better understanding of this disease is needed," they

conclude, "so that new opportunities for therapeutic
intervention may be developed."

What breastcancer.org says about this article

Breast cancer is rare in men, but it does happen. According to

the study reviewed here, men diagnosed with early-stage
breast cancer are more likely to die from the cancer than
women diagnosed with early-stage disease. Men with early-
stage disease survived about 6 years, while women survived
about 15 years. (For people with advanced breast cancer at
diagnosis, men and women had the same survival times.)

There are a number of possible reasons for the difference in

survival, including:
• Genetic or biological differences between the breast cancers in men and
the breast cancers in women. This means that male breast cancers may
develop, grow, and spread differently than female breast cancer. Breast
cancer in men also may respond differently to treatment than breast
cancer in women.
• Differences in when breast cancer is diagnosed. Diagnosing early breast
cancer in men may take longer compared to diagnosis in women.
• Treatment needs. Because breast cancer is rare in men, it's hard to study
the best way to treat it. Most male breast cancer treatments are modeled
on treatments for women. A different approach may be needed.

Men with breast cancer risk second cancer, too

Last Updated: 2007-01-25 15:05:49 -0400 (Reuters Health)

WASHINGTON (Reuters) - Men who have survived breast cancer

have a higher risk of a second cancer than most other men,
U.S. researchers reported on Thursday.

They said men who have had breast cancer need to be closely
watched for new cancers, particularly of the breast, stomach
and skin.

Breast cancer will be diagnosed in 2,030 men in the United

States alone this year and kill 450 of them, according to the
American Cancer Society.

Sacha Satram-Hoang and colleagues at the University of

California at Irvine looked at California cancer statistics from
1988 to 2003. Of the 1,926 diagnosed with breast cancer for
the first time, 221 or 11.5 percent were diagnosed with a
second new cancer -- not a spread of the original tumor -- after
their breast cancer diagnosis.

They were especially prone to breast, colorectal, bladder and

stomach cancers and melanoma, Satram-Hoang and colleagues
wrote in the journal Breast Cancer Research.
"Our study shows that men diagnosed with a first primary
breast cancer have a 16 percent increased risk of developing a
new primary cancer in comparison with men in the general
population," the researchers wrote.

The earlier the men developed cancer, the higher their risk of a
second cancer.

The researchers said it is not clear why.

The men could have a genetic mutation that puts them at risk,
such as BRCA1 and BRCA2 mutations. "Male tumors related to
BRCA1 and BRCA2 include breast, melanoma, stomach,
prostate, colon and pancreatic cancer," they wrote.

The men could also be exposed to some environmental or

occupational cause of cancer, or there could be other
differences, such as obesity, which is linked with some cancers.

What breastcancer.org says about this article:

Breast cancer is a rare disease in men, but it does happen. The

study reviewed here found that men diagnosed with breast
cancer were 16% more likely than men without breast cancer to
develop another, new cancer. For some men, the second cancer
was a new breast cancer (not spread from the first breast
cancer). Other men in the study developed another type of
cancer, including colon, bladder, stomach, and skin cancer. The
study couldn't say why men who had breast cancer had a
higher risk of a second cancer.

There are factors that increase the risk of breast cancer in men.
These include a family history of breast cancer, genetic
mutations, obesity, alcohol, and using hormonal medicines. It's
likely that these and other unknown factors increase a man's
risk of cancer, including breast cancer. The challenge to doctors
is to identify these unknown risk factors for cancer. When the
risk factors are known and understood, men AND women will
have the hope that they can more effectively lower their risk of
all forms of cancer, including breast cancer.
สีแดง เอาไว้พูดตอนพรีเซน เพราะมันเหมือนสรุปเนื้อหาของ research ไว้