Men's Health: Male Breast Cancer
The Borneo Post - Sunday, 1 September, 2002

Breast cancer in men is very rare, but it does happen. The biggest issue is that it is a largely unexpected disease ... and it's not something that's being looked for. As men are mainly unaware of breast cancer, they do not regularly or never examine themselves, and doctors may not examine the symptoms either. If men are concerned with breast anomalies, (in cases where they happened), they will generally delay seeing a physician. Many are unaware that men could develop breast cancer. The various types of breast cancer found in women are also diagnosed in men. Almost all breast cancers in men are carcinomas, which is the same for women. Researchers claim survival rates are the same for men and women at various stages of the disease but, mainly because male breast cancer is usually detected at a later date, the risk of fatality for men is higher.

There are three grades of breast cancer and men invariably develop grade three, the most aggressive form. Men are usually older than women at the time of diagnosis. Men are also less likely than women to develop subsequent cancer in the second breast, but are generally more likely than women to have had another type of cancer or to develop another type of cancer later.

ASSOCIATED FACTORS
Increased Oestrogen
Oestrogen is used to treat cases of prostate cancer, but the effects on cases of male breast cancer are minimal. Where large doses of oestrogen have been taken, such as in transsexual sex changes, the oestrogen doses have had a much greater impact on male breast cancer cases.

Kinefelter's Syndrome
Kinefelter's syndrome is a genetic chromosomal disorder producing an extra X chromosome. Men with the disease have a higher than normal count of oestrogen in their cells, have abnormalities in the sex organs and are about 20 times more likely than average to develop breast cancer.

Gynecomastia
Gynecomastia is the enlargement of the male breast not due to obesity. It is the growth of ducts and surrounding tissues and it is normal during puberty due to hormonal changes. It can also result from hormonal drugs such as oestrogen and non-hormonal drugs used in the treatment of high blood pressure, migraines, cardiovascular disorders and seizures. Gynecomastia is also a condition in Kinefelter's syndrome. There are many other reasons for the enlargement of the male breast though, including liver, kidney, thyroid, adrenal or testicle problems, especially in older age. However, male breast enlargement, especially in only one breast, may indicate something is wrong, and men who develop symptoms are urged to have them examined immediately.

Testicular Infection
It has been found that a number of male breast cancer patients also have a history of testicular infection, injury or undescended testes.

Radiation Exposure
As with female breast cancer, there has been a link with male breast cancer and past radiation exposure. For example, there are several cases of male breast cancer that have been cited where radiation and chemotherapy were used in the chest area as treatments in childhood.

MEN AT RISK
Older Men
The average age of men diagnosed with male breast cancer is 65 and it is quite rare in men before the age of 35.

Liver Disease
Liver disease is the most common marker for increased oestrogen in the body. The liver is responsible for the excretion of oestrogen that is naturally produced in men, so where liver dysfunction is present, the level of circulating oestrogen will rise. That will give increased oestrogen stimulation to the breast, and all the evidence is that in women, it's the major factor in the risk of breast cancer.

There needs to be significant impairment of the liver function, in particular, cirrhosis of the liver. Therefore, researchers also cite that men with a history of alcoholism may be at greater risk of developing breast cancer. In countries where malnutrition, parasites and infection affect the liver, such as in the Middle East and Africa, there is a higher percentage of cases compared with the US. For example, male breast cancer represents 6 percent of all breast cancer in Egypt and 15 percent in Zambia, compared with average rates of around one percent in the US. And interestingly, it has been found that people moving from one country to another will develop that country's incidence of breast cancer, linking development closely with diet and environment.

SYMPTOMS
Most male breast cancers are not very large. A painless lump under the nipple or surrounding the areola (brown pigment around the nipple) is by far the most common symptom, although soreness and/or itchiness of the area is also common. Another symptom is discharge from the nipple, more common in male cases of breast cancer than in women. Also, the nipple may discharge blood or may be inverted.

There may be other nipple changes such as thickening of the skin or inflammation. Enlarged breasts not due to puberty or weight gain (although these may be parallel symptoms) can be a sign, especially if the enlargement is unilateral, or in one breast only. This could, however, be unilateral gynecomastia. A malignant breast lump is more likely to be hard and irregular, whereas a condition from, say, gynecomastia will typically be a firm, well-defined and tender swelling.

SELF-TESTING AND DIAGNOSIS
Men need not carry out regular self­examinations like women, but should definitely be aware of any changes. The same diagnostic tools used for women are used for men - i.e., family history, examination and the mammogram. A definitive diagnosis can only be made through biopsy. Oestrogen tests may also be carried out and chromosome diagnosis may be called for if Kinefelter's disease is suspected. Medical experts will usually determine whether the cancer is from other parts of the body and has spread to the breast or whether the breast is the primary location, as this will determine the treatment. The testes may also be examined, as sometimes tumours in this region are responsible for breast enlargement.

TREATMENT
The treatment for male breast cancer is usually the same as for women, although often simpler for men because their breast mass is much smaller and male function and psychological effects are not as great. Usually the treatment is to have a full mastectomy including the nipple. Surgery is usual when the tumour is localised in the breast area. Other treatments may include radiation or chemotherapy, though it plays a secondary role. Orchidectomy (removal of the testes) has proved beneficial for some male breast cancer patients, as it causes tumours to shrink. Similarly, the removal of the adrenal glands and the pituitary gland and hormone therapy has achieved similar results.

HEALTH EFFECTS
There are side-effects of breast cancer treatments, where psychological area is most affected. Psychological problems for men stem from the fact that the condition is really rare and can lead to isolation and helplessness. As breast cancer is perceived as a female/hormonal disease, men may begin to suspect his masculinity: indeed, the treatment may involve surgical castration or taking feminising drugs. Also, loss of strength in the arm after mastectomy can lead in some men to an inability to perform at sports or manual labour. The biggest experience men would feel is what it says about their identity as men and about their sexuality because they would be perceived as - and may perceive themselves as - men who have developed a disease, which is seen as belonging to women.

COMPLEMENTARY THERAPIES
There has been very little research on alternative therapies for male breast cancer patients, apart from diet and positive mental attitude. However, there is some evidence that a reduction in fat intake or reduction of weight may reduce the likelihood of recurrence or advancement. That evidence is currently not very strong. As for positive mental attitude, there is in fact reasonably good evidence that, following a diagnosis of cancer, people who have an optimism about the future will survive longer than people who don't.

TREND
New research now points to other contributors such as environmental contamination from chemicals. A number of pesticides do have oestrogen-like actions and this has been shown to be responsible for things like infertility in some animal species and feminisation of fish. There is also indication of sperm count diminishing over time and male infertility is on the rise; this is speculated to be a consequence of increasing exposure to environmental oestrogen in various ways. Any trend like that might be expected to flow through into male breast cancer rates.

Male breast cancer is a small risk but it is there. It seems that the most crucial element in treating such cases successfully is that men know about the disease and have symptoms examined as early as possible. Experts' advice is that men should not delay seeing a doctor if they detect any enlargement or lump in either breast. Although the most common cause of breast enlargement in men is gynecomastia, any male who does experience a breast enlargement that is unilateral should have it checked out quickly.