Male breast cancer: traditionally under-diagnosed and under-researched, but hopefully that’s changing
For several reasons, including potential social stigma and a significantly smaller number of patients, male breast cancer has never had anywhere close to the awareness and research commitment that’s seen for women affected by breast cancer. An article in the New York Times in September 2019 highlighted these disparities in research and clinical studies, reporting on recent FDA guidelines encouraging increased participation by men in breast cancer trials. However, with the announcement in October 2019 that Mathew Knowles, Beyonce’s father, was being treated for breast cancer, there has been an increased focus in the media on male breast cancer. With this increased awareness will hopefully come many of the benefits seen with awareness around breast cancer in women, including men with breast masses seeking more timely medical attention and more research support for male breast cancer.
Among the many misconceptions around breast cancer in men is that presentation and treatment are the same as for women. While there are some similarities, there are many differences, primarily related to the fact that men do not receive screening mammograms and have an increased chance of having a genetic cause for their breast cancer. To address some of these issues, I was fortunate enough to sit down to discuss male breast cancer with Robert Warren, MD, MBA, and professor of medicine and co-director of the Betty Lou Ourisman Breast Health Center at Georgetown (he also happens to be my dad!).
Here’s our interview on presentation and evaluation of breast cancer in men, treatment options, and the importance of genetic testing after diagnosis:
Dr. Anne Peled: What are some common presenting symptoms of male breast cancer?
Dr. Robert Warren: The most common symptom is a mass in the breast, followed by breast pain. Men may also notice changes in their skin or nipple appearance.
AP: What should men do if they feel a mass in one of their breasts?
RW: They should first see their primary care provider for a clinical exam. Based on findings, their providers may recommend breast imaging and/or referral to a breast surgeon.
AP: Is breast imaging for men who have a breast mass the same as for women?
RW: Similar to women, men with a breast mass are typically recommended to have both a mammogram and an ultrasound. Solid breast masses in men have a characteristic appearance on both imaging studies, which would prompt a biopsy if the masses looked at all suspicious.
AP: When men get breast cancer, do they do as well as women if appropriately treated?
RW: In the past, it was thought outcomes after male breast cancers were the same. However, more recent studies have shown that outcomes may be worse in men than women, which is likely related to the fact that men are often diagnosed at later stages because they are not getting regular screening like women. Men with breast masses may not get them evaluated as quickly, which can lead to late diagnoses and potentially larger masses and lymph node involvement. Still, in general, when caught early, men diagnosed with breast cancer have overall very good outcomes.
AP: What is the usual treatment for breast cancer in men?
RW: Breast cancer surgery for men usually involves mastectomy and lymph node biopsy. Some men may be candidates for skin-sparing or nipple-sparing mastectomy. Radiation may be recommended after mastectomy but is not typically needed. Male breast cancer is even more likely than breast cancer in women to be hormone receptor-positive, so nearly all men receive a hormone-blocking medication called tamoxifen after surgery. Some men may be recommended to have chemotherapy, which is decided based on tumor factors and genomic testing results similar to how it is determined in women.
AP: If men are diagnosed with breast cancer, should they and other family members undergo genetic testing?
RW: Yes, all men diagnosed with breast cancer should have a genetic evaluation, as men with breast cancer have an increased chance of gene mutations such as BRCA2 mutations. Depending on testing results, other family members may be recommended to have testing as well.