Although rare, males are at risk, too
Frank LaFasto remembers clearly the night in late June 1995 when he settled down with his wife to watch the news. She rested her head on his shoulder, placed her hand over his heart and said, “What’s this bump?”
She had found a small lump on the nipple of his left breast. LaFasto, a Lake Forest resident who was 46 at the time, initially thought the lump was scar tissue or a bruise from playing touch football or basketball. But when he mentioned it to his two sisters, they reminded him that their mother and aunt had breast cancer and encouraged him to see a doctor.
LaFasto made an appointment with David J. Winchester, MD, a surgical oncologist in Evanston at what is now NorthShore University HealthSystem. Winchester took a biopsy and shortly afterward told LaFasto the news: He had breast cancer.
“I thought it was a mistake because I did an hour’s run before I went to the hospital; I didn’t eat red meat or junk food, and I did everything right for my body,” LaFasto recalls. But there was no denying the truth. Two days later, Winchester performed a mastectomy on LaFasto.
Signs and symptoms
Breast cancer is rare in men. The American Cancer Society estimates that there will be 2,470 new cases of breast cancer in U.S. men in 2017 and about 460 men will die from it.
Shikha Jain, MD, a hematologist/oncologist at Northwestern Memorial Hospital, says that while some men who have breast cancer have no symptoms, the most common ones are:
- A painless lump or a stiffening or thickening of the breast.
- Changes in the skin such as puckering, dimpling, redness or a scaling rash that doesn’t go away.
- Changes in the nipple such as redness or scaling on or around it.
- An outward nipple that begins to turn inward.
- Discharge from the nipple.
Because many men are not aware that they can have breast cancer, they ignore the symptoms and don’t consult a doctor right away. As a result, the disease may not be diagnosed at an early stage.
While it is difficult for men to have a mammogram because they don’t have as much breast tissue as women, an ultrasound can easily pick up an abnormality. A biopsy is the next step to confirm the diagnosis.
Because many men are not aware that they can have breast cancer, they ignore the symptoms and don’t consult a doctor right away.”
There are fewer options for breast cancer surgery for men than for women, Winchester says. “Men’s breasts are anatomically smaller than women’s breasts, and breast cancers in men are almost always centrally located so there is no role for a lumpectomy,” he says. “The standard operation for treating early-stage breast cancer is a mastectomy. We also take a sample of the lymph nodes.” In addition to surgery, treatment may include radiation and chemotherapy. Men seldom choose breast reconstruction, he says.
Men whose breast cancers are sensitive to estrogen are treated with tamoxifen. They typically take the medication for five years, Jain says, though recent studies show a greater benefit when taken for 10 years in certain cases.
“Men are anxious about this drug because it can cause menopausal side effects such as hot flashes and mood swings, but we have over-the-counter and prescription drugs to manage those side effects,” she says. “It has been shown to reduce the reoccurrence of the cancer and also the occurrence of a second cancer.”
Risks and tests
The risk of breast cancer increases as men grow older, Jain says. Men are diagnosed with the cancer at the median age of 65 in African Americans and 68 in Caucasians. Men who have taken drugs with estrogen as part of treatment for prostate cancer or as part of gender reassignment therapy are also at risk.
Other risk factors include obesity or cirrhosis of the liver, both of which can increase estrogen levels; radiation for cancer in the chest area; an undescended testicle; having both testicles removed; or Klinefelter syndrome, in which an individual is born with two X chromosomes instead of one and higher levels of female hormones.
Men and women who carry mutations of the BRCA1 and BRCA2 genes that produce tumor suppressor proteins have an increased risk of breast cancer, as well. Men with BRCA mutations are also at a higher risk of prostate cancer and some other cancers.
When LaFasto was diagnosed with breast cancer, a test for BRCA mutations did not exist, but he knew he was at increased risk due to his family history. Two years after the mastectomy on his left side, he decided to have a prophylactic mastectomy on the right side to reduce the risk of the cancer reoccurring.
When he was eventually tested for the gene mutation, he learned that he had BRCA1, inherited from his mother. “My fears immediately evolved from worrying about myself to worrying about my five children,” LaFasto says. Sons and daughters of an individual with BRCA1 or BRCA2 mutations have a 50 percent chance of inheriting the parent’s mutation, according to the National Cancer Institute.
“I strongly recommend gene testing for men who have a history of breast cancer in their family,” Jain says. “Men should know how their breasts feel normally, so they can see a doctor when they recognize the symptoms of cancer. They also should exercise, adopt healthy eating habits and avoid alcohol and smoking to lower their risk.”
Catching cancer early is important, Jain says. “Since early detection of breast cancer is important, all men should be proactive about their health.”