Breast cancer in men

What causes breast cancer in men?

The exact cause of breast cancer isn't known. But some things can raise the chance of developing it. These are called risk factors.

Breast cancer in men is rare, so most men with these risk factors will never actually develop it.

Diagnosing breast cancer in men

If you have symptoms, you’ll usually start by seeing your GP. They’ll examine you and refer you to a breast clinic to see a specialist.

At the breast clinic

At the clinic, you’ll see a specialist breast doctor or nurse. You may also see a specialist breast nurse.

They’ll usually ask you if:

• you have had any other breast or health problems
• anyone in your family has had breast cancer or ovarian cancer

The doctor or nurse will examine your chest area. They’ll also check the lymph nodes in your armpits and above your collarbone. After this, they’ll explain which tests you need.

Tests

After your examination, your doctor or nurse will tell you what tests you need. These may include the following tests.

Breast ultrasound

An ultrasound uses sound-waves to build up a picture of the breast tissue. A gel is spread onto the area and a small device is moved across it.

You may also have an ultrasound scan of the lymph nodes in the armpit. If any of the nodes feel swollen or look abnormal on the ultrasound, the doctor will take a biopsy of them.

Mammogram

A mammogram is a low-dose X-ray of the breast tissue. It’s done by a radiographer.

You’ll need to take off your top for the mammogram. You’ll usually have the mammogram standing up or in an upright position.The radiographer will position you so your chest is against the X-ray machine. Your breast tissue is then firmly pressed with a flat, clear, plastic plate. This keeps the breast tissue still and helps get a clear picture.

You may find this uncomfortable or painful. But it should only last for as long as the mammogram takes. You’ll need to stay still while the picture is taken.

Breast biopsy

There are different ways you may have a biopsy.

A biopsy is when a doctor removes a small piece of tissue or a sample of cells from the lump or abnormal area. The sample is then checked for cancer cells.

The types of biopsy usually used include:

• fine needle aspirate (FNA)
• needle core biopsy
• excision biopsy

Macmillan Cancer Support have more information about types of breast biopsy.

Test results

You may have many of the tests on the same day. But you’ll usually have to wait up to 2 weeks for some results. You may also need to come back to the hospital for further tests.

Macmillan Cancer Support have more information on waiting for test results.

Further tests after diagnosis

If the biopsy results show breast cancer cells, you’ll need more tests before you start treatment.

You may have blood samples taken. This is to check your general health and to see how well your kidneys and liver are working.

You may have an X-ray of your chest to check your lungs and heart.

You may also have other tests to:

• find out more about the size and position of the cancer
• see if it has spread to other parts of the body

This may include the following tests.

MRI (magnetic resonance imaging) scan

An MRI scan uses magnetism to build up detailed pictures of your body.

Bone scan

A bone scan shows up abnormal areas of bone.

You’ll have a small amount of a radioactive substance injected into a vein. Then you’ll wait 2 or 3 hours before you have the scan. After 24 hours, your body will have got rid of the radioactivity in your urine.

CT scan

A CT scan takes a series of X-rays, which build up a three-dimensional picture of the inside of the body.

PET or PET-CT scan

A PET-CT scans uses low-dose radiation to check the activity of cells in different parts of the body.

The results will help you and your doctor decide on the best treatment.

Waiting for test results can be a difficult time. Macmillan Cancer Support have more information on waiting for test results.

Staging and grading of breast cancer in men

The stage of cancer describes its size and how far it has spread, based on your test results.

The grade of a cancer describes how cancer cells look compared with normal cells. This gives an idea of how quickly the cancer might grow or spread.

Your cancer doctor and nurse will explain the results of the tests and what they mean. Together you and your doctor decide on your treatment plan.

Receptors for breast cancer in men

Breast cancer cells may have receptors on the outside of the cells. Hormones, like oestrogen, can attach to the receptors and encourage the cells to grow.

Some breast cancer cells have too much of a protein called human epidermal growth factor receptor 2 (HER2) on their surface.

A doctor called a pathologist tests cancer cells taken during a biopsy or surgery for receptors.

The result help you and your doctor decide on the most effective treatment for you.

Hormones help control how cells grow and what they do in the body. You’ll have small amounts of the hormones oestrogen and progesterone in your body. Oestrogen can encourage breast cancer cells to grow.

Most oestrogen is made from male sex hormones (androgens). The testicles make a small amount.

Breast cancer that has oestrogen receptors is called oestrogen receptor positive or ER positive breast cancer. The term ER is used because the American spelling of oestrogen is estrogen. Some hospitals also check whether the cancer cells are progesterone receptor positive (PR positive).

Most breast cancers in men are ER positive. They respond well to hormonal therapy.

Some breast cancer cells have too much of a protein called HER2 on the surface. The extra HER2 protein encourages the cancer cells to divide and grow. This is called HER2 positive breast cancer.

HER2 positive breast cancer is uncommon in men.

Cancer that doesn’t have receptors for either HER2 or the hormones oestrogen and progesterone is called triple negative breast cancer.

Genetic testing

You’ll usually be offered genetic testing, even if you don’t have a family history of breast cancer. This is because men with breast cancer have an increased risk of having a gene change. This is also called a mutation.

A mutation is a change in a gene that can run in families (be inherited). In inherited breast cancer, BRCA1 and BRCA2 are the 2 genes usually found to have a change. Your cancer doctor or breast care nurse can explain more about this to you.

If you’re worried about breast cancer in your family, talk to your GP or breast specialist. They can refer you to a family history clinic or a genetics clinic.

Treatment for breast cancer in men

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctors look at different factors to help decide which treatments are likely to work best for you. These include:

• the stage and grade of the cancer
• whether the cancer cells have oestrogen receptors (are ER positive)
• whether the cancer cells have HER2 receptors (are HER2 positive) – this isn’t common in men

Your cancer doctor and breast care nurse will explain about the different treatments. They can help you make decisions about your treatment.

Macmillan Cancer Support have more information in their treatment overview.

For most men, the main treatment for early breast cancer is surgery to remove the cancer. Types of surgery for breast cancer include the following.

A mastectomy is when the whole breast is removed. This is the most common type of surgery for breast cancer in men.

Breast-conserving surgery (wide local excision) is where the cancer and some surrounding normal breast tissue is removed.

Your surgeon will usually remove some or all the lymph nodes in your armpit. Or you may be offered radiotherapy to the lymph nodes instead.

Macmillan Cancer Support have more information about having your operation. You may also need support when dealing with changes to your body after surgery.

Treatment before surgery

Before the operation, you may sometimes have chemotherapy, targeted therapy or hormonal therapy. This is called neo-adjuvant treatment.

Treatment after surgery (adjuvant treatment)

Adjuvant treatment is treatment you have after surgery. Your cancer doctor will usually offer you one or more of the following treatments:

Hormones help control how cells grow and what they do in the body. The hormone oestrogen can encourage some breast cancers to grow.

Hormonal therapy is given if the breast cancer is ER positive. The most commonly given hormonal therapy for men is Tamoxifen.

Radiotherapy uses high-energy rays. You may have it to the chest wall after surgery.

If you had a wide local excision, you’ll usually have radiotherapy to the remaining breast tissue.

Some men may also have radiotherapy to the lymph nodes in the armpit or the lower part of the neck.

Chemotherapy uses different drugs to treat breast cancer. It may be given before or after surgery.

Targeted therapies interfere with the way cells grow. They can reduce the risk of HER2 breast cancer coming back.

Read more information in Macmillan Cancer Support’s treatment overview.

Macmillan Cancer Support have more information on cancer treatment options and getting organised before cancer treatment.

After breast cancer treatment

After treatment, you’ll have check-ups with your cancer doctor or regular contact with your nurse.

At first, your check-ups may be every few months. But eventually you may have them once a year.

If you notice any new symptoms between appointments, it’s important to contact your doctor or nurse for advice. They’ll give you contact numbers so you don’t have to wait until your next appointment.

Instead of regular appointments, your nurse may give you information about what to look out for. They will give you contact numbers and ask you to contact them or your cancer doctor if there’s anything you’re worried about.

You may have your follow-up appointments at a nurse-led clinic. This means you’ll only go to your cancer doctor if something needs to be checked further.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan online community – you can talk to others affected by cancer, ask questions and share your experience

Be aware of changes

You may have regular check-ups, but it’s still a good idea to know what is now normal for you. The treated side of your chest will look and feel different. This will depend on the treatment you have had.

Your breast care nurse or cancer doctor can tell you what to expect and what to look out for. It’s also important to be aware of what to look out for in your untreated breast area.

If you notice anything unusual, contact your cancer doctor or breast care nurse straight away.

Lymphoedema

Lymphoedema is a swelling of the arm or hand on the side you had treatment. It sometimes happens after surgery or radiotherapy to the lymph nodes in the armpit. It usually develops slowly, months or years after treatment.

Lymphoedema is more likely to happen if all or many of your lymph nodes were removed. Having radiotherapy to the armpit as well as surgery increases the risk.

You may have had only 1 or 2 lymph nodes removed. This is called a sentinel lymph node biopsy. The risk of lymphoedema is low after this. If you’re not sure what type of lymph node surgery you had, your breast care nurse can tell you.

If you notice any swelling in your arm, hand or chest, ask your doctor or nurse to check it. The earlier lymphoedema is diagnosed, the easier it is to manage and treat successfully.

Sex and fertility

Cancer and its treatments can sometimes affect your sex life or your ability to make someone pregnant (your fertility).

Sex

Breast cancer and its treatments and side effects may affect your sex life and your feelings about yourself.

You may have:

• loss of sex drive (low libido)
• erection difficulties (erectile dysfunction or ED)

Difficulties often slowly improve after treatment, but it may take longer. Some people may continue to have difficulties. There are lots of different ways to help manage this.

Macmillan Cancer Support have more information about sex and cancer. You can also talk to your doctor or nurse for further help and support.

Fertility

Some breast cancer treatments may affect your fertility.

Some chemotherapy drugs can make you unable to make someone pregnant (infertile).

If you’re taking hormonal therapy drugs, you may have trouble getting or keeping an erection. This is usually temporary, and you may still be able to make someone pregnant. But some hormonal therapy drugs can reduce the number of sperm you produce.

It’s important to talk to your cancer doctor about your fertility before treatment starts. It may be possible to store sperm before treatment begins.

Becoming infertile can be very hard to cope with, whether or not you already have children. You may find it helpful to talk about your feelings with a trained counsellor. If you need more specialist help, ask your cancer doctor or breast care nurse to arrange this for you.

Contraception

Your doctor will advise you not to make someone pregnant while having some types of breast cancer treatments and for some time afterwards. They’ll explain which drugs may affect sperm, which may harm a developing baby.

It’s important to use effective contraception. You can talk about this with your doctor or nurse.

Macmillan Cancer Support have more information on finishing cancer treatment.

Secondary breast cancer in men

Secondary breast cancer is when cancer cells spread from the breast to other parts of the body. Cancer that starts in the breast is called primary breast cancer.

For many people, primary breast cancer never comes back after treatment. But sometimes cancer cells spread to other parts of the body through the blood or the lymphatic system.

Breast cancer cells that have spread may begin to grow and form another tumour. This is called a secondary breast cancer or metastatic breast cancer.

The most common places for breast cancer to spread to are the:

• bones
• lungs
• liver
• brain
• skin

This doesn’t mean that secondary breast cancer will spread to all of these places.

The symptoms of secondary breast cancer depend on where in the body the cancer has spread. These symptoms can be caused by other conditions. But tell your GP, cancer doctor or specialist nurse if you have any.

Always tell them if you develop new symptoms, especially if they last more than 2 weeks.

Macmillan Cancer Support have more information on how secondary breast cancer symptoms may be managed.

Treatment for secondary breast cancer in men

Treatments for secondary breast cancer depend on where in the body the cancer has spread to.

The main treatments to control secondary breast cancer are:

• hormonal therapy for breast cancer that’s ER positive
• chemotherapy
• targeted therapy
• radiotherapy to relieve pain from secondary breast cancer in the bone

Radiotherapy can also be used to shrink secondary cancer in the brain or lymph nodes.

You may have single or combined treatments one after the other to keep the cancer under control. This is called lines of treatment. You may have other treatments to control symptoms.

Macmillan Cancer Support have more information about treatments for secondary breast cancer.

Wellbeing

You’re likely to have different feelings to cope with during treatment. You may also be worried about practical issues like work or finances.

It’s important to take care of yourself. This may include:

• getting enough rest
• trying to keep physically active
• eating healthily

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes to the way you live like eating well and keeping active can improve your health and wellbeing and help your body recover.

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