Breast cancer in men

Breast cancer in men is rare. Each year, about 375 men are diagnosed with breast cancer in the UK.

Breast cancer can develop in the small amount of breast tissue behind the nipples.

In this video, Clinical Oncologist Bernadette Lavery talks you through:

• what breast cancer is
• the main types
• risk factors
• stages
• common treatments available to you

This content has been written for men, transgender (trans) women and people assigned male at birth.

There are different types of breast cancer, and knowing which type you have helps the doctors plan the best treatment for you.

Most breast cancers in men are invasive. This means the cancer cells have spread outside the lining of the ducts of the breast and into the tissue around it. Invasive breast cancer itself comes in different types.

Breast cancer of "no special type" is what doctors call it when the cancer cells look under the microscope as though they have no specific features. You may also see it written as "NST" or "not otherwise specified" (NOS).

It's also known as invasive ductal carcinoma, and it is the most common type of breast cancer. About 7 to 8 out of 10 of all breast cancers (70 to 80%) are this type.

Some breast cancer cells have features that mark them out as a particular kind of breast cancer. Doctors call these "special type" breast cancers, and they name them by how the cells look under a microscope.

The types include:

• tubular
• medullary
• mucinous
• cribriform

Men can get other types of invasive breast cancer too, but these are very rare.

Invasive lobular breast cancer is rare in men, because men have very few lobules in their breasts, if any at all.

Inflammatory breast cancer happens when cancer cells grow along the tiny channels in the skin of the breast (the lymph vessels) and block them. The breast then becomes inflamed and swollen.

Inflammatory breast cancer is rare.

Paget's disease of the breast causes a scaly rash on the skin of the nipple, much like eczema. In men, Paget's disease is rare.

The most common symptom of breast cancer in men is a painless lump under the nipple or areola. The areola is the darker area around the nipple.

Other symptoms may include:

• a nipple turning in (inverted nipple)
• changes in the size or shape of the breast
• an eczema-like rash on the nipple
• discharge or bleeding from the nipple
• a swelling or lump in either armpit
• an ulcer on the skin of the breast

You know how your chest area normally looks and feels. If you notice any change, see your doctor straight away. When breast cancer is diagnosed and treated early, treatment is likely to be more successful.

In the video, Phil and Nellie talk about their own experiences of being diagnosed with breast cancer. They also discuss some of the common misconceptions around breast cancer.

Doctors don't know the exact cause of breast cancer in men. But some things can raise the chance of developing it, and these are called risk factors.

Breast cancer in men is rare, so most men who have these risk factors will never develop breast cancer.

If you have symptoms of breast cancer, you'll usually start by seeing your doctor. They'll examine you and then refer you to a breast clinic, where you can see a specialist.

At the breast clinic, you'll see a specialist breast doctor or nurse, and you may see both.

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 that, they'll explain which tests you need.

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

An ultrasound scan uses sound waves to build up a picture of the breast tissue. The doctor spreads a gel on the skin and moves a small device across the area.

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

A mammogram is a low-dose X-ray of the breast tissue, and it's done by a radiographer.

You'll need to take off your top. Most often you'll stand for the mammogram, or sit upright. The radiographer will position you so your chest is against the X-ray machine. Your breast tissue is then pressed firmly with a flat, clear, plastic plate. This keeps the tissue still and helps get a clear picture.

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

If the biopsy shows breast cancer cells, you'll need some more tests before treatment starts.

You may have blood samples taken. These check your general health and how well your kidneys and liver are working.

You may also have an X-ray of your chest, so the doctors can check your lungs and heart.

Other tests may be done as well, to:

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

These may include the following tests.

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

A bone scan picks up areas of bone that look abnormal.

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

A CT scan takes a series of X-rays and builds them up into a three-dimensional picture of the inside of your body.

The stage of a cancer tells you its size and how far it has spread, and it's worked out from your test results.

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

Your cancer doctor and nurse will explain what your test results mean. You and your doctor then decide on your treatment plan together.

Breast cancer in men can have receptors on the outside of its cells. Hormones such as oestrogen can attach to these 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 for receptors. The cells are taken during a biopsy or surgery. The results 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 have small amounts of the hormones oestrogen and progesterone in your body, and 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, and they respond well to hormonal therapy.

The extra HER2 protein on some cancer cells encourages them to divide and grow. This is called HER2 positive breast cancer, and it is uncommon in men.

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

You'll usually be offered genetic testing for breast cancer in men, even if no one in your family has had breast cancer. That's because men with breast cancer have a higher risk of carrying a gene change, which is also called a mutation.

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

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

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

Your doctors look at several 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), which isn't common in men

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

For most men, the main treatment for early breast cancer in men is surgery to remove the cancer. There are a few types of surgery.

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 of the normal breast tissue around it are removed.

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

You may also need support when dealing with changes to your body after surgery.

Some men with breast cancer have chemotherapy, targeted therapy or hormonal therapy before the operation. Doctors call this neo-adjuvant treatment, and it isn't needed for everyone, only sometimes.

Adjuvant treatment is the treatment you have after surgery for breast cancer in men. Your cancer doctor will usually offer you one or more of the following.

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.

You can read more in Macmillan Cancer Support's treatment overview. Macmillan Cancer Support also has more information on cancer treatment options and on getting organised before cancer treatment.

After treatment for breast cancer in men, 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. Eventually you may have them once a year.

If you notice any new symptoms between appointments, 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, where you can talk to others affected by cancer, ask questions and share your experience

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

Your breast care nurse or cancer doctor can tell you what to expect and what to look out for. You also need to know what to watch for in the untreated breast area.

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

Lymphoedema is a swelling of the arm or hand on the side where 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 the treatment.

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

You may have had only 1 or 2 lymph nodes removed. This is called a sentinel lymph node biopsy, and the risk of lymphoedema after it is low. 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.

Cancer and the treatments for it can sometimes affect your sex life. They can also affect your fertility, which is your ability to make someone pregnant.

Breast cancer in men, and the treatments and side effects that come with it, may affect your sex life and the way you feel about yourself.

You may have:

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

These difficulties often improve slowly after treatment, though it may take longer for some people. Others may continue to have difficulties. There are many different ways to help manage this, and your doctor or nurse can give you further help and support.

Some breast cancer treatments can affect a man's fertility, so it helps to know what to expect.

Certain chemotherapy drugs can leave you unable to make someone pregnant (infertile). If you're taking hormonal therapy drugs, you may find it hard to get or keep an erection. This is usually temporary, and you may still be able to make someone pregnant. Some hormonal therapy drugs can also reduce the number of sperm you produce.

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. Many men find it helps to talk about their feelings with a trained counsellor. If you need more specialist help, ask your cancer doctor or breast care nurse to arrange it for you.

If you're being treated for breast cancer as a man, you're likely to have different feelings to cope with along the way. You may also worry about practical things like work or money.

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

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

Even if your lifestyle is already healthy, you may choose to make some positive changes after treatment. Small changes, like eating well and keeping active, can improve your health and wellbeing and help your body recover.