White Coat, Black Art·Dr. Brian's BLOG

A closer look at men who get breast cancer

You may not know this but a small percentage of men get breast cancer. A new study sheds light on intriguing findings on how men and women are treated differently for it.
In this Feb. 8, 2004 photo, singer Beyoncé arrives at the 46th Annual Grammy Awards with her father and manager Mathew Knowles in Los Angeles. He recently went public with his breast cancer diagnosis. (Mark J. Terrill/Associated Press)

Mathew Knowles, the father of superstar Beyoncé, went public last week with his breast cancer diagnosis. A new study provides some new insights on the treatment and prognosis of such men.

Fewer than one per cent of breast cancers occur in men. October is Breast Cancer Awareness Month.

In Monday's issue of  the journal Cancer, a team led by Dr. Kathryn Ruddy at the Mayo Clinic in Rochester, Minn., examined the records of 10,873 men diagnosed with Stage 1 to Stage 3 breast cancer between 2004 and 2014. Nearly a quarter of the men had breast-conserving surgery, and 70 per cent of those patients also got radiation. Forty-four per cent of patients received chemotherapy.

About 62 per cent of patients whose tumours were estrogen-receptor positive received anti-estrogen therapy. That means they were given drugs like tamoxifen. However, in this study, the researchers were not able to determine whether the men received tamoxifen or another anti-estrogen medication.

The study's authors made some intriguing findings about the differences in how men and women are treated for breast cancer.

More than two-thirds of the men with breast cancer had a mastectomy. This is in marked contrast to women with breast cancer. Other studies have shown that two-thirds of women have breast-conserving surgery and only one-third undergo mastectomy.

Mastectomy differences

The authors of the study said they aren't certain why men are more likely to have a mastectomy. One possible explanation is that, compared to women, men may not be as concerned about getting a good cosmetic result. Another factor is that male breast cancers are usually so close to the nipple area that the nipple must be removed. Alternatively, the smaller breast size in men means that all breast tissue cannot be removed with adequate margins of tissue that are free of cancer.

In the study, the five-year survival rate in men across all stages of breast cancer was 79.1 per cent. By contrast, the Canadian Cancer Society says the overall five-year survival rate for women is 88 per cent.

The study also found that black men, older men, and those with multiple unrelated illnesses, high tumour grade and stage had worse overall survival. Those who underwent total mastectomy also fared worse.

Better treatment standards

Patients who live in higher income areas had longer survival. So did men with progesterone-positive tumours. Those who got chemotherapy lived longer, as did those who got radiotherapy. Those who received anti-estrogen medications like tamoxifen also had longer survival.

As partly reflected in the study, treatment standards have changed over time. Over the 10-year study period, significantly more men underwent total mastectomy. Those who had breast-conserving surgery were more likely to undergo radiation. More men got anti-estrogen medications such as tamoxifen.

Like women, some men are at risk of recurrence of breast cancer in the other breast. For that reason, a growing number of men diagnosed with cancer are having the other (non-affected) breast removed at the time surgery. As is the case with women, a growing number of men with breast cancer are undergoing genetic testing to determine whether or not to recommend chemotherapy. But the benefit of that approach will only be clear after researchers unpack the results of long-term studies.

Male breast cancer is most common in men over the age of 60, though it can occur at any age.

The symptoms and signs of breast cancer in men are similar to those in women, including:

  • A painless lump or thickening in the breast tissue.
  • Changes to the skin covering the breast, such as dimpling, puckering, redness or scaling.
  • A redness or scaling of the nipple.
  • Sometimes, the nipple begins to turn inward. There may be blood or discharge coming from the nipple.

Like women, men who have any of these symptoms should see their doctor.

Breast cancer is (fortunately) rare in men. But that doesn't mean the symptoms should be ignored.

About the Author

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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