Male Breast Cancer
While breast cancer primarily affects women, thousands of men are diagnosed with the disease in the United States each year.
The five-year survival rate for male breast cancer is slightly lower than for female breast cancer. There are a number of different reasons for the lower survival rate. One is patient age, and the health challenges that come with that. At the time of diagnosis, the average age for a male breast cancer patient is 67, versus age 62 for females.
In addition, male breast cancer is typically more advanced when it is diagnosed. The tumor tends to be larger and the cancer is more likely to have spread to regional lymph nodes. Doctors attribute these later diagnoses to a general lack of awareness of male breast cancer, as well as the absence of widespread screening for the disease.
Types of male breast cancer
Like female breast cancer, male breast cancer can be classified by the molecular receptor status of the cancer cells.
Receptors are molecules that cancer cells produce on their surface. They can bond with, or recognize, specific proteins and hormones in the patient’s body. Researchers have identified receptors that fuel the growth of breast cancer cells when they bond with a specific protein or hormone. Interrupting this bond with cancer drugs can slow or stop the disease’s growth.
The three main receptor types for breast cancer (in both men and women) are:
- HER2-positive, a protein that promotes cell growth and multiplication. HER2-positive cancers have much higher levels of the HER2 protein than normal.
- Hormone receptor-positive, which recognizes the hormones estrogen and progesterone.
- Triple-negative, which doesn’t recognize HER2, estrogen or progesterone. Because there is no molecular receptor to interrupt, this is the most difficult breast cancer subtype to treat.
About 90% of breast cancers in men are hormone receptor-positive, while another 9% are both hormone receptor-positive and HER2-positive.
Male breast cancer risk factors
Anything that increases the chance of a person developing cancer is a risk factor. Doctors have identified several risk factors for male breast cancer.
- BRCA mutations: Normal BRCA1 and BRCA2 genes suppress the development of tumors. People with a mutated BRCA gene have a higher risk of breast cancer. Between 8%-15% of male breast cancer patients have a BRCA mutation, compared to 5%-10% of female breast cancer patients. In addition to causing breast cancer, BRCA mutations are also linked to ovarian cancer, pancreatic cancer and melanoma.
- Family history of breast cancer: The risk of breast cancer is doubled for men who have a parent, sibling or child with the disease.
- Age: As men age, their chances of developing breast cancer increases.
- Obesity
- Gynecomastia, or enlarged breasts caused by a hormone imbalance or certain medications
- Radiation exposure, often as part of treatment for another cancer
- Race: African-American men have a higher risk of male breast cancer than non-Hispanic white men.
Male breast cancer symptoms
The symptoms of male breast cancer are very similar to symptoms of breast cancer in women. They include:
- Lump or mass in the breast
- Lump or mass in the armpit
- Breast skin changes, including skin redness and thickening of the breast skin, resulting in an orange-peel texture
- Dimpling or puckering on the breast
- Discharge from the nipple
- Scaliness on nipple, which sometimes extends to the areola
- Nipple changes, including the nipple turning inward, pulling to one side or changing direction
- An ulcer on the breast or nipple, sometimes extending to the areola
- Swelling of the breast
Male breast cancer diagnosis
The first diagnostic procedure for male breast cancer is typically an imaging exam. Breast imaging is usually carried out with a mammogram or ultrasound. Occasionally, doctors will use magnetic resonance imaging (MRI) or other specialized examinations. Learn more about imaging exams.
Biopsy
If the imaging exam shows an unusual or suspicious mass or skin thickening, doctors will need a tissue sample to make a definitive diagnosis. The process of retrieving and examining this tissue under a microscope is called a biopsy.
For breast cancer, patients usually undergo an image-guided core needle biopsy. During this procedure, a live image of the breast tissue is used help doctors guide the needle to the suspected cancer tissue. In many cases, this biopsy is performed during the initial imaging exam in order to speed up the diagnosis.
If the biopsy reveals cancerous tissue, additional images and biopsies may be needed to determine the exact scope of the disease. This part of the diagnosis shows whether the cancer has spread to nearby lymph nodes or other parts of the body.
Molecular diagnosis
If the patient is diagnosed with breast cancer, doctors will also analyze the cancer cells to determine the disease’s molecular receptor subtype. By understanding the subtype, they can develop a comprehensive, personalized treatment plan.
Male breast cancer treatment
Treatment for male breast cancer is very similar to treatment for female breast cancer. Options include surgery, chemotherapy, radiation therapy and targeted therapy.
Because of the small breast size, most male breast cancer patients who get surgery undergo a full mastectomy (the removal of the entire breast) instead of a lumpectomy (the removal of just the tumor and a small amount of surrounding tissue).
Male breast cancer is extremely rare. About 1% of breast cancers in the United States occur in males. But certain men do run the risk of getting breast cancer. Men who are at risk, or who have symptoms of breast cancer, may need to get a mammogram.
We talked to Gary Whitman, M.D., in Breast Imaging about male breast cancer and what men can expect during a mammogram. Here’s what he had to say.
How do men get mammograms?
A mammogram is an X-ray of the breast tissue done on a special machine that compresses the tissue for an accurate image.
During the exam, the breast technologist will adjust and compress each breast to get the best picture. Each breast will be positioned on top of a plate or paddle. They will move a top plate down, pressing the breast between the two plates. They will then move the plates and compress the breast tissue from the side. The technologist will adjust your breast once it's compressed to ensure the best image.
Even though men have less breast tissue than women, with fewer ducts and lobules, mammograms for men and women are much the same. If there’s a small amount of breast tissue, it’s sometimes not a great fit with the imaging device, but we do the best that we can.
At MD Anderson, we do a lot of imaging of men. We’re used to handling them, and we have techniques to get a good image.
For the best image, and to reduce the risk of having to come back for a second mammogram, do not wear deodorant, powders, lotions or scents on the day of your mammogram. They can appear as an abnormality on the image.
Who should get a mammogram for male breast cancer?
You should talk to your doctor about getting a mammogram if you have symptoms of male breast cancer.
The most common symptom of breast cancer in men is a lump or a mass in the breast. Often this turns out to be gynecomastia, or simply a concentration of male breast tissue that can be felt through the skin. The best way to find out if it is harmless is to get a mammogram.
Other symptoms of male breast cancer include nipple discharge, nipple pain and changes in the look or feel of the skin on the breast. That can include redness, an orange-peel appearance, change in color, dimpling or puckering.
Having one or more of these symptoms does not mean you have breast cancer. But it is a sign that you should talk to your doctor, especially if it lasts two weeks or more.
Should men with a family history of breast cancer get a mammogram?
If you have a strong family history of breast cancer or a family history that indicates a genetic mutation that increases breast cancer risk, talk to your doctor about genetic counseling to get a better picture of your risk. Once your risk is determined, your doctor may recommend a mammogram.
A strong family history means you have a first-degree relative (mother, father, sibling, child) with early-onset breast cancer, breast cancer in both breasts or ovarian cancer. Any of these may indicate that you have inherited a BRCA1 or BRCA2 gene mutation that raises your breast cancer risk, as well as your risk for prostate cancer.
What should transgender individuals know about male breast cancer and mammography?
If you have transitioned from one gender to another, or are in the process, it’s important to share as much information as possible with your doctor, especially regarding surgeries and hormone medications.
If your doctor recommends you get a mammogram, it also is important to share this information with your technologist to ensure the most accurate image.
For these patients, we want to make sure that the intake and the examination are done in a sensitive, patient-focused manner.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Teresa and Billy Mayo have shared almost everything during their 46-year marriage. But the couple recently shared something they never anticipated: breast cancer.
Teresa was diagnosed in 2018, and Billy in 2020.
“We thought we were done with breast cancer when Teresa finished treatment,” Billy says. “It never occurred to me that I could get breast cancer, too.”
Mammogram signals the first signs of trouble
The couple's story began in December 2017, when Teresa visited her local hospital for a routine mammogram.
“I faithfully got mammograms every December,” she says. “They were always normal – until that one.”
The images showed a suspicious area in the outer portion of Teresa’s left breast.
To confirm or rule out cancer, she underwent a core needle biopsy. This procedure uses ultrasound images to guide a special biopsy needle into the breast tumor. An attached vacuum device suctions tissue from the tumor into the needle, and the samples are sent to the lab for analysis. The results would be available in five to seven days, the radiologist said.
“How could I possibly wait that long?” Teresa asks. “I was like a cat on a hot tin roof.”
Three days later, her family doctor phoned with an unexpected request: “Can you drop by my office? We need to talk.”
“That’s the moment I knew I had breast cancer,” Teresa says.
Teresa’s invasive lobular carcinoma diagnosis
With Billy by her side, Teresa listened intently as the doctor shared her diagnosis: invasive lobular carcinoma, a type of cancer that begins in the milk-producing glands (lobules) of the breast, then invades the surrounding breast tissue. Teresa would need surgery.
“My mind immediately jumped to MD Anderson,” she recalls.
Instead of following up on her doctor’s referral to a local surgeon, she went home and filled out MD Anderson’s online self-referral form.
“MD Anderson is the top-rated cancer hospital in the country,” she says. “That’s where I wanted to be.”
In good hands at MD Anderson The Woodlands
Teresa’s first appointment was at MD Anderson The Woodlands, just 13 miles from her home north of Houston. When she arrived, she was anxious and didn’t know what to expect.
“I asked God to give me a sign that everything would be OK,” she recalls.
At that moment, a woman who attends Teresa’s church rounded the corner. The two were surprised to see each other. As fate would have it, the woman was a nurse who worked with Craig Kovitz, M.D., Teresa’s new oncologist.
“I started to relax,” Teresa says. “I knew I was in good hands.”
MRI produces surprise results
Kovitz spelled out Teresa’s treatment plan: surgery to remove the tumor and reconstruct her breast, followed by radiation to destroy any individual cancer cells that may have remained in the breast after the tumor was removed.
Because the stage I cancer was caught early, Teresa would likely not need chemotherapy. The surgeon would biopsy the lymph nodes near her breast just to make sure. If they were cancerous, chemotherapy would be added to her treatment plan.
“When cancer cells break away from a tumor, they can travel to the lymph nodes. Lymph fluid carries them to other areas of the body, where new tumors can form,” Kovitz explains. “That’s why it’s important to check lymph nodes during breast cancer surgery.”
Teresa underwent an MRI to prepare for surgery. The image measured the grape-sized tumor in her breast at 3.6 centimeters – not the pea-sized 1.3 centimeters reported by her local hospital.
“Lobular breast cancer is difficult to visualize on a mammogram,” says Kovitz. “Instead of forming a distinct lump, it grows in flat sheets or as single cells arranged in a line. It takes special skills to envision and accurately measure a tumor of this type.”
Lumpectomy, breast reconstruction and radiation therapy
Using the new images for guidance, Teresa’s surgical team biopsied the lymph nodes closest to her breast. They were cancer-free. She could skip chemotherapy.
Surgeons next removed the cancerous tissue from her breast through a lumpectomy, a procedure that removes only the tumor plus a small amount of the healthy tissue surrounding it. This ensures that all the abnormal tissue is eliminated.
“Lumpectomy is an effective treatment option for early-stage breast cancer like Teresa’s,” Kovitz explains. “The goal is to remove the cancer while conserving as much of the breast as possible.”
A month after the lumpectomy, Teresa returned to MD Anderson, where plastic surgeons used tissue from her healthy, right breast to reconstruct the missing area in the left one.
“I was very pleased with the results, Teresa says. “Everything looks proportional, and even better than before cancer.”
Then came the final step – six radiation therapy treatments, delivered by radiation oncologist Valerie Reed, M.D.
By the time Teresa’s treatments ended, all signs of cancer were gone.
“Billy and I celebrated,” she recalls. “We thought cancer was in our rear-view mirror, but we soon learned we were wrong.”
Billy’s male breast cancer diagnosis
Only five months after Teresa’s treatment ended, Billy was diagnosed with breast cancer.
“It happened last October when I was drying off after my shower,” he recalls. “Teresa walked into the bathroom, put her hands on my shoulders, and said ‘don’t move.’”
Standing before her husband, Teresa looked intently at his right breast, then his left.
“Your right nipple is inverted,” she said. “Don’t you ever look in the mirror? Haven’t you noticed something’s wrong?”
“I’m a guy,” Billy responded. “I only look in the mirror when I shave or comb my hair.”
Using the pads of her fingers, Teresa felt one breast, then the other. She felt a thickened area in the right breast.
She called the couple’s family doctor, who ordered a mammogram, ultrasound and biopsy.
“Billy and I had an overwhelming feeling of déjà vu,” Teresa says. “We’d been down this road before.”
The doctor called at 7:30 on a Friday night with the results.
“We knew what that meant,” Billy says.
Billy had stage II ductal carcinoma, a form of breast cancer that begins in the milk ducts.
“Many people are surprised to learn that male breasts have milk ducts,” the doctor explained. “However, men lack adequate levels of the hormone prolactin needed to make milk.”
The tumor was just over 3 centimeters large – about the same size as Teresa’s, but more aggressive. It had already invaded more than half the surrounding breast tissue.
“Teresa and I could hear our doctor fighting back tears,” Billy says. “We’ve known her for decades. She’s not only our doctor, but also our friend.”
The moment the call ended, he turned to Teresa. “Well, you know where we’re going,” he said.
“Of course, I do,” Teresa responded. “We’re heading back to MD Anderson.”
Returning to MD Anderson The Woodlands for male breast cancer treatment
The route to MD Anderson The Woodlands was a familiar one.
“I’d taken Teresa dozens of times,” Billy says. “Not only did I know how to get there, but I knew where to park and where the breast clinic was located.”
Giancarlo Moscol, M.D., Billy’s oncologist, recommended a complete mastectomy, followed by 16 chemotherapy sessions and 30 radiation treatments. The entire treatment plan would take nine months to complete.
Mastectomy and lymph node removal
Two weeks later, breast surgeon Elizabeth FitzSullivan, M.D., removed Billy’s right breast. She also removed 40 lymph nodes after finding the cancer had spread.
Four hours after the operation, Billy sat up in bed and ate dinner. That evening, he walked around the hospital floor for 30 minutes. At 5:30 the next morning, he took another half-hour walk, then packed to go home.
“I never needed anything stronger than Tylenol,” he says of his pain level.
Chemotherapy, radiation and a clean bill of health
After recovering at home for six weeks, Billy returned to the hospital to begin chemotherapy. Kovitz prescribed AC-T, a combination of the chemotherapy drugs doxorubicin and cyclophosphamide, followed by treatment with paclitaxel.
A nurse helped Billy prepare for his first infusion.
“I read her nametag, and realized her husband was in the Knights of Columbus men’s church group with me,” Billy says. “Teresa and I have a knack for bumping into MD Anderson nurses who attend our church. We find it comforting.”
With his Hawaiian shirts and straw hat, Billy was a popular figure in the infusion unit. His iconic handlebar moustache fell out after a few treatments. He vowed to regrow it.
“I felt naked without it,” he says.
Despite the COVID-19 pandemic and an ice storm in February, Billy completed all 16 weeks of chemotherapy infusions on time this May. Halfway through, it occurred to him that he should retire from designing and building chemical plants – a job he had held more than four decades.
“I asked myself, ‘I’m 67 years old, why am I still working?’” he says.
“Battling breast cancer is a job in itself.”
Billy’s treatment ended this past July when he completed two months of radiation therapy under the care of radiation oncologist Pamela Schlembach, M.D.
Celebrating being cancer-free
Like Teresa, Billy today shows no evidence of cancer.
To celebrate, the couple are looking forward to visiting their granddaughters, Maggie, 7, and Rosie, 2, in Virginia. Both are fully vaccinated against COVID-19. Recently, they received a third booster dose of the vaccine in preparation for their trip.
“We haven’t seen our granddaughters in two years due to cancer and COVID-19 travel restrictions,” Teresa says. “We can’t wait to hug and squeeze them.”
Advice from a male breast cancer survivor
Teresa and Billy will continue returning to MD Anderson for regular checkups. They each take a daily oral medication to reduce the chances of cancer returning.
Billy now encourages all men, regardless of their health status, to check their breasts each month.
“If you don’t know how, ask your doctor or your spouse to show you,” he says. “Breast cancer is not just a woman’s disease. Men have breasts, too, and we can get cancer.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.