Male Breast Cancer Treatment (PDQ®)–Health Professional Version

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General Information About Male Breast Cancer

Incidence and Mortality

Estimated new cases and deaths from breast cancer (men only) in the United States in 2019:[1]

New cases: 2,670.
Deaths: 500.

Male breast cancer is rare.[2] Fewer than 1% of all breast carcinomas occur in men.[3,4] The mean age at diagnosis is between 60 and 70 years; however, males of all ages can be affected with the disease.

Anatomy

Risk Factors

Predisposing risk factors for male breast cancer appear to include the following:[5,6]

Radiation exposure to breast/chest.
Estrogen use.
Diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter syndrome.
Family health history: Definite familial tendencies are evident, with an increased incidence seen in men who have a number of female relatives with breast cancer.
Major inheritance susceptibility: An increased risk of male breast cancer has been reported in families with BRCA mutations, although the risks appear to be higher with inherited BRCA2 than with BRCA1 mutations.[7,8] Genes other than BRCA may also be involved in predisposition to male breast cancer, including mutations in the PTENtumor suppressor gene, TP53 mutations (Li-Fraumeni syndrome), PALB2 mutations, and mismatch repair mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome).[9-11] (Refer to the High-Penetrance Breast and/or Gynecologic Cancer Susceptibility Genes and Management of Male Carriers of BRCA Pathogenic Variants sections in the PDQ summary on Genetics of Breast and Gynecologic Cancersfor more information.)

Clinical Features

Signs of breast cancer in men may include the following:

A lump or thickening in or near the breast or in the underarm area.
A change in the size or shape of the breast.
A dimple or puckering in the skin of the breast.
An inverted nipple.
Fluid from the nipple, especially if it is bloody.
Scaly, red, or swollen skin on the breast, nipple, or areola.
Peau d’orange.

Diagnostic Evaluation

When breast cancer is suspected, patient management generally includes the following:

Confirmation of the diagnosis.
Evaluation of the stage of disease.
Selection of therapy.

The following tests and procedures are used to diagnose breast cancer:

Clinical breast examination.
Mammography.
Ultrasonography.
Breast magnetic resonance imaging, if clinically indicated.
Biopsy, including estrogen-receptor and progesterone-receptor status and HER2/neugene amplification of the biopsy sample.[12]

(Refer to the Diagnosis section in the PDQ summary on Breast Cancer Treatment for information about evaluating the contralateral breast and molecular profiling [estrogen-receptor and progesterone-receptor status and human epidermal growth factor receptor 2 (HER2/neu) expression status of the tumor].)

Histopathologic Classification

The pathology of male breast cancer is similar to that of female breast cancer, and infiltrating ductal cancer is the most common tumor type (refer to Table 1).[13] Intraductal cancer, inflammatory carcinoma, and Paget disease of the nipple have also been seen in men, but lobular carcinoma in situ has not.[13]

Lymph node involvement and the hematogenous pattern of spread are similar to what is observed in female breast cancer.

Table 1. Tumor Location and Related Histologic Subtypes for Male Breast Cancer

Tumor Location	Histologic Subtype
NOS = not otherwise specified.
Carcinoma, NOS
Ductal	Intraductal (in situ)
	Invasive with predominant component
	Invasive, NOS
	Comedo
	Inflammatory
	Medullary with lymphocytic infiltrate
	Mucinous (colloid)
	Papillary
	Scirrhous
	Tubular
	Other
Lobular	Invasive [14]
Nipple	Paget disease, NOS
	Paget disease with intraductal carcinoma
	Paget disease with invasive ductal carcinoma
Other	Undifferentiated carcinoma
Other	Metaplastic

Prognosis and Predictive Factors

Factors that correlate well with prognosis include the following:[5,15]

Size of the lesion.
Presence or absence of lymph node involvement.

Overall survival is similar to that of women with breast cancer. The impression that male breast cancer has a worse prognosis may stem from the tendency toward diagnosis at a later stage.[2,5,16]

References

American Cancer Society: Cancer Facts and Figures 2019. Atlanta, Ga: American Cancer Society, 2019. Available online Exit Disclaimer. Last accessed January 23, 2019.
Giordano SH, Cohen DS, Buzdar AU, et al.: Breast carcinoma in men: a population-based study. Cancer 101 (1): 51-7, 2004. [PUBMED Abstract]
Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992. [PUBMED Abstract]
Fentiman IS, Fourquet A, Hortobagyi GN: Male breast cancer. Lancet 367 (9510): 595-604, 2006. [PUBMED Abstract]
Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002. [PUBMED Abstract]
Hultborn R, Hanson C, Köpf I, et al.: Prevalence of Klinefelter's syndrome in male breast cancer patients. Anticancer Res 17 (6D): 4293-7, 1997 Nov-Dec. [PUBMED Abstract]
Wooster R, Bignell G, Lancaster J, et al.: Identification of the breast cancer susceptibility gene BRCA2. Nature 378 (6559): 789-92, 1995 Dec 21-28. [PUBMED Abstract]
Thorlacius S, Tryggvadottir L, Olafsdottir GH, et al.: Linkage to BRCA2 region in hereditary male breast cancer. Lancet 346 (8974): 544-5, 1995. [PUBMED Abstract]
Ding YC, Steele L, Kuan CJ, et al.: Mutations in BRCA2 and PALB2 in male breast cancer cases from the United States. Breast Cancer Res Treat 126 (3): 771-8, 2011. [PUBMED Abstract]
Silvestri V, Rizzolo P, Zanna I, et al.: PALB2 mutations in male breast cancer: a population-based study in Central Italy. Breast Cancer Res Treat 122 (1): 299-301, 2010. [PUBMED Abstract]
Boyd J, Rhei E, Federici MG, et al.: Male breast cancer in the hereditary nonpolyposis colorectal cancer syndrome. Breast Cancer Res Treat 53 (1): 87-91, 1999. [PUBMED Abstract]
Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005. [PUBMED Abstract]
Burstein HJ, Harris JR, Morrow M: Malignant tumors of the breast. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1401-46.
Yeatman TJ, Cantor AB, Smith TJ, et al.: Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg 222 (4): 549-59; discussion 559-61, 1995. [PUBMED Abstract]
Cutuli B, Lacroze M, Dilhuydy JM, et al.: Male breast cancer: results of the treatments and prognostic factors in 397 cases. Eur J Cancer 31A (12): 1960-4, 1995. [PUBMED Abstract]
Ravandi-Kashani F, Hayes TG: Male breast cancer: a review of the literature. Eur J Cancer 34 (9): 1341-7, 1998. [PUBMED Abstract]

Stage Information for Male Breast Cancer

The AJCC staging system provides a strategy for grouping patients with a similar prognosis. The stage of the disease is determined by the following:

Tumor size.
Lymph node status.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
Human epidermal growth factor receptor 2 (HER2/neu) status in the tumor.
Tumor grade.

Treatment decisions are based on the stage of disease and the general health of the patient.

The TNM (tumor, node, metastasis) staging system for male breast cancer is identical to the staging system for female breast cancer. (Refer to TNM Definitions in the Stage Information for Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)