General Information about Male Breast Cancer
Stages of Male Breast Cancer
Recurrent Male Breast Cancer
Treatment Option Overview
Treatment Options

Initial Surgery Adjuvant Therapy Distant Metastases

Treatment Options for Locally Recurrent Disease
Changes to This Summary (12/16/2003)
To Learn More
About PDQ

General Information about Male Breast Cancer

Key Points for This Section

Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Radiation exposure, high levels of estrogen, and a family history of breast cancer can affect a man’s risk of developing breast cancer. Male breast cancer is sometimes caused by inherited gene mutations (changes). Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men. Survival for men with breast cancer is similar to survival for women with breast cancer. Certain factors affect prognosis (chance of recovery) and treatment options.

Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

Breast cancer may occur in men. Men at any age may develop breast cancer, but it is usually detected (found) in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer.

The following types of breast cancer are found in men:

• Infiltrating ductal carcinoma: Cancer that has spread beyond the cells lining ducts in the breast. Most men with breast cancer have this type of cancer.
• Ductal carcinoma in situ: Abnormal cells that are found in the lining of a duct; also called intraductal carcinoma.
• Inflammatory breast cancer: A type of cancer in which the breast looks red and swollen and feels warm.
• Paget’s disease of the nipple: A tumor that has grown from ducts beneath the nipple onto the surface of the nipple.

Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast), which sometimes occurs in women, has not been seen in men.

Radiation exposure, high levels of estrogen, and a family history of breast cancer can affect a man’s risk of developing breast cancer.

Risk factors for breast cancer in men may include the following:

• Exposure to radiation.
• Having a disease related to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter’s syndrome (a genetic disorder).
• Having several female relatives who have had breast cancer, especially relatives who have an alteration of the BRCA2 gene.

Male breast cancer is sometimes caused by inherited gene mutations (changes).

Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men.

A doctor should be seen if changes in the breasts are noticed. Typically, men with breast cancer have lumps that can be felt. A biopsy can be done to check for cancer. The following are different types of biopsies:

• Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle aspiration biopsy.
• Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
• Excisional biopsy: The removal of an entire lump or suspicious tissue.

After the tissue or fluid has been removed, a pathologist views it under a microscope to check for cancer cells.

Survival for men with breast cancer is similar to survival for women with breast cancer.

Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer (whether it is in the breast only or has spread to other places in the body).
• The type of breast cancer.
• Certain characteristics of the cancer cells.
• Whether the cancer is found in the other breast.
• The patient’s age and general health.

Stages of Male Breast Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Breast cancer in men is staged the same as it is in women. (Refer to the PDQ summary on Breast Cancer Treatment ¹ for more information.) The spread of cancer from the breast to lymph nodes and other parts of the body appears to be similar in men and women.

Recurrent Male Breast Cancer

Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.

Treatment Option Overview

Key Points for This Section

There are different types of treatment for men with breast cancer. Four types of standard treatment are used to treat men with breast cancer: Surgery Chemotherapy Hormone therapy Radiation therapy Other types of treatment are being tested in clinical trials.

There are different types of treatment for men with breast cancer.

Different types of treatment are available for men with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site ². Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used to treat men with breast cancer:

Surgery

Surgery for men with breast cancer is usually a modified radical mastectomy (removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles). Some of the lymph nodes under the arm may also be removed and examined under a microscope.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials.

Information about ongoing clinical trials is available from the NCI Cancer.gov Web site ².

Treatment Options

Breast cancer in men is treated the same as breast cancer in women. (Refer to the PDQ summary on Breast Cancer Treatment ¹ for more information.)

Most men diagnosed with breast cancer will receive a modified radical mastectomy (removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles).

Therapy given after an operation when cancer cells can no longer be seen is called adjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, and/or hormone therapy after surgery to try to kill any cancer cells that may be left.

• Node-negative: For men whose cancer is node-negative (cancer has not spread to the lymph nodes), adjuvant therapy should be considered on the same basis as for a woman with breast cancer because there is no evidence that response to therapy is different for men and women.
• Node-positive: For men whose cancer is node-positive (cancer has spread to the lymph nodes), adjuvant therapy may include the following:
  • Chemotherapy plus tamoxifen (to block the effect of estrogen).
  • Other hormone therapy.

These treatments appear to increase survival in men as they do in women. The patient’s response to hormone therapy depends on the presence of hormone receptors (proteins) in the tumor. Most breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, including hot flashes and impotence (the inability to have an erection adequate for sexual intercourse).

For men with distant metastases (cancer that has spread to other parts of the body), hormone therapy, chemotherapy, or a combination of both has shown some success. Hormone therapy may include the following:

• Orchiectomy (the removal of the testicles to decrease hormone production).
• Luteinizing hormone-releasing hormone agonist with or without total androgen blockade (to decrease the production of sex hormones).
• Tamoxifen for cancer that is estrogen-receptor positive.
• Progesterone (a female hormone).
• Aminoglutethimide (to lessen the amount of estrogen produced).

Hormone therapies may be used in sequence (one after the other). Standard chemotherapy regimens may be used if hormone therapy does not work. Men usually respond to therapy in the same way as women who have breast cancer.

Treatment Options for Locally Recurrent Disease

For men with locally recurrent disease (cancer that has come back in a limited area after treatment), treatment is usually either:

• Surgery combined with chemotherapy; or
• Radiation therapy combined with chemotherapy.

Changes to This Summary (12/16/2003)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

To Learn More

Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov ³ Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ⁴. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

About PDQ

PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov ³, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov ⁵. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. In referring to a lesion or growth, may be cancerous or premalignant (likely to become cancer).

Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

An anticancer drug that belongs to the family of drugs called nonsteroidal aromatase inhibitors. Aminoglutethimide is used to decrease the production of sex hormones (estrogen in women or testosterone in men) and suppress the growth of tumors that need sex hormones to grow.

The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.

A gene on chromosome 13 that normally helps to suppress cell growth. A person who inherits an altered version of the BRCA2 gene has a higher risk of getting breast, ovarian, or prostate cancer.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the bloodstream. Lymphoma is cancer that begins in the cells of the immune system.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells.

Treatment with anticancer drugs.

The muscles, bones, and joints that make up the area of the body between the neck and the abdomen.

A type of chronic, progressive liver disease in which liver cells are replaced by scar tissue.

A type of research study that uses volunteers to test new methods of screening, prevention, diagnosis, or treatment of a disease. The trial may be carried out in a clinic or other medical facility. Also called a clinical study.

The removal of a tissue sample with a needle for examination under a microscope.

The process of identifying a disease by the signs and symptoms.

Refers to cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes.

In medicine, a tube or vessel of the body through which fluids pass.

DCIS. A noninvasive, precancerous condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, ductal carcinoma in situ may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Also called intraductal carcinoma.

A hormone that promotes the development and maintenance of female sex characteristics.

ER+. Breast cancer cells that have a protein (receptor molecule) to which estrogen will attach. Breast cancer cells that are ER+ need the hormone estrogen to grow and will usually respond to hormone (antiestrogen) therapy that blocks these receptor sites.

A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.

Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external-beam radiation.

The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.

Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.

An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.

A chemical made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in a laboratory.

A protein on the surface of a cell that binds to a specific hormone. The hormone causes many changes to take place in the cell.

Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body's natural hormones. Sometimes surgery is needed to remove the gland that makes hormones. Also called hormonal therapy, hormone treatment, or endocrine therapy.

The most common type of invasive breast cancer. It starts in the cells that line the milk ducts in the breast, grows outside the ducts, and often spreads to the lymph nodes.

A type of breast cancer in which the breast looks red and swollen and feels warm. The skin of the breast may also show the pitted appearance called peau d'orange (like the skin of an orange). The redness and warmth occur because the cancer cells block the lymph vessels in the skin.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

A portion of an organ, such as the liver, lung, breast, thyroid, or brain.

LCIS. A condition in which abnormal cells are found in the lobules of the breast. LCIS seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.

LH-RH agonist. A drug that inhibits the secretion of sex hormones. In men, LH-RH agonist causes testosterone levels to fall. In women, LH-RH agonist causes the levels of estrogen and other sex hormones to fall.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called a lymph gland.

Surgery for breast cancer in which the breast, most or all of the lymph nodes under the arm, and the lining over the chest muscles are removed. Sometimes the surgeon also removes part of the chest wall muscles.

The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration.

Cancer that has not spread to the lymph nodes.

Cancer that has spread to the lymph nodes.

Surgery to remove one or both testicles. Also called orchidectomy.

A part of the body that performs a specific function. For example, the heart is an organ.

A form of breast cancer in which the tumor grows from ducts beneath the nipple onto the surface of the nipple. Symptoms commonly include itching and burning and an eczema-like condition around the nipple, sometimes accompanied by oozing or bleeding.

A female hormone.

The likely outcome or course of a disease; the chance of recovery or recurrence.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

Energy released in the form of particles or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, and medical x-rays.

The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material decays (breaks down).

A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell.

Cancer that has returned after a period of time during which the cancer could not be detected. The cancer may come back to the same site as the original (primary) tumor or to another place in the body.

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, exposure to radiation or other cancer-causing agents, and certain genetic changes.

The extent of a cancer within the body. If the cancer has spread, the stage describes how far it has spread from the original site to other parts of the body.

Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called standard of care or best practice.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

Treatment with anticancer drugs that travel through the bloodstream, reaching and affecting cells all over the body.

A drug used to treat breast cancer, and to prevent it in women who are at a high risk of developing breast cancer. Tamoxifen blocks the effects of the hormone estrogen in the breast. It belongs to the family of drugs called antiestrogens.

One of two egg-shaped glands found inside the scrotum that produce sperm and male hormones. Also called a testis.

A group or layer of cells that are alike and that work together to perform a specific function.

Therapy used to eliminate male sex hormones (androgens) in the body. This may be done with surgery, hormonal therapy, or a combination.

A mass of excess tissue that results from abnormal cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.