More men die from breast cancer than from testicular cancer
Of the 9355 men diagnosed with breast cancer in the United States from 2004 to 2008, there were 1934 deaths, compared with 1758 deaths from 39 641 cases of testicular cancer.1
Male carriers of the BRCA2 mutation have an 80-fold increased lifetime risk of breast cancer
Although male carriers of the BRCA2 mutation have a markedly increased risk of breast cancer, the estimated lifetime risk in the general population of men is 0.1%.2 Risk factors for male breast cancer include family history, gene mutations (BRCA2, BRCA1), age, Klinefelter syndrome, chest radiation and altered testosterone– estrogen levels (e.g., due to liver cirrhosis, gonad dysfunction, estrogen use, obesity).2
Screening recommendations for men with a strong family history, genetic predisposition or history of breast cancer include monthly self-examination, semiannual clinical examination (starting at age 35) and baseline mammography (at age 40) with further annual mammography if increased breast density is seen on a baseline mammogram.3 No screening guidelines exist for men in the general population.
Male breast cancer usually presents with a palpable subareolar mass
Although the most common cause of a breast mass in men is gynecomastia, 75% of cases of male breast cancer present with a palpable subareolar mass.2,4 Less common features include ulceration, nipple retraction or discharge, pain and axillary adenopathy.2
Men with breast cancer experience symptoms for an average of 6 months before the diagnosis is made2
Breast cancer in men presents at more advanced stages than in women, with 38% of men having axillary nodal involvement compared with 29% of women.5 The stage- and age-adjusted 5-year survival rates for men and women are similar, but comorbidities in older men lead to worse prognosis.5
Palpable breast masses in men require mammography and possible biopsy
In one study, mammography had a sensitivity of 92% and specificity of 90% for male breast cancer (n = 104).6 A spiculated or irregular mass (with or without calcification) is the typical mammographic appearance. Breast ultrasonography can confirm the presence of a suspicious mass and facilitate ultrasound-guided biopsy. Biopsy is recommended for all suspicious masses.2 Histology shows infiltrating ductal cancer in 90% of cases.2
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Footnotes
Competing interests: None declared.
This article has been peer reviewed.
References
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