Breast cancer, they too?

Breast cancer is, without a doubt, the most frequent (30%) of the tumors that affect women. However, it is rare in men and does not constitute more than 1% of all diagnosed breast tumors (99%, therefore, affect women). So far the big differences, since in all other aspects male breast cancer behaves very similar to female.

WHAT YOU SHOULD KNOW

• Uncommon: it affects only 1% of men, but its incidence is increasing.
• Age: it is the most important risk factor, it affects especially between 60-70 years.
• Early diagnosis: as in women, detecting it early is key for treatment and subsequent cure.

They can suffer too

Traditionally, men have never considered the possibility that they could develop breast cancer, which is why they have never explored themselves, nor have they taken into account the warning signs (which we will discuss later) and, therefore, they have never consulted with the doctor this issue. All this has changed and therefore its incidence, despite being low (0.8 new cases per 100,000 inhabitants / year), has not stopped increasing in the last 15-20 years, much more rapidly than in the case of, probably due to a greater awareness of men, who now understand the symptoms and communicate them and this is probably why there is a considerable increase in early diagnoses. Even so, it is estimated that in men the diagnosis of breast cancer is delayed up to 18 months from the appearance of the first symptoms.

Risk factor's

There are unquestionable risk factors for breast cancer, which in the case of men present some specific peculiarities due to sex:

• Aging: it is the most important risk factor, since the incidence increases considerably with age. However, it affects men somewhat older than women, between 60 and 70 years.
• Elevated levels of estrogens: these occur due to being overweight, excessive exposure to environmental estrogens (DDT, consumption of meat treated with hormones to fatten cattle), abuse of alcohol or drugs such as marijuana, and severe liver disease.
• Exposure to radiation to the chest, especially in the period of puberty.
• (chromosomal pattern 47 XXY), which has an incidence of 1 case in every 100 males born, has high levels of estrogens and also usually causes gynecomastia (enlargement of the breasts).
• Genetic inheritance: linked to abnormalities in some genes such as BRCA1 and BRCA2, which increase the risk of breast cancer in men who inherit them. If they are detected, they force to review the males of the family, who may also have inherited them.

Symptoms

Regarding the symptoms, that is, the symptoms and warning signs of breast cancer, the following self-examination findings should be highlighted, later confirmed by the expert:

• Appearance of lumps in the breast.
• Unmotivated pain in the nipple.
• Inverted nipple.
• Secretions from the nipple.
• Ulcerative lesions on the nipple or areola.
• Appearance of lumps in the armpit.

Diagnosis

It is essential to reach an accurate diagnosis as early as possible, as it is the key to treatment and proper cure. This is usually done by:

• Mammography.
• Ultrasound
• Cytology of nipple secretions.
• Biopsy, by fine needle puncture (cytology), with a core needle (stereotaxic), partial tumor incision or total excision, both open.

The anatomo-pathological study of the samples obtained by biopsy, shows us a series of findings, fundamental for the treatment and prognosis of the disease:

• Tumor size. The bigger, the worse the prognosis in principle.
• The type of tumor, which in the case of men is almost always ductal carcinoma.
• Degree of tumor aggressiveness.
• If it affects neighboring structures such as the skin, muscles or adjacent ribs.
• Local or axillary lymph node involvement.
• Tumor estrogen hormone receptor concentration. The more there are, the better the prognosis initially.
• Concentration of receptors for HER2 proteins. The larger it is, the more aggressive the tumor is.

The diagnosis is completed by means of a tumor extension study, which tells us if the tumor has overflowed the breast and has spread to other places in the body. For this, tests such as chest radiography, bone scintigraphy, computed tomography (CT), magnetic resonance imaging (MRI) or PET (positron emission tomography) are used.

Treatment

The initial treatment of breast cancer in men follows, as we have said at the beginning, the same protocols and uses the same techniques as in the case of women:

• Surgery: it is the treatment of choice. In men, a radical mastectomy is usually performed and, rarely, partial breast surgeries. A local lymph node excision is performed at the same time. If these are affected by a tumor, the axillary nodes on the same side are also totally or partially removed.

The most common complementary treatments for surgery are:

• Radiotherapy: local or axillary, it is used as a complement in cases of large tumors, with positive resection margins or with vascular or lymphatic involvement.
• Hormone therapy: it is a complementary antiestrogenic treatment, which acts on the hormonal receptors of tumor cells, slowing their development. Common drugs are tamoxifen and aromatase inhibitors (anastrozole or letrozole). In men, they logically occur with loss of sexual appetite, hot flashes, weight gain, and sexual dysfunction.
• Chemotherapy: it is used in cases of high-grade, metastatic, hormone receptor-negative or HER2-positive tumors. Also in cases of recurrent disease, despite hormonal therapy. Associated drugs (ACT, CMF, CEF, FAC) or individual drugs (capecitabine, gemcitabine, vinorelbine) are used.
• Targeted therapies: Such as immune system-directed therapy (trastuzamab), which marks tumor cells and is useful in cases of tumors with HER2 protein receptors. There is also a targeted antiangiogenic therapy (bevacizumab) directed against the newly formed blood vessels that feed the breast tumor.

Forecast

The global cure rate, similar to that of women, reaches 60% in Spain, a percentage that reaches up to 90% in cases of early diagnosis of poorly evolved and non-disseminated tumors.