Breast cancer among men slowly on the rise & usually detected late: Doctors

The colour pink is neither exclusive to women nor is the disease it represents: breast cancer.

Men’s first thoughts when told they have breast cancer is outright denial: “But we don’t have breasts!” Statistics, however, reveal a different picture.

While breast cancer is over 100 times more common in women, diagnosis in men contributes to less than 1 per cent of cases. However, men are far less likely to detect breast cancer early on.

Male breast cancer is a rare and understudied disease. If the diagnosis is ‘emasculating’, the burden of their illness is more so. For many, being a man with a ‘woman’s disease’ is crippling and accompanied with feelings of exclusion and other stressors.

Doctors say they are observing a slow rise in breast cancer among men.

“Overall, breast cancer cases are on the rise,” says Vijay V Haribhakti, director, Oncosciences at HN Reliance Foundation Hospital, Mumbai. “We now see male breast cancer patients every one or two months. Compared to this, we see female breast cancer patients in almost every OPD.” So the ratio, he adds, has not changed much.

Another emerging factor is that the disease is now being diagnosed in relatively younger men.

Says Niranjan Naik, director, Surgical Oncology, Fortis Memorial Research Institute, Gurugram, “It is mostly seen in men aged between 60 and 80, but now we are also seeing younger male patients (45- to 48-year-olds).”

As with any kind of cancer, it’s important to pick up the signs early. In men, this is all the more critical for survival – since the cancer tends to spread faster to the adjacent organs because men have less breast tissue.

Naik explains: “Cancer in women would take time to catch skin. A lump of up to 5 cm can be Stage 2 cancer in women, while in men a lump as small as one cm can be Stage 3. Most male patients we see approaching us are in a relatively higher stage of cancer than their female counterparts.”

Survival and early signs

Survival rates differ slightly. “Typically, the five-year survival rate for male breast cancer patients is about 77 per cent. This is lower than women, who have an 84-odd per cent chance,” says Nikhil S Ghadyalpatil, senior consultant medical oncologist and hemato-oncologist, Yashoda Hospitals, Hyderabad. “As with women, male breast cancer patients in the advanced stage have dismal long-term outcomes.”

But what are the initial signs? Men have less breast tissue, so most cases have presentations in the nipple-areola area. Swelling in the nipple, distortion of the nipple, or swelling in the underarms are signs. There could be discharge from the breast, or a change in its shape or size. Lumps in the breast are typically painless, say doctors. Only in some cases does one see painful lumps.

A family history of breast cancer or the presence of a harmful variant of the BRCA gene are major causal factors for male breast cancer.

In fact, doctors say the disease is gender agnostic.

“We have seen cases where the daughter of a male breast cancer patient also presents with breast cancer,” Haribhakti says. “It’s not that the hereditary equation is only between mothers and daughters. If there is a family history of breast cancer, then both men and women have a risk of developing it.”

Fixing the problem

Do men worry about the effects of treatment – like hormonal imbalances leading to ‘feminine’ characteristics? Doctors say men with high levels of estrogen are more likely to develop breast cancer, as are men who are obese (because estrogen is stored in fat cells).

“When we start their treatment, we give drugs that reduce the estrogen levels,” says Naik. “So, there is no way anyone can develop any of the so-called feminine qualities.”

That said, men often hesitate to disclose their diagnosis for fear of inviting ridicule, derision, or even curiosity. In urban areas, though, men tend to cope better than in villages, doctors say.

The surgery in men, meanwhile, is not difficult.

“During the surgery, hardly any breast preservation or conservation is required,” Haribhakti says. “The nipple area is surgically removed. This is where the surgeries are slightly different from female breast cancer.” He adds, “In all the male patients I have operated on in the last two years, we were able to give a very acceptable scar and appearance.”

Still, patients have their apprehensions. Ghadyalpatil points out, “Surgical treatment typically involves mastectomy with lymph node dissection. There is a bit of stigma attached to the disease, though, and many patients hesitate to see a doctor in the initial stage.” And this hesitation, say doctors, can prove costly.

Screening for male breast cancer 

1. Screening recommended for high-risk men with a strong family history of breast cancer – and not for all men
2. Screening includes monthly breast self-examination; and ultrasound of breasts after the age of 40
3. Ultrasound is a better option than mammogram