DEAR MAYO CLINIC: There's so much information about breast cancer in women. But I was wondering, do men get breast cancer, and if they do, how is it diagnosed and treated?

ANSWER: Men do get breast cancer — more than 2,500 men in the U.S. are diagnosed with this cancer every year. While accounting for only about 1% of total breast cancers in the U.S., there are some countries in which male breast cancer is more common. As in females, the most common breast cancer in males is ductal carcinoma — about 90% of males are diagnosed with this type of cancer.

What are the symptoms of breast cancer in men?

A lump is the most common symptom of male breast cancer, but there also can be discharge from the nipple or pain in the breast area. A breast lump in males feels much as it does in women — it's usually firmer than the surrounding tissue and may have irregular edges. In men, because they have less breast tissue, the lump is often close to the nipple.

Since breast cancer screenings, such as mammograms and breast exams, aren't typically recommended for men, they usually find a lump on their own. If men notice an unusual lump, experience nipple discharge, or chest or breast discomfort, they should seek medical attention promptly to determine the cause.

Who is at risk for male breast cancer?

The risk for breast cancer in males increases with age and is more common in those who have a family history of breast cancer, especially male breast cancer. Some genetic mutations such as BRCA1 and BRCA2, also are known risk factors. Those with Klinefelter syndrome, a rare condition that occurs when males have an extra X chromosome, also are at higher risk.

Some medical treatments also can put men at greater risk, such as chest wall radiation, sometimes given to treat lymphoma. Some testicular and liver abnormalities that affect hormone levels also increase the risk for male breast cancer.

When should men seek medical care for breast changes?

For men experiencing symptoms, the first step is breast imaging, usually a mammogram and an ultrasound, and sometimes a breast MRI. If the findings of the exam and imaging are concerning, a biopsy will be ordered.

Breast cancer in men is staged the same as in women — from 0 to 4. If detected at stage 0 before the cancer becomes invasive, nearly all patients will be cured. However, if cancer is detected at stage 4, that means it has spread to other parts of the body, and it usually can be treated but not completely eliminated.

Female breast cancers are more often detected at stage 0 and 1, while a higher proportion of male breast cancers are found at stages 2, 3 and 4. When detected at the same stage, the prognosis for breast cancer in a male is no worse than that of breast cancer in a female. However, male breast cancers are more often diagnosed after they have already grown quite large in the breast, spread to lymph nodes under the arm or elsewhere in the body.

If men are diagnosed with stage 0 to 3 cancer, surgery will be part of the treatment plan, while at stage 4, treatments will primarily use medications to fight the cancer throughout the body.

For men requiring surgery, a mastectomy, or the entire removal of the breast tissue, is a common choice. But some men also choose lumpectomy —removal of only part of the breast.

Chemotherapy, endocrine therapy and radiation decisions for men are largely based on evidence from women with breast cancer. However, the Translational Breast Cancer Research Consortium is enrolling men in the ETHAN trial, designed specifically for men. In the ETHAN trial, men who were recently diagnosed with stage 1-3 breast cancer are assigned to take different types of anti-estrogen and targeted therapy medications to find out how best to shrink male breast cancer before surgery. The results of this trial will advance treatment for male breast cancer patients in the future.

Because breast cancer is less common in males, some patients with male breast cancer can feel isolated or even ashamed of having a cancer typically associated with females. That's why it's important for men to talk with their healthcare team about how they're feeling and, if possible, connect with other male breast cancer survivors in person or through online support groups.

To diagnose more men before their cancers grow large and spread, it's important that they seek medical attention for changes in their chest wall, nipple, underarms or neck. In addition, men who are diagnosed with breast cancer are encouraged to participate in clinical trials, when available, to help improve male breast cancer treatment. Detecting cancer early and optimizing evidence-based treatments will lead to more cures.

Kathryn Ruddy, M.D., Oncology, Mayo Clinic, Rochester, Minnesota

Join the conversation at the Mayo Clinic Connect Breast Cancer Support Group.

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