Updated: 5/11/2020

Male Breast Cancer

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https://upload.medbullets.com/topic/120431/images/snap.jpg
https://upload.medbullets.com/topic/120431/images/gynecomastia.jpg
https://upload.medbullets.com/topic/120431/images/ductal_ca.jpg
https://upload.medbullets.com/topic/120431/images/xxy.jpg
Snapshot
  • A 66-year-old man presents to his primary care physician for a routine check-up. He states that he has felt well and has no issues but mentions that he has felt a small lump in his chest under his left nipple. On physical examination, the physician notices that the patient has gynecomastia and palpates a firm, non-tender mass in the subareolar region of his left breast. No lymph nodes are palpable in the axilla. A mammogram is obtained and shows the finding seen in the image.
Introduction
  • Overview
    • breast cancer in males is similar to that in females with regards to the pathophysiology, diagnosis, and treatment but is more rare
  • Epidemiology
    • incidence
      • < 1% of all breast cancers diagnosed per year
      • < 0.5% of all cancer diagnoses in men in the US
    • demographics
      • average age of presentation ~65 years
        • ↑ incidence with age
    • risk factors
      • age
      • family history of breast cancer
        • positive in ~30% of cases
      • Klinefelter syndrome (XXY)
        • strongest risk factor
      • gynecomastia
      • exogenous estrogen or testosterone use
      • radiation exposure
  • Pathophysiology
    • nearly all cases are ductal carcinoma
    • environmental and genetic risk factors may be associated with the development of male breast cancers (see above)
  • Prognosis
    • 5-year mortality - ~8%
    • worse prognosis compared with women with breast cancer
    • similar to breast cancer in women, tumor size and the presence of lymph node metastasis are the most important prognostic factors
      • often not detected until late in its course
        • > 40% of patients have stage 3 or 4 disease at diagnosis
Presentation
  • Symptoms
    • painless lump in the breast
    • skin changes
  • Physical exam
    • painless lump in the breast
      • 75% in the subareolar region
        • nipple involvement more common than in women
    • axillary lymphadenopathy
Imaging
  • Mammogram
    • indications
      • distinguish between malignancy and gynecomastia
    • findings
      • microcalcifications
      • spiculate margins around an increased density
Studies
  • Biopsy
    • core needle biopsy
      • indications
        • definitive histologic diagnosis
        • distinguish between in situ versus invasive cancer
      • findings
        • majority of cases have infiltrating ductal carcinoma histology
Differential
  • Gynecomastia
    • key distinguishing factors
      • typically bilateral and symmetric breast enlargement
      • no skin changes or axillary lymphadenopathy
  • Breast abscess
    • key distinguishing factor
      • localized and painful inflammation, often with systemic symptoms (i.e., fever and malaise)
  • Lipoma
    • key distinguishing factor
      • ovoid mass of fat
Treatment
  • Surgical
    • simple mastectomy
      • management of choice in early-stage disease cases
  • Medical
    • tamoxifen
      • use as adjuvant chemotherapy in patients with locally advanced disease
    • radiation therapy
      • for patients who undergo breast-conserving surgery and patients treated with mastectomy and found to have involved lymph nodes on final pathology

 

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