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Updated: Dec 26 2021

Male Breast Cancer

  • 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)
  • 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
  • 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
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