Patrick Borgen, MD, chair and surgery director of the Breast Cancer Program at Maimonides Medical Center, discusses common symptoms of breast cancer in male patients.

One of the key questions in male breast cancer is what symptoms men should look for, according to Borgen. The most common symptom is bloody nipple discharge in the absence of trauma, which results in a male breast cancer diagnosis most of the time, Borgen says. 

Additionally, a painless mass directly below the nipple is indicative of male breast cancer, Borgen adds. In women, the terminal duct lobular units are distributed throughout the global surface of the breast. Conversely, vestigial duct tissue in men are located only behind the nipple; this is the area men should be checking for masses, Borgen concludes.

Videos

Patrick Borgen, MD, discusses common symptoms of breast cancer in male patients.

Dr. Borgen on Common Symptoms of Male Breast Cancer

Adam M. Brufsky, MD, PhD, a professor of medicine, associate chief in the Division of Hematology/Oncology, co-director of the Comprehensive Breast Cancer, and associate director of clinical investigation at the University of Pittsburgh, discusses treatment options for male patients with breast cancer.

Men with breast cancer are treated similarly to postmenopausal women with the disease, Brufsky says. Androgen receptors (ARs) are likely to act as a tumor suppressor in this patient population, Brufsky adds. One upcoming trial will examine the use of an AR agonist in patients with estrogen receptor–positive, AR-positive metastatic breast cancer.

This research could impact the male patient population due to the potential role of ARs in male breast cancer, Brufsky says. Additionally, male patients tend to present with more advanced disease, namely stage II or higher; earlier-stage disease is uncommon, although cases are beginning to rise, Brufsky notes. 

A handful of treatment options are available for this population, including neoadjuvant and adjuvant chemotherapy, mastectomy, radiation, and tamoxifen. Aromatase inhibitors have also been considered for use, although some experts believe they may boost testosterone levels, which could either help or hinder the treatment of this patient population, Brufsky concludes.

Adam M. Brufsky, MD, PhD, discusses treatment options for male patients with breast cancer.

Dr. Brufsky on Treatment Options for Male Breast Cancer

Javier Cortés, MD, PhD, head of breast cancer and gynecological cancers at Hospital Universitario Ramón y Cajal, as well as a clinical investigator in the breast cancer research program at Vall d’Hebron Institute of Oncology, discusses the incidence and management of male patients with breast cancer in Spain.

For every 100 women diagnosed with breast cancer in Spain, there is 1 man diagnosed, according to Cortés. Approximately 33,000 new cases of breast cancer are being diagnosed on an annual basis in the country and about 350 of them are male, Cortés adds.

Male and female patients receive similar treatments; however, if aromatase inhibitors are used in male patients, they must be combined with luteinizing hormone-releasing hormone analogues, according to Cortés. Overall treatment strategies should not differ greatly between male and female patients, Cortés concludes.

Javier Cortés, MD, PhD, discusses the incidence and management of male patients with breast cancer in Spain.

Dr. Cortés on the Incidence and Management of Male Breast Cancer in Spain

Sara A. Hurvitz, MD, director of the Breast Cancer Clinical Research Program and co-director of the Santa Monica University of California, Los Angeles (UCLA) Outpatient Hematology/Oncology Practice, as well as an assistant professor of medicine in the Division of Hematology/Oncology of the David Geffen School of Medicine at UCLA, discusses the incidence of male breast cancer in the United States.

While male breast cancer may not be common, it is not rare by any means, according to Hurvitz. Hurvitz explains that there are currently 10 to 11 male patients within her own practice who have been diagnosed with breast cancer. Approximately 1% of all breast cancers that are diagnosed are men, resulting in approximately 1500 cases of male breast cancer being diagnosed annually in the United States, Hurvitz says.

These cases tend to be both diagnosed in later stage and higher grade vs female patients with breast cancer, which could be due in part to the fact that men aren't screened with mammography. Additionally, men don't always know the symptoms to look for in their chest and breast area, which could also account for why male breast cancer is often diagnosed later, Hurvitz concluded.

Sara A. Hurvitz, MD, discusses the incidence of male breast cancer in the United States.

Dr. Hurvitz on Incidence of Male Breast Cancer

Patrick Borgen, MD, chair and surgery director of the Breast Cancer Program at Maimonides Medical Center, discusses treatment strategies for patients with male breast cancer.

The biology of breast cancer in male vs female patients has some differences, one being that virtually all male breast cancers are ductal; almost no incidence of lobular disease has been reported in these patients, Borgen says. Additionally, male breast cancers tend to be estrogen receptor (ER)positive and often progesterone receptor positive. This offers the opportunity to utilize several treatment strategies, Borgen explains.

Notably, due to the rarity of male breast cancer, there has never been a clinical trial conducted exclusively for these patients, Borgen adds. As such, investigators have had to extrapolate data from trials that have been conducted in female patients with breast cancer. Despite this gap in clinical research, it has been found that the selective ER downregulator tamoxifen has just as much efficacy in men with breast cancer as it has with women, Borgen concludes.

Patrick Borgen, MD, discusses treatment strategies for patients with male breast cancer.


Male Breast Cancer | Videos

Dr. Borgen on Common Symptoms of Male Breast Cancer

Dr. Brufsky on Treatment Options for Male Breast Cancer

Dr. Cortés on the Incidence and Management of Male Breast Cancer in Spain

Dr. Hurvitz on Incidence of Male Breast Cancer

Dr. Borgen on Treatment Strategies for Male Breast Cancer