Male breast can­cer ex­ists

The Herald (Zimbabwe) - - Zinwa / Lancet / Stocks - Dr Bless­ing Zam­buko

MR FRANK Chikepe (not his real name) is a 63-year-old se­nior busi­ness ex­ec­u­tive, run­ning his own man­u­fac­tur­ing com­pany. He is twid­dling his thumbs in ner­vous­ness as he waits for his fam­ily prac­ti­tioner to tell him about the re­sults that have just been de­liv­ered by Lancet Clin­i­cal Lab­o­ra­to­ries.

Sec­onds later, he springs up from his seat in dis­be­lief when his doc­tor in­forms him that the pathol­ogy re­port con­firms that he has can­cer of the breast. Frank man­ages to re­gain his com­po­sure af­ter a few min­utes and in a near whis­per says to the doc­tor, “But I don’t have breasts?! ”Breast can­cer arises in the tis­sues of the breast, which are mainly com­prised of spe­cialised glands which pro­duce milk dur­ing lac­ta­tion (breast­feed­ing). Men have a pair of poorly de­vel­oped breasts which are not nor­mally re­quired to pro­duce any­thing but may still de­velop can­cer­ous tis­sues within.

Mr Chikepe was sur­prised per­haps be­cause breast can­cer in men is much less com­mon than that oc­cur­ring in women. About 1 per­cent of all breast can­cers oc­cur in men which seems to be a very small frac­tion, but ac­tu­ally trans­lates to about 50 new cases every year in Zim­babwe. It is im­por­tant to note that breast can­cer is on the in­crease, like other can­cers as­so­ci­ated with in­creas­ing west­ern­i­sa­tion of life­styles. There have been many myths put forth re­gard­ing the causes of can­cer in gen­eral and breast can­cer is no ex­cep­tion. There are mul­ti­ple fac­tors now known to be as­so­ci­ated with the de­vel­op­ment of breast can­cer in men and some of these fac­tors in­clude cer­tain types of liver dis­ease, obe­sity, and con­di­tions af­fect­ing the func­tion of the testes. What all these con­di­tions have in com­mon is the propen­sity to in­crease the lev­els of the fe­male hor­mone oe­stro­gen in the body. In other cases, the lev­els of the male an­dro­gen hor­mone testos­terone, are de­creased as well.

Med­i­cal and recre­ational drugs are also as­so­ci­ated with the de­vel­op­ment of male breast can­cer, and in­clude dig­i­talis used in the treat­ment of heart fail­ure, tri­cyclic com­pounds for the treat­ment of de­pres­sion, and mar­i­juana. An­other im­por­tant risk fac­tor is the pres­ence of in­her­ited ge­netic mu­ta­tions which are as­so­ci­ated with the de­vel­op­ment of breast can­cer. The most com­mon hered­i­tary syn­dromes are the Hered­i­tary Breast-Ovar­ian Can­cer Syn­drome (BRCA2) and the Cow­den syn­drome (with a mu­ta­tion in a gene called PTEN).

We must briefly dis­cuss gy­nae­co­mas­tia at this point. Gy­nae­co­mas­tia is a be­nign (non–can­cer­ous) en­large­ment of one or both breasts in males. This con­di­tion is fairly com­mon in new­borns and in­fants, at pu­berty, and in men over the 50 years.

The fac­tors known to be as­so­ci­ated with male breast can­cer are also im­pli­cated in the de­vel­op­ment of gy­nae­co­mas­tia. No spe­cific treat­ment for gy­nae­co­mas­tia is re­quired in the new­born and ado­les­cent as the con­di­tion tends to re­solve spon­ta­neously. In older in­di­vid­u­als, re­moval of the un­der­ly­ing cause is of­ten suf­fi­cient but in cer­tain cases, a sur­gi­cal pro­ce­dure called mas­tec­tomy will be re­quired to re­move the breast tis­sue. This is a cos­metic pro­ce­dure since the growth is harm­less, but the re­moved tis­sue must be sent to a med­i­cal lab­o­ra­tory where a pathol­o­gist will ex­am­ine the spec­i­men and com­pletely ex­clude the pos­si­bil­ity of can­cer.

Breast can­cer in males is gen­er­ally a dis­ease of the el­derly and most com­monly af­fects men above the age of 60 years. It has been seen how­ever, in chil­dren par­tic­u­larly in the con­text of fa­mil­ial syn­dromes.

Can­cer of the breast is usu­ally pain­less. The pres­ence of a painful or ten­der growth in the breast is usu­ally in­dica­tive of less sin­is­ter con­di­tions or gy­nae­co­mas­tia. When one de­tects the pres­ence of a growth or lump in their breast or the ax­illa (armpit), they should see their pri­mary care prac­ti­tioner as soon as is pos­si­ble who will or­der fur­ther in­ves­ti­ga­tions or re­fer as ap­pro­pri­ate.

Ini­tially imag­ing by use of mam­mog­ra­phy or ul­tra­sound is per­formed but ul­ti­mately, di­ag­no­sis must be made by the “gold-stan­dard” which is ex­am­i­na­tion of tis­sue re­moved from the growth by a Spe­cial­ist Pathol­o­gist who will con­firm the pres­ence or ab­sence of can­cer. In his/her re­port, the pathol­o­gist will also com­ment on the ag­gres­sive­ness of the can­cer. The use of mam­mog­ra­phy is a very ef­fec­tive screen­ing tool for the pre­ven­tion of breast can­cer among women, but it is not sim­i­larly cost-ef­fec­tive in males. It is for­tu­nate how­ever, that the male breast con­tains much less tis­sue than the fe­male breast and it is pos­si­ble to de­tect any growths as they emerge. Screen­ing is use­ful only for in­di­vid­u­als at high risk like mem­bers of fam­i­lies with the hered­i­tary can­cer syn­dromes.

The treat­ment of breast can­cer is a mul­ti­dis­ci­plinary af­fair an­chored on the avail­abil­ity of a ro­bust clin­i­cal pathol­ogy prac­tice run by pathol­o­gists with ex­pe­ri­ence in di­ag­no­sis of breast pathol­ogy (breast dis­ease). The pathol­o­gists’ re­port con­firms the di­ag­no­sis and goes on fur­ther to com­ment on the prog­nos­tic and pre­dic­tive fac­tors. Prog­nos­tic fac­tors are mi­cro­scopic and molec­u­lar char­ac­ter­is­tics of the can­cer which re­late to the po­ten­tial ag­gres­sive­ness of the tu­mour and how likely it is to spread to dis­tant or­gans and cause death.

Pre­dic­tive fac­tors will in­di­cate to the other mem­bers of the multi-dis­ci­plinary team (MDT) of med­i­cal spe­cial­ists, the like­li­hood of the can­cer to re­spond to var­i­ous treat­ment regimes. This is im­por­tant be­cause we are now in the era of per­son­alised treat­ment, where treat­ment of two in­di­vid­u­als with breast can­cer may be very dif­fer­ent. In fact, treat­ment which works in one case may be quite toxic to the other in­di­vid­ual! Mr Chikepe un­der­went surgery, and the Lancet Clin­i­cal Lab­o­ra­to­ries pathol­ogy re­port con­firmed that the can­cer was lo­calised to the breast and was re­moved com­pletely.

The in­for­ma­tion in this ar­ti­cle is not in­tended or im­plied to be a sub­sti­tute for pro­fes­sional med­i­cal ad­vice, di­ag­no­sis or treat­ment. All con­tent con­tained in or is avail­able through this ar­ti­cle is for gen­eral in­for­ma­tion pur­poses only. It is not pos­si­ble to write ex­haus­tively about can­cer of the breast in this ar­ti­cle. Any com­ments and ques­tions may be for­warded to the au­thor via the elec­tronic mail (email) ad­dresses be­low. Dr Bless­ing Zam­buko is a Con­sul­tant Spe­cial­ist Pathol­o­gist, reg­is­tered with the Med­i­cal and Den­tal Prac­ti­tion­ers’ Coun­cil of Zim­babwe (MDPCZ) and prac­tises with Lancet Clin­i­cal Lab­o­ra­to­ries.c on­tact on [email protected] or bless­ing.zam­[email protected]

Newspapers in English

Newspapers from Zimbabwe

© PressReader. All rights reserved.