Male breast cancer exists

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 info@lancet.co.zw or blessing.zambuko@lancet.co.zw