Breast Cancer, Male

Key Features

• Rare; average age, 70 yr

• Poorer prognosis than for female breast cancer (even stage I)

• Hormonal influences likely play an important role

Clinical Findings

• Painless lump beneath the areola, usually found after age 50

• Nipple discharge, retraction, or ulceration

• Gynecomastia not uncommonly precedes or accompanies male breast cancer

• Increased incidence of breast cancer in men with prostate cancer

• Examination usually shows a hard, ill-defined, nontender mass beneath the nipple or areola

• Cancer staging is the same in men as in women

Diagnosis

• Biopsy is required to confirm diagnosis

• Differential diagnosis

  • Gynecomastia

  • Metastatic cancer from another site (eg, prostate)

  • Fatty breast enlargement of obesity

Treatment

• Modified radical mastectomy in operable patients

• Irradiation for localized, symptomatic metastases to skin, lymph nodes, or skeleton

• Adjuvant chemotherapy is used for the same indications as in female breast cancer

• Tamoxifen, 20 mg orally once daily, for advanced-stage male breast cancer

• Castration produces regression in 60–70%

• 5-year survival rate for node-positive disease: ~69%

• 5-year survival rate for node-negative disease: ~88%