Although Breast cancer is mostly found in females, 1% of breast cancers are found in males. They can occur at any age but most commonly found in the age group of 60 to 70 years long. Risk factors for breast cancer include any radiation given to the chest in the past, having a high estrogen level in the blood like in cirrhosis of liver, having one or more female blood relatives or having genetic mutations like BRCA2.
Although above are risk factors many of the patients may not have either of these risk factors and can still develop breast cancer. Male breast cancer may present with either one or more of these feature like lump in the breast or underarm, puckering in the breast, alteration in the shape or size of breast, inversion of nipple, blood stained discharge from nipple, reddening, swelling or thickening or orange peel like appearance of skin over the breast.
Dr Vishnu Agarwal Consultant Surgical Oncology, Jaslok Hospital and Research Centre says any of the above features should make the person consult the doctor and get investigated. Initially, the mammography is advised and if there is suspicious lesion the biopsy is done to know whether it is cancerous or not as many times it may just be a noncancerous growth.
If cancer is found then either whole body PETCT may be done to know whether there is any spread to other organs and to determine the stage of cancer. Above tests will also tell us the future plan of treatment.
Many times Male breast cancer is diagnosed at later stage as men don’t think about its possibility. Stage of the cancer is based on the size of the primary tumour and its spread to loco regional lymph nodes or other parts of the body. Grade and other BIOPSY features tell us how aggressive is the tumour in growing locally and tendency to spread.
Based on these features the treatment is planned. There are various receptors in breast cancer like Estrogen receptor ER, progesterone receptor PR, CERB2, these receptors may or may not be expressed on tumour and they very much determine the plan of treatment and prognosis of patient apart from other factors like staging and grading of tumour.
There are various treatment options like surgery, chemotherapy, hormonal therapy, radiation therapy and targeted therapy.
Modified Radical Mastectomy is normally advised for Male patients compared to females where breast conservative surgery is preferred until or until there are contraindications to it or if patient doesn’t want.
For early and localized breast cancer and good pathology Surgery is done first followed by other treatments mentioned above depending on the stage and pathological features after surgery.
Surgery involves removal of the breast along with axillary lymph nodes.
Treatment guidelines are almost the same in male and female breast cancer patients.
If it is locally advanced tumour. Then chemotherapy is first given to reduce the extent of cancer and then surgery is advised. Chemotherapy may be adjuvant chemotherapy that is when it is given after surgery or it may be called neo adjuvant chemotherapy when it is given before surgery.
After chemotherapy one may receive hormonal therapy, perception therapy depending on which receptors, described above, are positive. Radiation therapy is given to all patients who have undergone breast conservation surgery but only to selected patients who have undergone total mastectomy like one having large tumour or having lymph nodes showing cancer spread.
For patients who have metastatic breast cancer surgery may not be indicated until or unless it is large lump with local inflammation or fumigation causing difficulty to deal with.in these case treatment is with the intent of prolonging the life and not complete cure. These patients may be treated only by chemotherapy, hormonal therapy or targeted therapy and if there metastasize to the bones they may have to undergo radiation to the affected bones which will not only relieve bone pain but also prevent them from fractures.
The side effects of chemotherapy can be hair loss, loss of appetite, nausea and vomiting and low blood count therapy increasing some chances of infection but all these side effects can be minimized by giving additional medications.
These are short term side effects and go away after completing the treatment.
Some patients may need to take hormonal therapy in the form of tablets for as long as ten years in order to prevent a recurrence. Herceptin therapy is indicated in CERB2 positive cancers and is expensive but it is important to take that treatment and good thing is that it is becoming cheaper with time.
The most important thing to remember is that if there are any features as described above, men should consult their doctor and just not neglect it think that breast cancer is only in females.
Also, treatment of breast cancer is not Surgery only and in most cases, a combination of treatment is needed as all modalities of treatment are important in order to achieve long term cure.
There is nothing to fear if we diagnose breast cancer early and get it treated as early as possible. The best policy is to try not to have cancer and there are various preventive measures which one can take some of them are no smoking, avoid alcohol, diet with more fruits and vegetable rather than high-fat diet, regular yoga and exercise. Regular self-examination is very important for diagnosing breast cancer.
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