Male Breast Cancer and Gynecomastia
Male breast cancer is much less common than breast cancer in females. The literature suggests that for every male who are diagnosed with breast cancer, there will be approximately 100 females diagnosed with breast cancer.
Because of the rarity of male breast cancer, routine screening mammograms are not recommended for males at any age. Diagnosis of breast cancer in males is almost exclusively centered on the evaluation of lumps in the breast. Since there are multiple causes of male breast lumps (most of which are benign), it is important that both physicians and patients have a clear understanding of the significance of lumps or new symptoms, such as nipple discharge or pain in the male breast.
Male breast lumps:
Teens: The significance of a male breast lump is in large part related to a patient’s age. Breast lumps are common in teenage / adolescent males. The lumps are almost always due to hormonal changes, and for the most part they go away on their own. These breast lumps are referred to as gynecomastia.
Most of these lumps are followed by a pediatrician. If the lump has unusual physical characteristics, if it becomes a cosmetic problem, or there are concerns from the parents or patient, these patients are often referred to a breast surgeon. In select cases, surgical removal of the lump is appropriate. In most cases, however, the lump will slowly resolve on its own. Although testicular tumors are unusual in this age group, we always perform a testicular examination for these patients (see next section).
20-40 age group: Breast lumps in the 20-40 year-old age group of males are also usually benign in our experience, but testicular cancer is a major issue of concern, since the peak incidence of testicular cancer is in the 20-40 year-old age group. Of note, testicular cancers can produce chemicals that cause breast enlargement. Thus, in situations in which males in this age group present with lumps in one or both breasts, we pay particular attention to the possibility of a testicular cancer.
A testicular examination is performed by the physician. If any abnormalities are found, we do an ultrasound of the testicles. If the testicular examination is unremarkable, then we order blood tests to evaluate the possibility of a hidden or occult testicular cancer (we currently order a beta-HCG and an alpha-feto protein test). If these tests are all negative, the patient is advised to do a regular testicular and breast examination and to report any changes.
If the testicular examination is normal, we next evaluate the breast lump. Most cases of breast lumps in this age group are due to either medication (see list below) or the actual cause is unknown. We have not seen or heard of a single case of male breast cancer in this age group. However, we recognize that a breast cancer is still a possibility.
Fortunately, most cases of gynecomastia in this age group present as a flat, rubbery, smooth, central breast mass. Male breast cancers are typically hard and irregular in shape and sometimes tender. If we have any doubts about the diagnosis, we do a mammogram and a core needle biopsy.
Even in the case of a benign biopsy, we continue to follow these patients for at least one year. In situations where a medication associated with gynecomastia is identified, we work with the referring doctor in an attempt to identify alternative medications. Young males taking body-building products who develop gynecomastia are being seen with increased frequency. In most cases, the breast enlargement resolves when the medications are stopped.
In cases of benign gynecomastia, we simply follow the patient and reassure him that in most cases the tenderness will go away, and in many cases the lump will become less obvious. In cases where there are either cosmetic concerns or the lump is bothersome, we remove the enlarged breast tissue. In a vast majority of cases, the patient can anticipate an excellent cosmetic result.
Over-40 years of age: Since breast cancer is most commonly detected in men between 60 and 70 years of age, we are concerned about any unexplained male lumps that occur after the age of 40. In general, the evaluation of patients in this age group is similar to the 20-40 age group.
However, in the over-40 age group, medications (see list below) are more often the cause of breast enlargement. Also, cancer is much more common in the over 40 age group. For this reason, in addition to the standard evaluation, these patients almost always receive a diagnostic mammogram and some form of biopsy. If a benign diagnosis can be established, the patient is followed conservatively. If the diagnosis is cancer, a standard mastectomy is usually performed.
Pictures of male breast cancer:
Medications that can cause gynecomastia:
- Steroids, such as prednisone or hexadrol. Also body-building anabolic steroids and food supplements containing steroid compounds.
- Anti-ulcer medications (such as cimetidine).
- Medications used to treat epilepsy (such as phenytoin [Dilantin]).
- Digitalis and other cardiac medications.
- Anticancer medications (alkylating agents).
- Anti-androgen drugs (such as flutamide, finasteride, cyproterone, spironolactone).
- Anti-anxiety and antidepressant medications (such as diazepam, (Valium) and tricyclic antidepressants).