Madrid, 25 November 2019. Approximately 1% of all people diagnosed with breast cancer are men. So, an estimated 300 men receive a diagnosis of breast cancer each year in our country. The male population is not always aware of this. Often men don’t even know that they can get breast cancer. To combat this situation, Doctor María Isabel Gallegos, an oncologist with the Breast Unit of the MD Anderson Cancer Center Madrid, has picked November, the month devoted to promoting men’s health, to ask men to conduct regular breast self-examinations, too.
Because most breast cancer prevention campaigns target women, “men are bewildered when they’re diagnosed with a tumour that’s so strongly thought of as a woman’s thing, but the truth is that a small proportion of breast cancer shows up in men,” Doctor Gallegos says. Therefore, her recommendation is “for men to learn to do self-examinations, and, if they find anything has changed, basically lumps or abnormalities, usually on one side and pain-free, they should go to their doctor and have it checked out”.
Though most cases in men are diagnosed in localised or locally advanced stages and few cases are discovered in metastatic stages, it is a fact that breast cancer is detected at rather later ages in men than in women, and at more-advanced stages (many having spread to the armpit), due to the fact that men are less aware of the fact that they can get breast cancer and there are no specific screening programmes for men.
GEICAM has started up a record of breast cancer in men
Because breast tumours are less frequent in men, it’s tricky to estimate numbers about the prevalence of the disease, classify patients and run clinical trials. To throw some light on these subjects, the Spanish Breast Cancer Research Group (Grupo Español de Investigación en Cáncer de Mama, or GEICAM) has started keeping a record of cases of breast cancer in men, which will enable researchers to identify the defining characteristics of cancerous breast tumours when appearing in men as opposed to women.
At present our knowledge about breast cancer in women is being extrapolated to men’s breast tumours, which are organised according to the same classification system. Doctor Gallegos says, “Most male breast tumours are hormone sensitive; that is, their cells express oestrogen or progesterone receptors (65-90%), and very few cases are in the more-aggressive subtypes, like HER2- (5%) or triple-negative cancer (1%)”.
With so little scientific evidence available on men alone, the tendency in treatment is to extrapolate from what’s used in women, except in the area of surgical treatment. “Since men have so little mammary tissue, mastectomy is the surgery chosen in most cases, unlike the conservative approach to surgery that we tend to for women”, explains Doctor Gallegos.
Ten percent of breast cancer cases in men are hereditary
Age, family history, obesity and diagnoses of genetic disorders or syndromes related with hormone imbalances that favour the production of female hormones and oestrogens are some of the risk factors that make men more likely to develop breast cancer. In addition, like women, men who have a BRCA mutation are also at greater risk of developing breast cancer, although the risk percentages are not the same.
“Women bearers of BRCA have around a 49 to 60% risk of developing breast cancer, depending on their particular genetic disorder, while the risk in men is much lower”, says Doctor Gallegos. She adds that “about 10% of breast cancer cases in men are hereditary; that is, they’re born with inherited mutations (BRCA2 is the best known) and therefore more risk of developing cancer. The rest of the cases are sporadic”.
The doctor issued a reminder of the importance of contacting a unit specialising in family genetic cancer if a male member of the family gets breast cancer. “A case like that could put us on the track of an inherited risk, and if that can be confirmed we can help that family detect other cases early on”, she assured. She also reminded people that most breast tumours in men appear sporadically and have no inherited genetic component.