Like many diseases, breast cancer does not discriminate based on biological sex. The view that breast cancer is a “women’s disease” is a common misconception: the truth is, men, too, are at risk of developing breast cancer, and it has the potential to be more dangerous.
Dr Nik Muhd Aslan Abdullah, clinical oncologist at a medical centre in Subang Jaya, explains that cancer can potentially develop wherever breast tissue is present on an individual, regardless of whether they are male or female.
Still, it is comparatively much rarer in men and, therefore, can be quite isolating for those who are diagnosed with it.
Breast cancer in both men and women share many similar attributes. The most common breast cancers in men are the same as those in women, namely invasive ductal carcinoma, invasive lobular carcinoma, and ductal carcinoma in situ.
Additionally, many of the most pressing early warning signs in men are similar to those in women, such as lumps in breast tissue, skin dimpling or puckering, nipple retraction, and unusual discharge from the nipple.
A hormonal question
A majority of breast cancers grow in response to the hormones oestrogen or progesterone, as breast cancer cells that are hormone-receptor (HR) positive can latch on to specific chemicals that circulate through the body and allow for growth to happen.
Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive compared with women.
“Breast tissue itself grows in response to oestrogen and is prohibited by testosterone. While it is a primarily female hormone, men have them in their bodies, too, just at lower levels,” he explained.
“Breast cancer cells in men are sensitive to hormonal imbalances, so any factors or conditions that lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”
Conditions such as Klinefelter syndrome – a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens – as well as injury to the testicles, use of androgen inhibitors, liver cirrhosis (scarring of the liver), and even obesity can all result in raised oestrogen levels in men.
That said, since the majority of breast cancers in men are HR-positive, this also makes them more likely to respond to hormone treatments.
“Like chemotherapy, this is a form of systemic therapy that can be used to help lower the risk of the cancer cells spreading, or treat cancer that has come back after treatment.”
What’s in your genes?
Genetics is another factor that could lead to a man developing breast cancer: one out of every five patients is found to have had a familial history of the disease.
Nik recommends for men with a family history of cancer to seek counsel from their doctors on genetic screening tests, especially those over age 50.
“These tests are done through blood sampling. A genetic counsellor is able to guide you on what to look out for and what can be done with the results given.
“If positive, they can also provide advice on treatment for the patient, as well as what it would mean for their families and children.”
Asked about the outlook for men with breast cancer, Nik emphasises that those who are diagnosed early can be cured early.
“Through many studies I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women, but this can be boiled down to the fact that they are often diagnosed late,” he said.
“Men sometimes wait too long to seek out a diagnosis for the symptoms they experience, not recognising the warning signs. As a result, the cancer may already have metastasised to a much more perilous state.”
Nik encourages men to not be afraid of seeking a doctor’s opinion if they find themselves experiencing any of the symptoms related to breast cancer.
“It can be cured and is very treatable if detected early on. Men’s perception and their willingness to get checked plays an important role in early diagnosis; they must feel empowered to seek help when they need it.”