Breast cancer in men
It's Breast Cancer Awareness Month and while our hearts go out to the women who get breast cancer (almost 49,000 a year in the UK), many people have no idea that it can affect men, too. It's rare in men - about 370 men a year are diagnosed with it - but it's every bit as devastating.
The biggest risk factor for breast cancer in men is the same as for women - getting older. Most cases of breast cancer are found in people over the age of 50.
We tend to think of breast cancer as a condition related to the female hormone, oestrogen. That's true for men, too - a rare genetic condition called Klinefelter's syndrome, where men are born with and extra X chromosome (XXY instead of XY) raises the breast cancer man 20-fold. Being very obese or chronic liver disease can also raise a man's risk by increasing his oestrogen levels. In addition, faulty genes such as the BRCA gene (which Angelina Jolie has done so much to raise awareness of) may account for as many as one in five male breast cancers, compared to one in 30 female equivalents. That means that men with a 'first-degree' family history of breast cancer in mother or sisters may be at increased risk, especially if more than one is affected or they were diagnosed under the age of 40.
The symptoms of breast cancer in men are also similar to those in women:
- A breast lump
- Changes to the nipple, including discharge (possibly blood-stained) or turning in of the nipple
- An ulcer of the skin of the breast that doesn't heal
- Nipple eczema.
The treatment is similar too. The added complication for men is that men have less breast tissue, which may make surgery harder to hide than the modern-day 'lumpectomies' offered to many women. Because of this lack of breast tissue, their cancer will also be closer to the pectoral muscles of the chest, increasing the risk of spread or recurrence. That means radiotherapy is more often used in men than in women, to reduce these risks. Because about 90% of male breast cancers are sensitive to oestrogen, they will often be offered long-term hormone treatment with medicines like tamoxifen. As well as nausea, hot flushes, problems sleeping and mood changes, this can cause loss of sex drive in men.
I've only seen a handful of men with breast cancer in my career, but I remember every one. While it's natural to feel helpless in the face of a diagnosis of cancer, they've told me about the added stigma of having a 'woman's' disease, and how they feel isolated and even ashamed. I'm delighted that breast cancer awareness campaigns have done so much to raise awareness of the most common women's cancer - it can only help to get women treated at an earlier stage, when success rates are higher. But let's spread the word more widely. Men may not get pregnant - but in some respects we need to remember that they're not so very different, after all.