Movember is a global movement to raise awareness about common men’s health issues such as prostate and testicular cancer. Men’s health entails so much more, however, and switching gears from Breast Cancer Awareness Month presents the opportune moment to focus on a much less talked-about issue: breast cancer in men.

If there is one message that men should hear, says radiologist Dr Johan Blomerus, it’s around early detection: any lump in the breast should be checked by your doctor without a moment’s delay.

Dr Blomerus is a partner at SCP Radiology and cautions that men are often diagnosed with breast cancer in an advanced stage.

This could be partly explained by the fact that the disease is rare in men (globally, men account for only about 1% of breast cancer patients) and that awareness campaigns are almost exclusively aimed at women. Men could therefore easily downplay their symptoms and wait too long before seeking medical advice. They are also not routinely screened for breast cancer like women are.

Still, the disease occurs in men too and by visiting a doctor immediately after noticing a lump or discomfort, men could significantly improve their prognoses and treatment outcomes.

This is what you should know about the potentially life-saving process of getting the correct diagnosis as early as possible.

Know the risk factors for breast cancer in men

Being aware of the risk factors can go a long way in helping men make informed decisions. According to the Cancer Association of South Africa (CANSA), the risk factors include:

• Older age, as breast cancer becomes more common in men over 40.
• The presence of a BRCA gene mutation in the family, especially BRCA2.
• A history of close relatives having had breast cancer.
• Raised oestrogen levels, which can be brought on by a number of factors such as hormone therapy for prostate cancer, cirrhosis (liver disease), heavy drinking, obesity, and Klinefelter’s syndrome.
• Previous radiation therapy to the chest.

Know your normal (and potential warning signs)

Dr Blomerus says that changes in adult men’s breasts are often because of a non-cancerous condition known as gynecomastia. This is a mostly harmless enlargement of the breasts due to hormonal imbalances and an increase in glandular breast tissue. Although it can be painful, it cannot “develop” into breast cancer.

On the other hand, patients could present with a small lump behind the nipple or areola that seems small and harmless at first but turns out to be a malignant growth in the milk ducts. (Yes, men do have mammary glands and milk ducts but these usually don’t develop beyond puberty.) More often than not, these malignant lumps are not painful and Dr Blomerus cautions that men should not dismiss a lumpy growth just because it isn’t painful to the touch.

Men should also be aware that there are different types of breast cancer, and different symptoms.

According to the Male Breast Cancer Global Alliance – an international cohort of survivors and clinicians who advocate for a better understanding of male breast cancer – men should visit their doctor if they notice any of the following changes:

• A lump in or near the breast or underarm.
• A change in the size or shape of the breast.
• Dimpling or puckering in the skin.
• An inverted nipple.
• Fluid from the nipple, especially if it’s bloody.
• Scaly, red, or swollen skin on the breast, nipple, or areola.
• Dimples in the breast that look like orange peel.

See your doctor as soon as you can

Dr Blomerus warns that early detection – before the cancer gets a chance to invade nearby structures or spread to other parts of the body – remains vital. He stresses again that painless lumps are a common symptom of male breast cancer and should never be ignored, no matter how harmless they may seem. “Men simply aren’t supposed to have lumps in their breasts, so any lump should be checked right away.”

Make an appointment with your general practitioner or family doctor, who will refer you for medical imaging based on your history, symptoms and a clinical exam.

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Ultrasound comes first

SCP’s lead sonographer, Chrisoné Smit, says that diagnostic ultrasound will often be performed first as it is a painless and highly effective tool to perform the initial screening.

“On ultrasound, we can very easily distinguish between gynecomastia and a growth with a different underlying pathology. Gynecomastia basically follows a ‘pattern’ of change within the breast tissue, while a tumour, in most cases, can be visualised as an irregular mass with specific characteristics.

“Once we have determined that there’s a mass, we carefully describe these characteristics by evaluating its shape, outline, colour and density. We also examine the mass for possible calcifications, increased blood flow, and we also look at the lymph nodes in the armpit as cancer typically spreads via these nearby lymph nodes to the rest of the body. We’ll often do this for both breasts and armpits for screening and comparison.

“Once this process is complete, we will know if a mammogram may be needed.”

A mammogram and a biopsy may come next

Mammography is an X-ray application that was specifically developed for breast imaging. Unlike for women, who are encouraged to get routine annual mammograms, the technology is used as a supplementary diagnostic tool for men with breast lumps.

Mammograms for men are done in exactly the same way as for women, although it may be somewhat more uncomfortable to position the breast: As much tissue as possible is compressed between two plates on the mammogram machine, and images are taken from two different angles.

“Thanks to the absence of functional glandular tissue, male breast cancer is exceptionally clear to see on a mammogram,” says Dr Blomerus. “A mammogram is more effective in imaging the extent of a tumour and also shows calcifications that ultrasound don’t always do.”

Once the tumour is well described and characterised by radiologists, a biopsy may be performed to remove a piece of tissue or a sample of cells from the body so that it can be analysed in a laboratory.

After leaving the radiology practice

Breast cancer in men is currently treated in much the same way as it is treated in women.

In order for treatment to be effective, the patient’s oncologist will request further tests and imaging to gather as much information about the cancer as possible. Apart from type, location and size, doctors will look for possible spread to lymph nodes or other parts of the body, the grade of the tumour, and the presence of certain biomarkers.

Depending on all of this information, treatment may include surgery, chemotherapy, hormone therapy, radiation or targeted therapy that fights very specific cancer cells, and follow-up visits will be required for some years.

The overall survival rate for men with breast cancer is currently lower than for women who are diagnosed, which places even more emphasis on acting fast, says Dr Blomerus.

The key message remains that earlier detection allows for more treatment options and better outcomes, so all men and their loved ones are encouraged to ensure medical care sooner rather than later.

• According to JAMA Oncology, breast cancer accounts for only 0.3% of all cancers in men globally. This November, we encourage you to read more about the most common cancers in South African men or to visit the Movember movement online.

For more information about breast cancer in men, read CANSA’s fact sheet or visit the Male Breast Cancer Global Alliance.

This article is intended to create awareness and none of the information it contains should replace the need for seeking personal advice from a professional medical practitioner.