A diagnosis that takes men by surprise

“You have breast cancer.” No one is ever prepared to hear a doctor utter those words -- especially if the patient is a man.

“Every one of them has been completely stunned by the diagnosis,” says Dr. Sharon H. Giordano of the male patients she has treated in her clinic at the M.D. Anderson Cancer Center in Houston. None knew that they had breasts in the first place, much less that they could get breast cancer.

Though men have far less breast tissue than women -- one reason, some scientists believe, that female breast cancer is 100 times more common -- doctors detect breast tumors in about 1,500 men in the United States each year. Four hundred men with breast cancer die. (For comparison, about 230,900 men develop prostate cancer, and 29,900 die of the disease.)

Although it remains rare, rates of male breast cancer are rising in the United States. Now researchers are learning more about this form of the disease.

Cancerous tumors can form in the male breast at any age, though they are more common in older men. The average man has a one in 1,000 chance of developing breast cancer. If your mother or sister has had the disease, your risk increases fourfold, though four in 1,000 is still very low. However, risk increases if multiple family members have had breast cancer, especially if one of them is male.

Giordano and several colleagues conducted the largest survey to date on the incidence, survival rates and other aspects of male breast cancer and published their findings this month in the journal Cancer.

They found that rates of male breast cancer in the United States have increased 26% over the last quarter-century. No one is sure why rates are rising, but one familiar villain may be complicit: the nation’s obesity epidemic.

“Fat tissue makes estrogen,” explains Giordano, and the so-called female hormone (which men produce too) fuels the growth of breast tumors. Some scientists also suspect that increased exposure to agricultural and industrial chemicals that contain estrogen-like substances may be partly to blame. (Rates of breast cancer among women are rising twice as fast, though superior screening and detection may help explain the difference.)

Giordano also found that men tend to be older when diagnosed with breast cancer (the median age is 67) than women (63). Her team showed that breast tumors in men usually aren’t detected until they have reached a later, more deadly stage. In fact, men with advanced breast cancer stand only a one in four chance of surviving five years.

Doctors have long believed that male breast cancer is unusually virulent, but another recent study challenges that perception.

“I was always taught that male breast cancer is a very aggressive, wild type of tumor. But breast cancer in men tends to be more indolent,” says Dr. William F. Anderson of the National Cancer Institute.

In the June issue of the journal Breast Cancer Research and Treatment, Anderson and several colleagues examined more than 1,400 cases of male breast cancer and found that the disease typically resembles breast cancer in older women, which Anderson says is usually less aggressive than tumors that arise in younger women.

Anderson’s finding not only suggests that early detection of male breast tumors would save lives, but that men with the disease may respond best to treatment strategies that work well for older women, such as opting for hormonal treatments like Tamoxifen instead of chemotherapy.

However, surgery is usually necessary too. Most men undergo a mastectomy, which removes the entire breast; in the case of a large tumor, some chest muscle may be taken out as well.

Scientists have noticed that men and women who develop breast cancer tend to be well educated and have high incomes. Doctors have presumed that wealthy women with lots of schooling had a higher risk for breast cancer because they put off having children; having a greater number of menstrual cycles is believed to increase risk. But how does that explain high rates among wealthy, educated men?

“It’s clearly not that they’re having more menstrual cycles,” says research scientist Cynthia O’Malley of the Northern California Cancer Center in Union City. Using U.S. census data, O’Malley is studying 2,000 cases of male breast cancer in California to determine whether living in an affluent neighborhood increases risk.

Can you spare 10 seconds each month? Examine your chest now and then. Cancerous breast tumors usually appear as hard, painless lumps (though some tumors can be painful). The nipple may turn inward or ooze discharge (which can vary in color and consistency). Or the nipple may develop a sore that doesn’t heal.

If something feels weird, get it checked out, but insist that your doctor remove his or her blinders before examining you, advises Giordano.

“If a patient has a lump,” she says, “it needs to be worked up and not dismissed just because he’s a man.”

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Timothy Gower can be reached by e-mail at tgower@comcast.

net.