Dear Doctor: My husband's mother had breast cancer, and so did both of his aunts. He's really worried about our two daughters' risk, but I've read that breast cancer can affect men as well. Shouldn't he also be worried about himself?
Dear Reader: Most breast cancer is diagnosed in women, but you're correct -- it occurs in men as well. One percent of all breast cancers are found in men. For men who inherited the BRCA1 or BRCA2 genes, the incidence of breast cancer rises to 6 percent. (The BR of BRCA comes from the word "breast," and the CA from the word "cancer.")
Both boys and girls have a small amount of breast tissue around and beneath the nipple. When girls reach puberty, their bodies make hormones that cause the growth and development of the glands and ducts that will make and carry milk, as well as the surrounding tissues to support those structures. Men have significantly lower levels of these so-called female hormones, so their breasts don't develop in the same way. However, men still have that slight amount of breast tissue. And though the small number of glands and ducts found in male breast tissue are not functional, they can still be the site of breast cancer.
Male breast cancer can occur at any age but is more commonly found in older men. In addition to age, risk factors for men include a family history of breast cancer and the inherited gene mutations discussed above. Other risk factors include exposure to whole-chest radiation, as in certain cancer treatments, and liver disease. That's because one of the liver's many roles is the balancing of our sex hormones. In severe liver disease, hormone levels can become skewed and lead to an abundance of estrogen, which raises breast cancer risk.
As with all cancers, early detection is important. Since men have less breast tissue, lumps or other abnormalities can be easier to find. However, that same lack of tissue means there's less distance for cancer to travel and spread to surrounding tissues. Another factor is the lack of awareness that male breast cancer exists, which makes it easy to ignore warning signs. For men with a history of breast cancer in their families, as with your husband's, performing regular breast exams is a good idea. In addition to lumps, keep an eye out for changes to the skin or nipple, including redness, scaliness, dimpling or puckering, discharge from the nipple, and breast or nipple pain.
If anyone in your or your husband's family has the BRCA mutation, then your husband may want to consider genetic testing. If he does decide to follow through, we strongly recommend enlisting the help of a genetic counselor. At the very least, this family history of breast cancer should be information that your husband shares with your family doctor. When caught in the earliest stages, which accounts for close to half of all diagnoses, the five-year survival rate for male breast cancer is 100 percent. We can't think of a better reason to become vigilant.
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