Male breast cancer (MBC) is rare with an estimated 150 men diagnosed in Australia this year, 12% of whom have a BRCA2 mutation. The median age at diagnosis is 71 years for men compared to 60 for women. Most men with enlarged breasts have “man boobs”, a condition known as lipomastia or pseudogynaecomastia, characterised by unilateral or bilateral breast tenderness due to hormonal changes. In contrast, MBC tends to present as unilateral, often nodular tumours located close to the nipple, sometimes accompanied by bloody nipple discharge.
Initial investigation includes ultrasound and mammography, followed by core-biopsy of the primary lesion and often fine-needle biopsy of abnormal axillary nodes. Common histologies include infiltrating ductal (90%), papillary carcinomas (3%) and DCIS (2%). ER-positive disease accounts for 80% of patients and HER2-positive disease is uncommon (<5%). For patients presenting with larger masses or clinically positive nodes, a PET-CT or CT and bone scan is necessary to assess loco-regional and distant disease and help determine whether axillary dissection, sentinel node biopsy or IMC irradiation is required.
Treatment is total mastectomy and sentinel node biopsy, but some centres are selectively using breast conservation techniques. Most patients require post-mastectomy radiotherapy, as the disease is often advanced at presentation and obtaining clear margins can be difficult. Limited studies support the use of adjuvant tamoxifen and/or chemotherapy, but not aromatase inhibitors alone.
Significant male-specific psychological issues include “contested masculinity”, “concealment” and “interaction with health services”. Male patients face a disease dominated by pink and the female sex and lack of community awareness. Limited male-specific information and variation in guidelines re BRCA-testing exist. Close follow-up is required after to monitor the disease, the other breast and to potential screen for other second tumours such as prostate cancer.