Does breast cancer occur in men? Every year in Russia, about 50 thousand people become ill with breast cancer. Approximately 1-1.5% of these cases occur in cancer in the stronger sex. Cancer in men differs little from “female” in aggressiveness, but more often it is found in stages 3 and 4. Men usually fall ill on average and old age.
Causes of breast cancer
In men, the chest is represented by a small amount of undeveloped glandular tissue, fatty tissue and connective fibers. Under the influence of adverse internal and external factors, atypical cells may appear in the mammary glands. Their structure and physiology are very different from the norm. Over time, these cells pass the path of progression and become more malignant.
Causes of breast cancer in men:
- unfavorable genetics;
- hyperestrogenic of any etiology;
- elderly age;
- obesity ;
- bad habits (smoking, addiction to alcohol);
- repeated chest injuries;
- radiation exposure;
- work in hazardous industries, etc.
An important factor in the occurrence of breast cancer in men is heredity. Every fifth patient with this diagnosis has a relative with a similar pathology. Scientists have shown that BRCA2 mutations play a major role in the disease of a malignant breast tumor.
In addition, one of the genetic diseases, Klinefelter syndrome, leads to oncology with a high probability. In patients with this pathology in the classical version there is one additional X chromosome (47, XXY). Such a set of genes is associated with low levels of androgens , testicular hypoplasia, gynecomastia . In men with an extra X chromosome, there is a relative hyperestrogenism. It is probably because of her that breast cancer develops.
Excess female sex steroids in men adversely affects the glandular tissue. Hyperestrogenism appears due to:
- hypogonadism (lack of testosterone) ;
- liver disease;
- taking certain medications, etc.
Because of the female hormones, the breast is hypertrophied with the development of true gynecomastia. Over time, atypia may occur in the glandular tissue that appears.
The older the man, the higher his risk of breast cancer. Most patients experience pathology in old age.
Causes of high risk of disease in this group of patients:
- age deficiency of testosterone due to andropause;
- high prevalence of metabolic disorders (diabetes, etc.);
- accumulation of adverse factors.
Overweight in men is associated with hyperestrogenism. Most androgens are transformed in adipose tissue into female sex hormones. The higher the body mass index and waist size, the more often oncology develops.
Alcohol has a strong negative effect on liver tissue. Alcoholism naturally leads to cirrhosis. Disorders in the liver are also manifested by the activation of the conversion of androgens to estrogens in hepatocytes. In addition, some alcoholic beverages (beer) contain analogues of female sex steroids, which have a direct effect on the glandular tissue.
Violate the normal hormonal balance and narcotic substances. For example, opioids, hashish, marijuana cause persistent hyperestrogenism.
Chest injuries in the glands lead to inflammation. This process is characterized by hyperemia, local accumulation of immune cells and changes in the composition of the tissue fluid. Chronic inflammation is a risk factor for oncology.
Radiation and exposure to hazardous working conditions affect the cell genome. Mutations occur in the tissues. If such atypical cells are preserved and not destroyed by immunity, then an oncological tumor occurs.
Symptoms of breast cancer in men
Fig. 1 - Symptoms of breast cancer in men.
Symptoms of the disease in men can be detected very early. In the chest area, the representatives of the stronger sex do not have a large amount of soft tissue. The tumor may be visible to the eye or palpable, even at small sizes. But, unfortunately, neither men nor doctors usually have a vigilance about this form of cancer. Therefore, with all the possibilities of early diagnosis, oncology is more often found at a late stage.
Symptoms of the disease in men:
- a neoplasm in the chest (usually under the areola);
- nipple retraction;
- shriveled areola skin;
- skin ulceration;
- redness of the skin;
- discharge from the nipples;
- increase in axillary lymph nodes.
The tumor to the touch can be heterogeneous, soldered to the surrounding tissues. Usually the neoplasm on palpation is painless.
Diagnosis of the disease
Cancer can be detected by a doctor of any specialty. In most cases with symptoms of the disease, patients come to the therapist or surgeon. To clarify the diagnosis, it is necessary to be examined by a breast oncologist.
Comprehensive survey includes:
- probing of the mammary glands and local lymph nodes;
- radiography (mammogram);
- Breast ultrasound ;
- tomography (CT, MRI);
- aspiration biopsy;
- the study of discharge from the nipple to atypia;
- a study of atypia discharged from an ulcer;
- hormonal profile;
- tumor markers (Ca-15-3, BRCA, REA).
Forms and stages of breast cancer
Based on the results of the diagnosis, an accurate diagnosis is established, including the form and stage of oncology.
The main types of cancer in men:
- ductal carcinoma non-invasive;
- ductal carcinoma infiltrative;
- lobular cancer infiltrative;
- Paget's cancer;
- edematous infiltrative neoplasm.
Table 1 - Stages of breast cancer.
|0||In situ neoplasm (“in situ”)|
|one||The volume of pathological tissue up to 2 cm, no metastases|
|2||Volume up to 2 cm and lymph node metastases / volume 2-5 cm and lymph node metastases / volume more than 5 cm without metastasis|
|3A||Tumor more than 5 cm and lymph node metastases|
|3B||Tumor with germination in the surrounding tissue|
|four||Any tumor and the presence of metastases in distant organs (for example, in the liver)|
Treatment of breast cancer in men
Patients with breast cancer receive a radical and conservative treatment. Most often, a man needs a complex effect on the oncological process.
The following methods are used:
- radiation therapy;
- chemotherapy treatment;
- hormone therapy.
If cancer is detected at an early stage (0 or 1), then surgical treatment is necessary. If it is possible to remove all glandular tissue, then no further treatment is recommended in most cases. According to the results of histology, chemotherapy is sometimes prescribed (if the tumor is highly aggressive). If a part of the mammary gland is preserved, then the patient is additionally given radiation therapy.
Treatment of stage 2 and 3 of breast cancer in men combines surgery, radiation, hormone therapy and chemotherapy (if there are metastases in the lymph nodes).
If a patient is diagnosed with stage 4, then the combination of chemotherapy and hormonal drugs comes first to the treatment regimen.
In men, radical removal of all glandular tissue is preferable (mastectomy).
Fig. 2 - Radical removal of the breast in men.
- simple (removal of glandular tissue, nipple);
- radical modification (removal of glandular tissue, nipple, regional lymph nodes);
- radical (removal of glandular tissue, nipple, regional lymph nodes, large and / or small pectoral muscles).
Organ-preserving operations are recommended extremely rarely and only at the earliest stages of the process.
Radiation therapy is usually prescribed after an organ-preserving operation or radical treatment of a tumor of stage 2-4.
The main method of treatment is remote. It involves exposure outside. The impact is on the area of the breast and other areas of the chest.
Chemotherapeutic agents are prescribed to patients with aggressive tumors of any stages. In some cases, this effect has to be abandoned (in case of a serious condition of the patient). Chemotherapy drugs block the growth and reproduction of cancer cells inside the neoplasm itself and in metastases.
- chemotherapy as the main method (at stage 3-4);
- neoadjuvant (in preparation for radical treatment);
- adjuvant (for the destruction of metastases).
Progressive chemotherapy is the means of targeted (targeted) therapy. They have fewer side effects and a better safety profile. Successful examples of such medicines are Trastuzumab, Pertuzumab, Lapatinib.
About 90% of breast tumors in men are sensitive to estrogen and / or progesterone. Such tumors respond to the use of hormonal agents.
Apply the following drugs:
- antiestrogens (block estrogen receptors), for example - Tamoxifen;
- aromatase inhibitors (reduce the level of estrogen, inhibit the conversion of androgens into estrogens), for example - Arimidex;
- LH releasing factors (luteinizing hormone inhibitors, reduce androgen levels), for example, Zoladex;
- synthetic derivatives of progesterone (compete for receptors at the level of tumor cells), for example - Megestrol.
Endocrinologist Tsvetkova I.G.