Fri | Oct 18, 2019

Dear Doc | Can men really get breast cancer?

Published:Sunday | October 7, 2018 | 12:00 AM

Q Dear Doc, I am quite concerned about a conversation I recently had with my wife. I have a tender lump in my breast near my nipple. I noticed it after she playfully poked me on my breast, and it has not gone away. It only hurts when I touch it to check if it is still there. When I told my wife that since she poked me I have had it, she responded that maybe I have breast cancer.

Now this has concerned me... Can men really get breast cancer? Do I need to see my doctor?

A That is a very good question, and a fact that attention really isn't placed much to.

Yes! men do get breast cancer.

While breast cancer in men is rare, it has many similarities to breast cancer in women.

Even though men do not have breasts like women do, they do have a small amount of breast tissue. The breasts of an adult male are similar to the breasts of a girl before she reaches puberty. However, because it is still breast tissue, men can get breast cancer, and the same types of breast cancers that women do. The types of cancers involving the parts of the breast that make and store milk are rare though.

Breast cancers in men share some of the risk factors associated with breast cancer in women, however, the majority of men with breast cancer have no identifiable risk factors.

It's rare for a man under age 35 to get breast cancer. Most breast cancers happen to men between ages 60 and 70.

As with breast cancer in women, a family history of breast cancer in a first-degree relative is associated with an increased risk of breast cancer among men.

Other risk factors include:

- Excessive oestrogen stimulation. This may be due to hormonal therapies, liver dysfunction, obesity, marijuana use, thyroid disease, or an inherited condition, such as Klinefelter syndrome.

- Testicular conditions. Inflammation of the testes (orchitis), undescended testes (cryptorchidism), and testicular injury. It is thought that these conditions may be associated with lower androgen (male hormone) production, resulting in a higher than normal estrogen (female hormone) to androgen ratio.

The major problem with breast cancer in men is that it is often diagnosed later than in women. This is simply because of a lack of awareness. Men are less likely to be suspicious of something such a breast cancer when symptoms arise, as well as the absence of routine screening exams. The small amount of breast tissue also makes it harder to feel, making it more difficult to catch these cancers early. It also means that it can spread more quickly to surrounding tissues.

Most men with breast cancer usually have a painless, firm mass that is usually below the areola (dark ring of skin around the nipple). It also occurs more often in the left breast than the right. There may also be skin changes, such as nipple retraction, ulceration, or attachment of the lump to the skin.

For men with a suspicious breast mass, assessment is similar to that of women and includes mammography and biopsy.

The mammogram is abnormal in up to 90 per cent of men with breast cancer. If it shows a suspicious mass, the doctor will then order a biopsy to confirm the diagnosis.

If you are concerned about the lump, it is reasonable to suspect breast cancer, and you should visit your doctor.


Is weight-loss surgery an option for me?


Q Dear Doc, I am very overweight. I find it difficult to walk short distances and as such, exercise has been very difficult and I am not losing any weight. Dieting has not helped much either, and I have given up. I am now considering weight-loss surgery. Do you think it is an option for me? I was also told that after the surgery, you cannot gain weight again, is that true?

A Weight loss surgery, also called 'bariatric surgery', is surgery to help you lose weight by making you take in fewer calories and nutrients. To determine if you are a candidate for weight-loss surgery, is dependent on a measure called 'body mass index', or BMI. Weight loss surgery is appropriate ONLY if you have not been able to lose weight through other means and if either:

- You have a BMI above 40 and have not responded to diet, exercise, or weight loss medicines.

- You have a BMI above 35 and also have a medical problem related to obesity, such as diabetes, heart disease, or high blood pressure.

- Have a BMI above 30, but only if you have certain medical conditions.

Please do not fall for the rumours, Yes! you can gain weight again after surgery.

You will need to change the way you eat after surgery. It is advised that you work with a nutritionist (a food expert) to learn how your diet should change. If you eat the wrong things, you could hurt your chances of losing weight.

If you are considering weight loss surgery, have the discussion with your doctor, who will refer you to a specialist called a bariatric surgeon for the surgery.