When people discuss breast cancer, the topic is usually toward its effect on women and the best ways to detect and cure the disease.

But another form of breast cancer — male breast cancer — is missed in the discussions, although it is just as deadly. The reason, medical experts say, is the rare occurrence of the disease in men.

“Nationwide, the incidence of breast cancer in men is very, very low; it’s .5 to 1 percent ,” said Dr. Sophy Mangana, radiation oncologist at the University of Mississippi Medical Center. “In the four years I have been with UMC, I have seen two cases.”

“According to the Mississippi Cancer Registry from 2009 to 2013, in Mississippi there were 12,176 breast cancer diagnoses,” said Terrance Shirley administrator of the UMMC Cancer Institute Research. “Of that, 96 were male and 36 African-American.

“In 2013, the last year we have records for, there were 2,464 diagnoses in Mississippi and 421 deaths, all non-male. Of the male breast cancer diagnoses, 29 were male and nine were African-American.”

Shirley, a member of Real Men Wear Pink, a group of 20 men who do fundraising and cancer awareness programs for the American Cancer Society, believes one reason male breast cancer is not discussed is a lack of knowledge.

“We just take it for granted there’s certain diseases women go through that only they go through, and there are certain diseases men go through,” he said. “We just don’t think about our breasts, because we don’t target that as a preventive type measure for men. It’s more important we get the word out that is something we need to be concerned about.

“The concern is we have people dying from a disease, and if they weren’t screened or diagnosed, we won’t know what we’re missing,” he said. “Awareness is something that’s not taken into consideration to the degree that it needs to be taken. It’s because of the rarity of it, it’s not spoken about a lot.”

While there are no self-diagnostic procedures for men when it comes to determining breast cancer, Shirley and Mangana say men should become concerned if they detect anything unusual in the chest cavity or the breast area.

“If you feel a lump in the breast or chest wall area or armpit that is uncommon, or if there is a history of breast cancer in your family and you feel something, then it is suggested that you get a diagnostic mammogram,” Shirley said.

There are other things to look for, Manana said.

“If its something benign like gynecomastia (the formation of breasts on a man), which is an over growing of the gland, weight gain or some other kind of benign legion, versus an invasive cancer,” she said. “If there is an overgrowth of a man’s breast, something’s wrong. Whether it’s benign or a tumor, there’s something wrong, and as soon as you get that, regardless if you’re 20 or 80, we want to examine you.”

Women are more at risk for breast cancer than men “because of our estrogen,” she said.

“Excess estrogen is actually one of the main risk factors for breast cancer, and as we get older as women, your balance of estrogen and testosterone goes off, so you have more estrogen and less of the other hormone.

“Anything that disregulates that is also going put a man at risk for that. But it’s less common that men have excess circulating estrogen in their body,” she said. “That may be the main reason why — and the other one is unknown, because it’s genetic. So we don’t know why it is there’s more men who either have a family history or with a mutation of their breast cancer gene that get breast cancer.”

If a man has one relative who at an older age was diagnosed with breast cancer, Mangana said, they are probably not at risk for breast cancer.

“Your risk of having that is probably not any greater than the other population,” she said. “If several other family members had breast cancer, I would be looking at either a breast cancer gene or another type of gene that predisposes a family to getting breast cancer, and if you have it more in the family, and you’re talking more of a risk.

“A lot of our breast cancer in women is still unexplained. We’re trying to find a link, but it’s a very small percentage that have a gene that’s making them make a cancer.”

Men, she said, can also have problem with estrogen.

“If you’re under hormonal therapy, we already know we’re giving you hormones to block your testosterone, and you are going to have excess estrogen in your body,” she said. “If you have liver disfunction, usually that comes with making less testosterone. Other indications, men stop growing hair on their legs and arms, impotence and obesity. It’s not terribly obvious. It’s so rare that it happens.”

The procedure to determine if a man has breast cancer is no different from a woman, Mangana said.

“The first step is to go to the physician and get an exam,” she said. “If there’s something suspicious, they might consider doing something right away, they might consider biopsy or draining it if it is a cyst. More than likely they’re going to consider a mammogram or a biopsy.”

And the mammogram is no different whether the patient is a man or a woman, said Shirley, who went through a “faux mammogram.”

“We did not turn on radiation, but I went through everything else you would if you were getting a mammogram,” he said. “That was the motivation to keep put in the forefront that not only women need to be concerned about breast cancer, but also men.

“I did what a woman would do. They took me back to a dressing room, I put on a gown, and they explained to me what they would do and what they were looking for, and how the process would go,” he said.

“They put me on the machine and they pushed the plates down and they squeezed my chest and they loaded me in like they would a woman and they adjusted and manipulated the machine as they would manipulate the machine for an actual mammogram, and it was uncomfortable,” he said. “They are pulling whatever tissue they can get to actually get under the plates for them to push down on.

“I have a new empathy for women and a new respect,” he said.

After the mammogram would come a biopsy, Mangana said.

“You always need biopsy confirmation to be able to call it cancer,” she said.

And there is no difference in treating a man or woman, she said.

“The main thing is they get referred to a genetics counselor and sent for BRCA testing to determine if they have the breast cancer gene,” she said. “The reason is they are more likely to have a familial-type (gene) inherited, especially if they have a family history.”

After the diagnosis, if the cancer is in the ductal carcinoma in situ, or early state, Mangana said, “We want to do a simple mastectomy and sample the lymph nodes or do a lumpectomy and give radiation.”

The male anatomy, however, can make one procedure difficult.

“Trying to preserve a breast in a man I wouldn’t consider ideal,” she said. “I would definitely advise my patients, and I did on one of them, to go for the simple mastectomy, simply because it wasn’t going to affect him cosmetically — a man is not going to worry whether or not they have breast tissue left.

“And it could be very difficult to do a lumpectomy unless it is a small lesion on somebody with not enough tissue,”
she said. “So I would recommend the mastectomy and then, depending on their risk factors, they may still need chemotherapy or radiation.”