Breast cancer doesn't discriminate

Breast cancer is widely considered to be solely a problem for women, like cervical or uterine cancer, and its presentation in society widely reflects that. The cancer ribbons are pink, and reminders to self-examine are geared toward women. When men are featured or mentioned in relation to breast cancer, it is largely as a supporter of a mother, wife or sister who has faced or is battling the disease.

But breast cancer is an equal opportunity offender; men can get breast cancer as well. So why doesn't anyone hear about it? Lack of awareness is a major culprit—men simply aren't made aware that they're at risk. Their recommended routine health screenings don't include personal breast exams or mammograms; the one cancer type they're regularly warned about and tested for is testicular cancer. After all, in our societal mindset and vernacular, men don't have breasts—they have pecs. It's also likely that the lack of discourse among those who are diagnosed is due to a hesitancy to speak out, to admit that they have a “woman's” kind of cancer.

For the most part, the lack of awareness is due to the fact that it is much rarer for men to get a breast cancer diagnosis than women. Dr. Julie Gralow, a breast cancer researcher at Fred Hutchinson Cancer Research Center and the University of Washington who also treats breast cancer patients at Seattle Cancer Care Alliance, noted that between ½ and 1 percent of breast cancer patients are men. According to the American Cancer Society, roughly 2,600 men are diagnosed with invasive breast cancer annually, compared to the 246,660 women expected to be diagnosed in 2016. Of those, 440 men will die of the disease each year, compared to 40,450 women—about 17 and 16 percent, respectively. While women have a 1 in 8 chance of developing breast cancer, men face a lifetime risk of 1 in 1,000.

Those risks jump significantly for both men and women in the face of certain mutations—specifically, in the BRCA genes. Roughly 1 in 400 people have BRCA mutations. The U.S. Centers of Disease Control note that men who present with the BRCA2 gene have a 7-percent chance of developing cancer in their lifetime. As for women, the American Cancer Society says women with BRCA1 mutations have a 55- to 65-percent chance of developing breast cancer, and a 45-percent chance with mutations of BRCA2.

BRCA1 and BRCA2 mutations can contribute to the development of prostate cancer as well. An October 2015 article by Joy Larsen Haidle on the National Society of Genetic Counselors blog noted that “the criteria for considering genetic testing for hereditary breast and ovarian cancer now includes men with aggressive forms of prostate cancer.”

“It’s important to look at the health history on both sides of the family,” Haidle wrote. “Half of the families who have an inherited risk of developing cancers inherited it from their father’s side of the family, but often the patterns are easier to see on their mother’s side. The chances of men developing cancer as a result of a BRCA1 or BRCA2 gene mutation are lower than the chances for women. Therefore, it may look like the gene is skipping a generation if the men don’t develop cancer. A man may inherit the mutation and not become sick, but his children and grandchildren remain at risk.”

The numbers are fairly different between the sexes when it comes down to breast cancer types as well. At the 2014 San Antonio Breast Cancer Symposium, researchers shared results from the largest series of male breast cancer cases ever studied. A total of 1,822 men with breast cancer were enrolled in the study, men who had been treated between 1990 and 2010 at 23 centers in nine countries.

When analyzing the tumors, it was found that 92 percent of tumors tested positive for the estrogen receptor, 5 percent tested positive for HER2 and 1 percent were triple-negative, meaning they tested negative for estrogen receptors, HER2 and progesterone receptors. By comparison, in women, roughly 70 percent of breast cancers are estrogen-receptor positive, 20 percent are HER2-positive and 10 to 15 percent are triple-negative, according to an AACR press release on the study results.

Dr. Fatima Cardoso, director of the breast unit at the Champalimaud Cancer Center in Lisbon, Portugal, and co-principal investigator of the study, noted that “Although we saw a significant improvement in overall survival for male breast cancer patients over time, the prognosis for men with breast cancer has not been improving as much as for women with the disease.”

“Our results tend to show that men diagnosed with breast cancer are not well managed in the clinic,” Cardoso added. “For example, even though most male breast cancers are ER-positive, we found that only 77 percent of patients received endocrine therapy like tamoxifen. We also found that even though 56 percent of male breast cancers are diagnosed when the tumors are very small, only 4 percent of patients had breast-conserving surgery; most had a mastectomy, which significantly impacted their quality of life.”

One of the leading causes of male breast cancer not being managed well is, ironically, the lack of more men with breast cancer. Given the sheer number of women diagnosed each year, there's no lack of volunteers for clinical studies to answer questions about diagnosis, disease progression, metastasis and the safety and effectiveness of various treatments. But numbers are much lower for men, and enrollment is often far from sufficient for clinical studies, which in turn leads to a lack of options in terms of investigating how established and exploratory therapies affect male breast cancer. Searching with the phrase 'women breast cancer' on ClinicalTrials.gov returns 3,047 studies; searching 'male breast cancer' on the same site returns just 580 results.

And male-centric studies are necessary. At present, given the dearth of data on how men with breast cancer react to certain drugs, treatment plans are made based on the data for women with breast cancer, which hardly guarantees similar results. But given the biological and hormonal differences between men and women—men produce half as much progesterone as women do, as well as less estrogen, though their estrogen production increases when they age—the cancers aren't going to present or develop the same, and the effectiveness of cancer drugs will vary as well.

Awareness needs to be raised both in the industry and in society; increased attention in the medical and pharma fields will spur more research into how breast cancer presents in men vs. women and how their reactions to current standards of care vary, and increased awareness among Joe Citizen will hopefully lead to more men getting checked and participating in trials, which will in turn offer more answers to better tailor treatment for male breast cancer.

So guys, keep an eye on yourselves. If there's a history of breast cancer in your family, talk to your doctor about your own risk. Keep an eye out for unusual lumps, pain or tenderness in your chest and armpits. And in case 'Save the ta-tas' isn't quite masculine enough a tagline for your tastes, run with this one instead:

Respect the pecs.