Anatomy of the male breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, fatty tissue, ducts, and other parts of the inside of the breast are also shown.
Estimated new cases and deaths from breast cancer (men only) in the United States in 2018: [1]
Male breast cancer is rare. [2] Fewer than 1% of all breast carcinomas occur in men. [3] [4] The mean age at diagnosis is between 60 and 70 years; however, males of all ages can be affected with the disease.
Predisposing risk factors for male breast cancer appear to include the following: [5] [6]
Signs of breast cancer in men may include the following:
When breast cancer is suspected, patient management generally includes the following:
The following tests and procedures are used to diagnose breast cancer:
(Refer to the Diagnosis section in the PDQ summary on Breast Cancer Treatment for information about evaluating the contralateral breast and molecular profiling [estrogen-receptor and progesterone-receptor status and human epidermal growth factor receptor 2 (HER2/neu) expression status of the tumor].)
The pathology of male breast cancer is similar to that of female breast cancer, and infiltrating ductal cancer is the most common tumor type (refer to Table 1). [13] Intraductal cancer, inflammatory carcinoma, and Paget disease of the nipple have also been seen in men, but lobular carcinoma in situ has not. [13]
Lymph node involvement and the hematogenous pattern of spread are similar to what is observed in female breast cancer.
| Tumor Location | Histologic Subtype |
|---|---|
| Carcinoma, NOS | |
| Ductal | Intraductal (in situ) |
| Invasive with predominant component | |
| Invasive, NOS | |
| Comedo | |
| Inflammatory | |
| Medullary with lymphocytic infiltrate | |
| Mucinous (colloid) | |
| Papillary | |
| Scirrhous | |
| Tubular | |
| Other | |
| Lobular | Invasive [14] |
| Nipple | Paget disease, NOS |
| Paget disease with intraductal carcinoma | |
| Paget disease with invasive ductal carcinoma | |
| Other | Undifferentiated carcinoma |
| Metaplastic | |
| NOS = not otherwise specified. | |
Factors that correlate well with prognosis include the following: [5] [15]
Overall survival is similar to that of women with breast cancer. The impression that male breast cancer has a worse prognosis may stem from the tendency toward diagnosis at a later stage. [2] [5] [16]
Note: The American Joint Committee on Cancer (AJCC) has published the 8th edition of the AJCC Cancer Staging Manual, which includes revisions to the staging for this disease. Implementation of the 8th edition began in January 2018. The PDQ Adult Treatment Editorial Board, which maintains this summary, is reviewing the revised staging and will make appropriate changes as needed.
The AJCC staging system provides a strategy for grouping patients with a similar prognosis. The stage of the disease is determined by the following:
Treatment decisions are based on the stage of disease and the general health of the patient.
The TNM (tumor, node, and metastasis) staging system for male breast cancer is identical to the staging system for female breast cancer. (Refer to Definitions of TNM and AJCC Stage Groupings in the Stage Information for Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
Standard treatment options for men with breast cancer are described in Table 2.
| Stage (TNM Staging Criteria) | Standard Treatment Options |
|---|---|
| Early/localized/operable breast cancer | Surgery with or without radiation therapy |
| Adjuvant therapy—chemotherapy, endocrine therapy, HER2-directed therapy | |
| Locoregional recurrent breast cancer | Surgery |
| Radiation therapy and chemotherapy | |
| Metastatic breast cancer | Hormone therapy and/or chemotherapy |
| HER2 = human epidermal growth factor receptor 2; TNM = tumor, node, and metastasis. | |
The approach to the treatment of breast cancer in men is similar to that in women. Because male breast cancer is rare, there is a lack of randomized data to support specific treatment modalities.
As in women, standard treatment options for men with early-stage breast cancer include the following:
Primary standard treatment is a modified radical mastectomy with axillary dissection. [1] [2] [3] Responses are generally similar to those seen in women with breast cancer. [2] Breast conservation surgery with lumpectomy and radiation therapy has also been used, and results have been similar to those seen in women with breast cancer. [4]
(Refer to Surgery in the Early/Localized/Operable Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
In men, no controlled studies have compared adjuvant treatment options. Adjuvant therapies used to treat early/localized/operable male breast cancer are outlined in Table 3.
| Type of Adjuvant Therapy | Agents Used |
|---|---|
| Chemotherapy | Cyclophosphamide plus methotrexate and 5-fluorouracil (CMF) [5] |
| Cyclophosphamide plus doxorubicin and fluorouracil (CAF) | |
| Doxorubicin plus cyclophosphamide with or without paclitaxel (AC, AC-T) | |
| Endocrine therapy | Tamoxifen [6] |
| Aromatase inhibitors with LHRH agonist [6] [7] [8] [9] [10] | |
| HER2-directed therapy | Trastuzumab [1] [6] |
| Pertuzumab | |
| HER2 = human epidermal growth factor receptor 2; LHRH = luteinizing hormone-releasing hormone. | |
In men with node-negative tumors, adjuvant therapy should be considered on the same basis as for women with breast cancer because there is no evidence that response to therapy is different between men and women. [11]
In men with node-positive tumors, both chemotherapy plus tamoxifen and other hormonal therapy have been used and are believed to increase survival to the same extent as in women with breast cancer.
Approximately 85% of all male breast cancers are estrogen receptor–positive, and 70% of them are progesterone receptor–positive. [2] [12] Response to hormone therapy correlates with the presence of these receptors. Hormonal therapy has been recommended in all patients with receptor-positive cancers. [1] [2] Tamoxifen use, however, is associated with a high rate of treatment-limiting symptoms, such as hot flashes and impotence, in male breast cancer patients. [13] Responses are generally similar to those seen in women with breast cancer. [2] (Refer to Postoperative Systemic Therapy and Preoperative Systemic Therapy in the Early/Localized/Operable Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
Regarding endocrine therapy, tamoxifen is generally used instead of an aromatase inhibitor (AI) because the data supporting the use of an AI in men with breast cancer are limited. A retrospective analysis of 257 men with stage I to stage III breast cancer included 50 men treated with an AI and 207 men treated with tamoxifen. The following results were observed:
The use of AI therapy with a luteinizing hormone-releasing hormone agonist has been reported in several cases in the literature. [7] The German Breast Group is conducting a randomized phase II clinical trial (NCT01638247) of tamoxifen with or without gonadotropin-releasing hormone (GnRH) analogue versus AI plus GnRH analogue in men with early-stage, hormone receptor–positive breast cancer; results are pending.
Standard treatment options for men with locoregional recurrent breast cancer include the following: [2]
Responses are generally similar to those seen in women with breast cancer. [2] [11]
(Refer to the Locoregional Recurrent Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
Standard treatment options for men with metastatic breast cancer include the following:
Hormonal therapy is used as the initial treatment. Responses are generally similar to those seen in women with breast cancer. [2] [11]
(Refer to the Metastatic Breast Cancer section in the PDQ summary on Breast Cancer Treatment for more information.)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Male Breast Cancer
Updated statistics with estimated new cases and deaths for 2018 (cited American Cancer Society as reference 1).
Stage Information for Male Breast Cancer
Editorial changes were made to this section.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of male breast cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
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Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
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The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Male Breast Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/breast/hp/male-breast-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389234]
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