Incidence and Mortality

Estimated new cases and deaths from breast cancer (men only) in the United States in 2020:[1]

• New cases: 2,620.
• Deaths: 520.

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.

Anatomy

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.

Risk Factors

Predisposing risk factors for male breast cancer appear to include the following:[5,6]

• Radiation exposure to breast/chest.
• Estrogen use.
• Diseases associated with hyperestrogenism, such as cirrhosis or Klinefelter syndrome.
• Family health history: Definite familial tendencies are evident, with an increased incidence seen in men who have a number of female relatives with breast cancer.
• Major inheritance susceptibility: An increased risk of male breast cancer has been reported in families with BRCA mutations, although the risks appear to be higher with inherited BRCA2 than with BRCA1 mutations.[7,8] Genes other than BRCA may also be involved in predisposition to male breast cancer, including mutations in the PTEN tumor suppressor gene, TP53 mutations (Li-Fraumeni syndrome), PALB2 mutations, and mismatch repair mutations associated with hereditary nonpolyposis colorectal cancer (Lynch syndrome).[9-11] (Refer to the High-Penetrance Breast and/or Gynecologic Cancer Susceptibility Genes and Management of Male Carriers of BRCA Pathogenic Variants sections in the PDQ summary on Genetics of Breast and Gynecologic Cancers for more information.)

Clinical Features

Signs of breast cancer in men may include the following:

• A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast.
• An inverted nipple.
• Fluid from the nipple, especially if it is bloody.
• Scaly, red, or swollen skin on the breast, nipple, or areola.
• Peau d’orange.

Diagnostic Evaluation

When breast cancer is suspected, patient management generally includes the following:

• Confirmation of the diagnosis.
• Evaluation of the stage of disease.
• Selection of therapy.

The following tests and procedures are used to diagnose breast cancer:

• Clinical breast examination.
• Mammography.
• Ultrasonography.
• Breast magnetic resonance imaging, if clinically indicated.
• Biopsy, including estrogen-receptor and progesterone-receptor status and HER2/neu gene amplification of the biopsy sample.[12]

(Refer to the Diagnosis section in the PDQ summary on Breast Cancer Treatment [Adult] 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].)

Histopathologic Classification

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.

Prognosis and Predictive Factors

Factors that correlate well with prognosis include the following:[5,15]

• Size of the lesion.
• Presence or absence of lymph node involvement.

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]

References

1. American Cancer Society: Cancer Facts and Figures 2020. Atlanta, Ga: American Cancer Society, 2020. Available online. Last accessed May 12, 2020.
2. Giordano SH, Cohen DS, Buzdar AU, et al.: Breast carcinoma in men: a population-based study. Cancer 101 (1): 51-7, 2004. [PubMed: 15221988]
3. Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992. [PMC free article: PMC1242473] [PubMed: 1319699]
4. Fentiman IS, Fourquet A, Hortobagyi GN: Male breast cancer. Lancet 367 (9510): 595-604, 2006. [PubMed: 16488803]
5. Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002. [PubMed: 12379069]
6. Hultborn R, Hanson C, Köpf I, et al.: Prevalence of Klinefelter's syndrome in male breast cancer patients. Anticancer Res 17 (6D): 4293-7, 1997 Nov-Dec. [PubMed: 9494523]
7. Wooster R, Bignell G, Lancaster J, et al.: Identification of the breast cancer susceptibility gene BRCA2. Nature 378 (6559): 789-92, 1995 Dec 21-28. [PubMed: 8524414]
8. Thorlacius S, Tryggvadottir L, Olafsdottir GH, et al.: Linkage to BRCA2 region in hereditary male breast cancer. Lancet 346 (8974): 544-5, 1995. [PubMed: 7658781]
9. Ding YC, Steele L, Kuan CJ, et al.: Mutations in BRCA2 and PALB2 in male breast cancer cases from the United States. Breast Cancer Res Treat 126 (3): 771-8, 2011. [PMC free article: PMC3059396] [PubMed: 20927582]
10. Silvestri V, Rizzolo P, Zanna I, et al.: PALB2 mutations in male breast cancer: a population-based study in Central Italy. Breast Cancer Res Treat 122 (1): 299-301, 2010. [PubMed: 20180015]
11. Boyd J, Rhei E, Federici MG, et al.: Male breast cancer in the hereditary nonpolyposis colorectal cancer syndrome. Breast Cancer Res Treat 53 (1): 87-91, 1999. [PubMed: 10206076]
12. Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005. [PubMed: 16079314]
13. Burstein HJ, Harris JR, Morrow M: Malignant tumors of the breast. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1401-46.
14. Yeatman TJ, Cantor AB, Smith TJ, et al.: Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg 222 (4): 549-59; discussion 559-61, 1995. [PMC free article: PMC1234890] [PubMed: 7574934]
15. Cutuli B, Lacroze M, Dilhuydy JM, et al.: Male breast cancer: results of the treatments and prognostic factors in 397 cases. Eur J Cancer 31A (12): 1960-4, 1995. [PubMed: 8562148]
16. Ravandi-Kashani F, Hayes TG: Male breast cancer: a review of the literature. Eur J Cancer 34 (9): 1341-7, 1998. [PubMed: 9849414]

Treatment of Early/Localized/Operable Male Breast Cancer

As in women, standard treatment options for men with early-stage breast cancer include the following:

• Surgery with or without radiation therapy (locoregional therapy).
• Adjuvant therapy (systemic therapy).

  -

  Chemotherapy.

  -

  Endocrine therapy.

  -

  Human epidermal growth factor receptor 2 (HER2)–directed therapy.

Treatment of Locoregional Recurrent Male Breast Cancer

Standard treatment options for men with locoregional recurrent breast cancer include the following:[2]

• Surgical excision.
• Radiation therapy combined with chemotherapy.

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 [Adult] for more information.)

Treatment of Metastatic Male Breast Cancer

Standard treatment options for men with metastatic breast cancer include the following:

• Hormone therapy and/or chemotherapy.

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 [Adult] for more information.)

References

1. Borgen PI, Wong GY, Vlamis V, et al.: Current management of male breast cancer. A review of 104 cases. Ann Surg 215 (5): 451-7; discussion 457-9, 1992. [PMC free article: PMC1242473] [PubMed: 1319699]
2. Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med 137 (8): 678-87, 2002. [PubMed: 12379069]
3. Kinne DW: Management of male breast cancer. Oncology (Huntingt) 5 (3): 45-7; discussion 47-8, 1991. [PubMed: 1829945]
4. Golshan M, Rusby J, Dominguez F, et al.: Breast conservation for male breast carcinoma. Breast 16 (6): 653-6, 2007. [PubMed: 17606375]
5. Walshe JM, Berman AW, Vatas U, et al.: A prospective study of adjuvant CMF in males with node positive breast cancer: 20-year follow-up. Breast Cancer Res Treat 103 (2): 177-83, 2007. [PubMed: 17039267]
6. Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist 10 (7): 471-9, 2005. [PubMed: 16079314]
7. Giordano SH, Hortobagyi GN: Leuprolide acetate plus aromatase inhibition for male breast cancer. J Clin Oncol 24 (21): e42-3, 2006. [PubMed: 16849742]
8. Cocconi G, Bisagni G, Ceci G, et al.: Low-dose aminoglutethimide with and without hydrocortisone replacement as a first-line endocrine treatment in advanced breast cancer: a prospective randomized trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 10 (6): 984-9, 1992. [PubMed: 1588379]
9. Gale KE, Andersen JW, Tormey DC, et al.: Hormonal treatment for metastatic breast cancer. An Eastern Cooperative Oncology Group Phase III trial comparing aminoglutethimide to tamoxifen. Cancer 73 (2): 354-61, 1994. [PubMed: 8293400]
10. Zagouri F, Sergentanis TN, Koutoulidis V, et al.: Aromatase inhibitors with or without gonadotropin-releasing hormone analogue in metastatic male breast cancer: a case series. Br J Cancer 108 (11): 2259-63, 2013. [PMC free article: PMC3681005] [PubMed: 23722469]
11. Kamila C, Jenny B, Per H, et al.: How to treat male breast cancer. Breast 16 (Suppl 2): S147-54, 2007. [PubMed: 18210656]
12. Joshi MG, Lee AK, Loda M, et al.: Male breast carcinoma: an evaluation of prognostic factors contributing to a poorer outcome. Cancer 77 (3): 490-8, 1996. [PubMed: 8630956]
13. Anelli TF, Anelli A, Tran KN, et al.: Tamoxifen administration is associated with a high rate of treatment-limiting symptoms in male breast cancer patients. Cancer 74 (1): 74-7, 1994. [PubMed: 8004585]
14. Eggemann H, Ignatov A, Smith BJ, et al.: Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients. Breast Cancer Res Treat 137 (2): 465-70, 2013. [PubMed: 23224235]

Purpose of This Summary

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.

Reviewers and Updates

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).

Board members review recently published articles each month to determine whether an article should:

• be discussed at a meeting,
• be cited with text, or
• replace or update an existing article that is already cited.

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.

The lead reviewers for Male Breast Cancer Treatment are:

• Joseph L. Pater, MD (NCIC-Clinical Trials Group)
• Karen L. Smith, MD, MPH (Johns Hopkins University at Sibley Memorial Hospital)

Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Levels of Evidence

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

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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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