If a question is put to the general population of Bangladesh right now about males suffering from breast cancer, most of us would be a bit sceptical whereas some of us might even laugh it off as a hilarious joke and some might frown upon “the joke”. Alas! The reality is far from jokes and taboos. For a fact, male breast cancer is as real as it gets and could be lethal if not diagnosed at an early stage.
A 29-year-old obese Korean man suffering from growing enlargement of a lump in his right breast was referred to the Korean Journal of clinical oncology. He had a normal sexual life without a noteworthy medical or family history of breast cancer. He reportedly did not smoke or drink alcohol for five years.
However, after subsequent examinations, his right breast contained a 2.5 cm round mass and his mammography revealed a non-uniform density in it. The mass was solid and ultrasonography revealed a mysterious lymph node enlargement. The final diagnosis was breast cancer but there was no sign of spread or metastasis.
Fig 1: Mammogram showed a 3 cm microlobulated, irregular high-density mass (arrows) — Korean Journal of Clinical Oncology
The stigma of male breast cancer
MBC could be embarrassing for male patients because breast cancer is socially known as a disease of females. Some men may feel less masculine after a diagnosis and be less likely to seek support, According to Dr Aithal, some men refrain from seeking help because they feel less masculine.
Men suffer from extreme embarrassment, loneliness, and shame dealing with the problem alone. Unlike women, there are limited or no support groups or palliative care for men suffering from MBC. “Given this is primarily a malignancy in women, studies have identified that men can feel isolated in their diagnosis.” Dr Lynch says, “They also report feelings of embarrassment and emasculation. Raising awareness of male breast cancer is one way to help alleviate feelings of embarrassment and isolation surrounding this diagnosis.”
Of all cases of breast cancer diagnosed in the US, according to American Cancer Society, about 1.0 per cent is male: about 2700 males have breast cancer compared to 270,000 females.
The treatments are usually guided by the treatments of female breast cancers. The problem arises because the female and male physiology and hormonal distribution are quite different from each other. So, treatments and researches should be accordingly to get the desired results.
Secondly, there is a lot less lack of awareness, and men are not taught to self-examine for the disease. As a result, most of them remain unaware of the deadly disease cropping up in their bodies.
The ones that develop symptoms choose to ignore them because most men don’t even expect that these symptoms might be due to breast cancer. This results in men being diagnosed at a much-advanced metastasised stage of cancer. This solely occurs due to a lack of awareness of MBC.
The hormonal cancer therapies must be designed differently for men and women.
On the whole, the outcome of breast cancer treatment in men is much worse in comparison to women because of these issues.
Men’s breast cancer
Men have a lower number of tissues and ducts and less functionality and so they are less likely to have breast cancer. Cells in any part of the body might be cancerous and men’s breast tissue is no different. When breast cells start growing uncontrollably, they can be viewed on an x-ray or felt as a lump. Malignant tumours are the ones that can spread to other parts of the body which is termed metastasis.
Factors that affect male breast cancer
1) Genetic mutation
2) Aging (a risk factor for MBC is higher in men above the age of 50)
3) No apoptosis (death) of the cell at the right time
4) Anomalous cellular functionality
5) Family history of breast cancer
6) Anomalous hormone secretion due to some other condition
7) Obesity
8) Some testicular conditions
Symptoms
According to the report of CDC, the most common symptoms of breast cancer in men are —
1) A lump or swelling in the breast.
2) Redness or flaky skin in the breast.
3) Irritation or dimpling of breast skin.
4) Nipple discharge.
5) Pulling in of the nipple or pain in the nipple area.
Symptoms of cancers can be misleading and these symptoms sometimes resemble other diseases’. So, seeking a physician’s help for an early diagnosis is highly recommended.
Treatments
Radiation therapy: Most of us have heard of radiation therapy. It uses high-energy beams to target and kill cancer cells. Often a radiation machine is placed outside that body that targets cancer cells inside the patient’s body and sometimes the machine is placed inside the body too.
Chemotherapy: Drugs are used in chemotherapy that kills the cancer cells and shrinks the malignant tumour. Chemotherapy is usually combined with other therapies and has very aggressive side effects. It is also used to prepare the patient for surgery by shrinking the tumour cells and making it easier for a site-specific surgery.
Hormone therapy: Hormone therapy is used to inhibit or add some hormone secretion in a way that is not in favour of the cancer cell development and invasion. This therapy can be administered orally or by injection.
Targetted therapy: Targetted therapy treats cancer by obstructing different functions of cancer cells by marking them so that the immune system can recognise and kill the cancer cells, obstructing cell division signals stopping the cancer cells to divide, stop blood vessel formation around the cancer cell to strive it off oxygen and suffocate the cancer cells to death and also deprive the cancer cells of the required hormones for growth.
Immunotherapy: Immunotherapy is used to train and support the immune system to make it strong enough to combat cancer cells. Naturally, our immune system is designed to fight off disease but cancer cells are smart enough to trick immune cells and dodge their attack. Hence immunotherapy targets those tricks and blocks pathways for the cancer cells to be able to hide from the immune system.
Fig2: A systemic generalized MBC treatment procedure is shown as follows. Course of treatment may change according to requirement of the patient — National Center for Biotechnology Information
All things considered, male breast cancer could be a lesser-known disease, but one should not ignore any symptom that could be related to breast cancer because even though it is common in elderly men, it may happen at any age. So, the necessity of preparedness against such disease is very important.
The author is a biotechnologist. She is now a research fellow in Asian Network for Research on Antidiabetic Plants (ANRAP). Email: [email protected]
