Overview

Breast cancer is often thought of as something that only affects women, but men can get it in rare cases. It develops in the small amount of breast tissue men have behind their nipples.

It usually occurs in men over 60, but can very occasionally affect younger men.

Symptoms of breast cancer in men

The symptoms of breast cancer in men include:

• a lump in the breast – this is usually hard, painless and does not move around within the breast
• the nipple turning inwards
• fluid oozing from the nipple (nipple discharge), which may be streaked with blood
• a sore or rash around the nipple that does not go away
• the nipple or surrounding skin becoming hard, red or swollen
• small bumps in the armpit (swollen glands)

When to see your GP

See your GP if you have:

• a lump in your breast
• any other worrying symptoms, such as nipple discharge
• a history of breast cancer (in men or women) in members of your family and you're worried about your chances of getting it

It's very unlikely you have cancer, but it's best to get your symptoms checked. Your GP will examine your breast and can refer you for tests and scans for breast cancer if needed.

If you do not have symptoms but have a clear family history of breast cancer, your GP may refer you to a genetic specialist to discuss your risk of getting it.

There are some inherited genes that increase your risk of cancer and a blood test can be done to check for these.

Treatments for breast cancer in men

The treatment for breast cancer in men depends on how far the cancer has spread.

Possible treatments include:

• surgery to remove the affected breast tissue and nipple (mastectomy) and some of the glands in your armpit
• radiotherapy – where radiation is used to kill cancer cells
• chemotherapy – where cancer medicine is used to kill cancer cells
• other medicines that help stop breast cancer growing – including tamoxifen and trastuzumab (Herceptin)

Many men have surgery followed by 1 or more of the other treatments. This can help stop the cancer coming back in the future.

Outlook for breast cancer in men

The outlook for breast cancer in men varies depending on how far it has spread by the time it's diagnosed.

It may be possible to cure breast cancer if it's found early.

A cure is much less likely if the cancer is found after it has spread beyond the breast. In these cases, treatment can relieve your symptoms and help you live longer.

Speak to your breast care nurse if you'd like to know more about the outlook for your cancer.

Causes of breast cancer in men

The exact cause of breast cancer in men is not known, but there are some things that increase your risk of getting it.

These include:

• genes and family history – inheriting faulty versions of genes called BRCA1 or BRCA2 increases your risk of breast cancer
• conditions that can increase the level of oestrogen in the body – including obesity, Klinefelter syndrome and scarring of the liver (cirrhosis)
• previous radiotherapy to the chest area

It's not certain if you can do anything to reduce your risk, but eating a balanced diet, losing weight if you're overweight and not drinking too much alcohol may help.

Symptoms

The main symptom of breast cancer in men is a lump in the breast. The nipple or skin may also be affected.

See a GP if you have a breast lump or any other symptoms that worry you.

It's very unlikely you have cancer, but it's best to get your symptoms checked.

Breast lump

Cancerous breast lumps usually:

• only happen in 1 breast
• grow under or around the nipple
• are painless (but in rare cases they can hurt)
• feel hard or rubbery
• do not move around within the breast
• feel bumpy rather than smooth
• get bigger over time

Most lumps and swellings are not a sign of cancer. They're usually caused by something fairly harmless, such as enlarged male breast tissue (gynaecomastia), a fatty lump (lipoma) or a fluid-filled bump (cyst).

A GP can check your lump and refer you for tests and scans for breast cancer if needed.

Other symptoms

Other signs of breast cancer in men include:

• the nipple turning inwards
• fluid oozing from the nipple (nipple discharge), which may be streaked with blood
• a sore or rash around the nipple that does not go away
• the nipple or surrounding skin becoming hard, red or swollen
• small bumps in the armpit (swollen glands)

You may get further symptoms if the cancer spreads to other parts of the body, such as the bones, lungs or liver.

These symptoms can include:

• feeling tired all the time
• aching or painful bones
• shortness of breath
• feeling sick
• itchy skin with yellowing of the skin and eyes (jaundice)

Diagnosis

See your GP if you have symptoms of breast cancer. They will examine you and ask about your symptoms.

Your GP can refer you to a specialist breast clinic for the following scans and tests if needed.

Ultrasound scan

An ultrasound scan of your breast may be done to look for a lump in your breast and see it it's solid or filled with fluid. A solid lump is more likely to be cancerous.

An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your breast.

You'll need to remove your top for the test, which involves a small device being moved over your chest to create an image on a screen.

Breast X-ray (mammogram)

An X-ray of your breast, called a mammogram, may be done to look for any lumps or unusual areas.

You take your top off for the test and your chest will be firmly pressed against a special plate while the scan is taken.

Biopsy

If a lump or unusual area is found in your breast, a biopsy will be carried out to check if it's cancer.

This is where a small piece of breast tissue is removed using a needle. Local anaesthetic is used first, to numb your skin, so the needle does not hurt.

The piece of tissue will be checked in a laboratory to see if it contains any cancer cells and to find out more about the cells (such as whether hormone treatment might work).

Coping with a diagnosis

Being told you have breast cancer can cause a wide range of emotions, such as shock, fear, confusion and, in some cases, embarrassment.

Feelings of isolation are also common. This may be because there's little in the way of information and advice for men with breast cancer.

Speak to your GP or care team if you're struggling to come to terms with your diagnosis. They can offer support and advice.

You may also find it useful to talk to other men with the condition. Cancer Research UK has Cancer Chat, an online forum for anyone affected by cancer.

Treatment

The treatment for breast cancer in men largely depends on how far the cancer has spread.  Possible treatments include surgery, radiotherapy and medicines.

You'll be cared for by a team of specialists who will help you make decisions about your treatment.

Your recommended treatment plan will depend on how far the cancer has spread, but the final decision about going ahead with treatment is yours.

You may find it useful to write a list of questions you'd like to ask your team. For example, you could ask about the advantages and disadvantages of particular treatments.

If the cancer has not spread very far beyond your breast, a cure may be possible. This will usually involve surgery, possibly followed by radiotherapy or a course of medicine.

If the cancer has spread into other parts of your body, a complete cure may not be possible. But treatment can help relieve symptoms and slow down the spread of the cancer.

Surgery

An operation called a mastectomy is the main type of surgery for breast cancer in men.

It involves removing all the breast tissue from the affected breast as well as the nipple, and possibly also the glands in your armpit and some of the muscle under your breast.

The operation is done under general anaesthetic (where you're asleep). You'll probably need to stay in hospital for 1 to 2 days.

It can take several months to fully recover. The Royal College of Surgeons of England has a leaflet for people recovering from a mastectomy with detailed information and advice.

Your body after surgery

After surgery, there'll be a straight scar across your chest where your nipple used to be and possibly a dent where the breast tissue was removed.

The scar will be raised and red at first, but it should flatten and fade with time. The area will also be bruised and swollen for the first few weeks.

It may be possible to have further surgery at some point to improve the appearance of your breast and create a replacement nipple. Other options include tattooing a new nipple on to your chest.

Talk to your care team about how your chest will look after surgery and what your options are for improving its appearance if necessary.

Possible complications

Side effects and risks of a mastectomy include:

• pain and discomfort for 1 to 2 weeks – you'll be given painkillers to help with this
• numbness or tingling around the scar and in your upper arm – this should pass within a few weeks or months, but can occasionally be permanent
• a wound infection, causing redness, swelling, warmth or discharge from the wound – tell your nurse or doctor if you get any of these symptoms
• painful swelling in the arm (lymphoedema) – this may be permanent, but can be treated

Before having surgery, talk to your surgeon and breast care nurse about the possible risks.

Radiotherapy

Radiotherapy is a treatment where radiation is used to kill cancer cells. In breast cancer in men, it may be used to:

• help stop the cancer coming back after surgery
• slow down the spread of the cancer and relieve symptoms if a cure is not possible

It involves several treatment sessions where a machine is used to carefully aim beams of radiation at the cancer. Each session usually only lasts for 10 to 15 minutes and you can go home afterwards.

A typical course of treatment involves 2 to 5 sessions a week over 3 to 6 weeks.

Side effects

Radiotherapy is not painful, although you'll probably get some side effects. Most of these should pass once treatment stops.

Common side effects of radiotherapy include:

• sore, red skin (similar to sunburn) on your chest
• feeling very tired
• feeling sick
• temporary hair loss in the area of your chest being treated

Hormone therapy

Hormone therapy is a treatment that involves taking medicine to block the effects of a hormone called oestrogen.

Around 9 in 10 breast cancers in men are "oestrogen receptor positive", which means the cancer cells need oestrogen to grow.

Hormone therapy can be used to:

• help stop the cancer from coming back after surgery
• slow down the spread of the cancer and relieve symptoms if a cure is not possible

The most commonly used hormone medicine is tamoxifen. This is taken as a tablet or liquid every day, usually for 5 years, but sometimes for longer.

Side effects

Tamoxifen can cause some unpleasant side effects, such as:

• feeling sick (this usually goes away quite quickly)
• hot flushes
• weight gain
• difficulty sleeping
• changes in mood, such as feeling irritable or depressed
• loss of sex drive (libido)

Tell your care team if you have any troublesome side effects. Other hormone medicines, such as a type called aromatase inhibitors, are available if needed.

Chemotherapy

Chemotherapy is a treatment where powerful medicine is used to kill cancer cells. It may be used if hormone therapy is not suitable for you.

In breast cancer in men, chemotherapy may be used to:

• help stop the cancer coming back after surgery
• slow down the spread of the cancer and relieve symptoms if a cure isn't possible

It involves several treatment sessions where medicine is given directly into a vein. Each session usually lasts a few hours and you can go home afterwards.

A typical course of treatment involves 6 sessions, with a break of a few weeks between each one to allow your body to recover.

Side effects

Chemotherapy can cause a range of unpleasant side effects, although most of these should pass once treatment stops.

Side effects of chemotherapy can include:

• feeling very tired
• feeling and being sick
• temporary hair loss
• being more vulnerable to infections – tell your care team if you feel unwell or develop symptoms such as a fever and chills
• loss of appetite
• diarrhoea
• infertility

Trastuzumab (Herceptin)

Trastuzumab (brand name Herceptin) is a medicine that blocks the effect of a substance called human epidermal growth factor receptor 2 (HER2).

In some breast cancers in men, HER2 contributes to the growth of the cancer cells.

Trastuzumab is usually used after radiotherapy or chemotherapy to help stop the cancer coming back.

It's given as a liquid directly into a vein or as an injection under your skin. You come into hospital for treatment and can go home shortly afterwards.

A typical course of treatment involves a treatment session every 3 weeks for a year.

Side effects

Trastuzumab can cause some unpleasant side effects, such as:

• a reaction to the medicine – this can cause chills, a fever, swelling of the face and lips, headache, hot flushes, feeling sick, wheezing and breathlessness
• tiredness and difficulty sleeping
• diarrhoea or constipation
• an increased risk of infections
• loss of appetite and weight loss
• pain in your muscles, joints, chest or tummy
• heart problems