Pink is the color for Breast Cancer Awareness Month this October. But is the femininity linked to breast cancer causing men with the disease to be forgotten?
In fact, it is estimated that 2,360 new cases of breast cancer will be diagnosed in men in the US this year, and around 430 men will die from the disease.
Admittedly, breast cancer in men is rare. A man's lifetime risk of the disease is 1 in 1,000, while a woman's is 1 in 8. But according to a 2012 study that assessed more than 13,000 male breast cancers from the US National Cancer Data Base, men with breast cancer are less likely to survive the disease than women.
The researchers found that at diagnosis, men were likely to have much larger breast tumors, and the cancer was more likely to have already spread to other areas of the body.
This may be attributed to the fact that awareness of breast cancer is so much greater among women than men. Guidelines call for regular screening, both clinical and mammographic, in women, leading to earlier detection.
And it seems the clinical team is not wrong. A 2010 study by Eileen Thomas, of the University of Colorado Denver, found that 80% of men surveyed were not aware that men could even develop breast cancer, and the majority could not identify any symptoms of male breast cancer other than a lump in the breast.
In this spotlight feature, we look at the signs of male breast cancer, the diagnostic and treatment options for the disease, and why there is such lack of awareness of male breast cancer among the general public.
'Most people don't think of men as having breasts'
"Many people don't know that men can get breast cancer because they don't think of men as having breasts," Jackie Harris, clinical nurse specialist at UK charity Breast Cancer Care, told Medical News Today. "In fact, both men and women have breast tissue, although men have much smaller amounts than women."
Until puberty, both young girls and boys have small amounts of breast tissue consisting of lobules (glands than can produce milk), ducts (small tubes that carry milk from the lobules to the nipple) and stroma (fatty and connective tissue).
When girls reach puberty, high levels of the female hormone estrogen cause substantial growth in lobules, ducts and stroma, producing full breasts. Because boys and men have low levels of estrogen, they are very unlikely to form fully grown breasts.
However, what breast tissue a man has still contains ducts, and cells in these ducts - like all cells in the body - can become cancerous. The cancerous cells can then enter the lymphatic vessels of the breast and grow in the lymph nodes situated above and below the collarbone and under the breast bone. Once in the lymph nodes, it is likely the cancer cells have entered the bloodstream and spread to other areas of the body.
Although most male breast cancer cases begin in the ducts - known as ductal carcinoma - it can also develop in the breast lobules (lobular carcinoma), but this only accounts for around 2% of all male breast cancers.
The risk factors for male breast cancer
Exactly what causes breast cancer in men is unclear. But many of the factors that increase the risk of breast cancer among women are the same for men.
As men age, their risk of breast cancer increases, with the average age of diagnosis being 68 years. Men who have a family history of breast cancer are also at increased risk of developing the disease.
One of the most well-known risk factors for breast cancer among women is inherited BRCA1 and BRCA2 gene mutations. Men who inherit these mutations are also at much higher risk of breast cancer. Those who have a BRCA1 mutation have a 1 in 100 lifetime risk of the disease, while a BRCA1 mutation poses a 6 in 100 lifetime risk.
Past research has suggested that men with Klinefelter syndrome - a congenital condition in which an additional X chromosome is present - are also at higher risk of breast cancer.
Other factors that increase the risk of breast cancer in women, such as smoking, obesity, radiation exposure and high alcohol consumption, can also increase men's breast cancer risk.
'It is vital for everyone to be breast aware'
Women are encouraged to frequently check their breasts for any abnormalities, such as lumps, discharge from the nipple or changes in appearance or texture. And although many men may not be aware of it, they should do the same.
The most common signs of breast cancer in men are lumps or swelling in the breast or lymph node areas, dimpling or puckering of the skin, nipple retraction, nipple discharge and scaling or redness of the nipple or surrounding skin.
It is important to note that such signs do not always indicate breast cancer; they could be caused by a condition called gynecomastia - a benign enlargement of breast tissue. But clinical experts stated that if men spot any of these changes, they should visit their clinician immediately to determine the cause:
"We know that the sooner the diagnosis, the more effective treatment may be and the vast majority of breast cancers are found by men and women themselves. It's vital for everyone to be breast aware.Encouraging men to get used to looking at and feeling their chest and under their arms regularly will help them to feel more confident about noticing any unusual changes so they can go to their doctor promptly."
Men embarrassed by breast cancer diagnosis
As with all cancers, early detection of breast cancer improves treatment outcomes. But as the study by this reseacrh team found, the majority of male breast cancers are found in the later stages, which negatively impacts the chances of survival.
Because the majority of information and research on breast cancer focuses on women, men can feel ashamed if they are diagnosed with an illness that is seen as feminine.
One reason behind this is lack of awareness. Because male breast cancer is rare and many men do not realize it can affect them, they put signs of the disease down to another cause and delay visiting their doctor.
But with lack of awareness comes embarrassment. Because the majority of information and research on breast cancer focuses on women, men can feel ashamed if they are diagnosed with an illness that is seen as feminine.
The study by Eileen Thomas, for example, found that 43% of men said they would question their masculinity if they were diagnosed with breast cancer.
And it is not just the thought of having breast cancer itself that can deter men from seeing their doctor; the diagnosis and treatment procedures that go with it can be difficult for men to deal with.
Diagnosis of breast cancer is very similar for men and women. After a clinical examination to determine any abnormalities in the breast tissue or lymph nodes, a man may be required to undergo a mammogram if there is any suspicion of breast cancer.
"I think that many people are surprised to hear that men can have mammograms," Susan Brown, director of health education at Susan G. Komen for the Cure - a non-profit breast cancer organization - told The Huffington Post, noting that men are embarrassed by having to undergo a procedure that is usually used on women.
"There's the whole awkwardness of the procedure itself. And then there's the idea that it's difficult for many men to even imagine having a mammogram. It's tough."
Men may also be required to have a breast ultrasound or magnetic resonance imaging (MRI) of the breast, before having breast tissue samples taken to confirm if cancer is present.
Could routine breast cancer screening in men improve diagnosis?
For men at high risk of breast cancer, such as those with an inherited BRCA gene mutation, some organizations recommended regular screenings.
The National Comprehensive Cancer Network, for example, recommend that men at high risk of breast cancer have a clinical breast exam every 6-12 months from the age of 35, and should consider having a mammogram at the age of 40. However, there are no routine screening recommendations for the average man.
According to the American Cancer Society: "Because breast cancer is so uncommon in men, there is unlikely to be any benefit in screening men in the general population for breast cancer with mammograms or other tests."
The organization admits, however, that routine screening for breast cancer in men has not been studied, therefore it is unclear as to whether it would be useful for early detection of male breast cancer or not.
It is important to note that there are still no routine screening programs for prostate cancer, which affects 1 in 7 men in the US. Past research into routine screening for prostate cancer has found that although it reduces deaths from the disease, it leads to overdiagnosis.
Given that the rate of male breast cancer is significantly lower, it is unlikely that routine screening for the disease will be considered anytime soon.
All treatments for male breast cancer based on data in women
Men with breast cancer have the same treatment options as women. The majority of male breast cancer patients have a mastectomy, which involves removal of all or some of the breast tissue and, in some cases, the removal of affected lymph nodes.
There have been very few in-depth studies looking at treatment for male breast cancer, meaning health care providers are using treatments that have only proved to be effective in women with the disease.
Male breast cancer patients may also need to have chemotherapy, radiation therapy, hormone therapy, targeted therapy or bone-directed therapy.
But some health care professionals have questioned the effectiveness of some of these treatments in men. To date, there have been very few in-depth studies looking at treatment for male breast cancer, meaning health care providers are using treatments that have only proved to be effective in women with the disease.
"Clinicians don't know much about how to treat men specifically," Dr. Kathryn Ruddy, of the Dana-Farber Cancer Institute in Boston, MA, told The Huffington Post. "Every treatment we do comes with the caveat that we're extrapolating from data in women."
Because of the rarity of male breast cancer, it can be challenging for scientists to receive the funding for research into the issue and to pull together enough participants to make the studies comprehensive.
But there has been some progress in the field. In 2007, researchers at the Breakthrough Toby Robins Cancer Research Centre in the UK, launched the ongoing Male Breast Cancer Study, with the aim of identifying genetic, lifestyle and environmental factors that increase breast cancer risk in men.
The study, which now has more than 1,500 participants, has already led to the discovery of a gene - called RAD51B - that causes breast cancer in men. It is hoped the study will eventually lead to tailored treatments for men with breast cancer.
Is male breast cancer awareness increasing?
There is no denying that breast cancer affects the lives of women much more than men. This year, it is estimated that 232,670 women will be diagnosed with invasive breast cancer and 40,000 will die from the disease. With figures like these, it is no wonder that breast cancer information and campaigns are more tailored toward women than men.
But it seems such focus on breast cancer in women has left many people feeling that male breast cancer is overlooked.
In 2009, a number of male breast cancer advocacy groups - including Out of the Shadow of Pink - worked together to establish the third week of October as Male Breast Cancer Awareness Week.
Although this campaign has only officially been declared in the states of Pennsylvania, Florida, New Jersey and Massachusetts, it seems the myth that men are unable to get breast cancer is finally being dispelled, and awareness of male breast cancer is gradually increasing.
As breast cancer survivor Bob Riter told The Huffington Post:
"I always say that under the microscope, breast cancer is breast cancer. It doesn't make a difference if you're a man or a woman."
For more information on male breast cancer, please visit the American Cancer Society.
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