When Cailynn Madigan was scared of thunderstorms as a child, her grandfather, who was a stormchaser, would ease her fears by talking to her about the science of weather. He explained many concepts to her over the years, and eventually his scientific outlook helped save the lives of both her and her mother.
When her grandfather discovered a lump in his breast, he asked his daughter, Susan, to get genetic testing. The results showed that he had passed the BRCA gene to the next generation.
Cailynn explained in an interview, “My grandfather passed away when I was 17, and I took that very hard. And then one day, I woke up and I really wanted to know. I needed a concrete answer. Did I have BRCA2—is this something I need to be concerned about?”
She consulted with a genetic counselor. Cailynn remembers, “She called two weeks later and said, ‘I’m really sorry, but you are BRCA2 positive.’” She decided to get a prophylactic mastectomy.
“I believe that if he was here and he was able to talk me through this, he would be proud that I’ve done all of this,” added Cailynn. “For me, it was watching my grandfather battle cancer. He had chemo and radiation, and I got to really see the truly horrifically ugly side of breast cancer. And I got to choose not to go through that.”
Susan also decided on surgery.
“I started to very slowly wake up and go, wait a minute, I also have BRCA2, and I also have breasts, and why am I not doing what my daughter is doing and saving my life too? She absolutely inspired me to move forward and take care of myself.”
Their plastic surgeon, Dr. Andrea Moreira, performed both prophylactic mastectomies. It was the first time she had performed surgery on a mother and daughter in the same week.
Cailynn said that after TV station KDKA interviewed her on the subject, she felt that she was helping others by continuing to spread the word about both male and female breast cancer. The American Society of Plastic Surgeons (ASPS) also recently honored Cailynn through its Patients of Courage: Triumph Over Adversity program.
“I think what really shook me and really made me want to talk about this was the fact that my grandfather and a lot of other people think that men don’t get breast cancer,” Cailynn explained. “I want to tell people that this exists, and there are things that you can do to help yourself before you even get sick. And there are things you can do to help yourself, after you get sick. I want to be a support person.”
Breast cancer in men is often detected at a later stage than in women. Women’s widespread opportunities for education on breast cancer and access to mammograms give them an advantage about recognizing changes in their bodies that require medical attention. But, with awareness, men can avoid the isolation and confusion of being diagnosed with what is mistakenly thought of as “a woman’s disease,” and their treatments for breast cancer can have positive outcomes.
Most breast cancers in men are estrogen-receptor (ER)-positive, but less frequently, men can also develop HER2-positive or triple-negative breast cancers. The most common type of breast cancer in men is invasive ductal carcinoma. This type of cancer starts in cells of the milk ducts, tube-like structures beneath the nipple (these ducts are present in both men and women but are more developed in women).
Invasive ductal carcinoma breaks through the walls of the ducts and spreads to surrounding tissue in the breast and can also spread to nearby lymph nodes and other parts of the body.
Other less common types include ductal carcinoma in situ (which is not found beyond the duct walls or nearby breast tissue), inflammatory breast cancer, and Paget’s disease of the nipple.
Risk Factors
According to the CDC, about 1 out of every 100 breast cancers diagnosed in the United States is found in a man. The CDC notes that certain men may be more at risk. Some of these risks include:
Genetic makeup: Certain genes, such as BRCA1 and BRCA2, or if a close family member has had breast cancer. Also Klinefelter Syndrome, a rare genetic condition in which a male has an extra X chromosome.
Age: Most male breast cancers are discovered after 50 years of age.
Previous treatments: Men who had previous radiation of the chest or hormone therapy treatment with drugs containing estrogen (which were used to treat prostate cancer in the past).
Physical conditions: Certain conditions that affect the testicles, liver disease, and obesity.
Signs and Symptoms
Early detection is important. The Dana Farber Cancer Institute Program for Breast Cancer in Men notes the signs and symptoms that men should watch for:
- A lump or swelling in the breast or in lymph nodes under the arm or around the collar bone
- Dimpled skin around the breast
- Nipple turning inward
- Redness or scaling of the breast or nipple
- Nipple discharge
If any of these symptoms are found, an appointment with a physician should be made as soon as possible.
The National Comprehensive Cancer Network (NCCN) recommends all men diagnosed with breast cancer get genetic testing for BRCA1 and BRCA2 (BRCA1/2) inherited gene mutations because men with breast cancer are more likely than women with breast cancer to have a BRCA1/2 inherited gene mutation.
Treatment Options for Male Breast Cancer
Treatments for male breast cancer depend on the type and stage. Early stage or non-invasive breast cancers can be treated with surgery or radiation therapy. Other treatments include: hormone therapy, chemotherapy, targeted therapies, immunotherapies, or a combination of treatments.
The American Society for Clinical Oncologists (ASCO) put together an expert panel to suggest some treatments based on a systematic review of 26 descriptive reports or observational studies. The results showed that many management approaches used for men with breast cancer are similar to those used for women. Here are a few of their findings.
- Men with hormone receptor–positive breast cancer who are candidates for adjuvant (after initial treatment) endocrine therapy should be offered tamoxifen.
- Men with hormone receptor–positive breast cancer who are candidates for adjuvant endocrine therapy but who cannot take tamoxifen treatment may be offered gonadotropin-releasing hormone agonist/antagonist and an aromatase inhibitor.
- Men who are treated with adjuvant endocrine therapy should be treated for an initial duration of five years.
- Men who have completed five years of tamoxifen, have tolerated therapy, and still have a high risk of recurrence may be offered an additional five years of tamoxifen therapy.
- Men with advanced or metastatic, hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancer should be offered endocrine therapy as first-line therapy except in cases of a life-threatening condition or rapidly progressive disease. Options include tamoxifen, an aromatase inhibitor with a gonadotropin-releasing hormone agent, and fulvestrant. Cyclin-dependent kinase 4/6 inhibitors can also be used.
- An ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy, regardless of their genetic predisposition.
More Research on the Horizon
More research is needed to study whether men would benefit from other types of treatment. One clinical trial, taking place at the Dana Farber Cancer Institute, for men with hormone receptor-positive breast cancer and hormone receptor negative breast carcinoma, is called ETHAN (Endocrine THerapies for mAle breast cancer). Phase II of this trial is looking into how well male breast cancer responds to preoperative treatment with endocrine therapy, and which endocrine therapy regimen is the most effective treatment for male breast cancer. The drugs used in this Phase II study are: tamoxifen, anastrozole, degarelix, and abemaciclib (this trial was still enrolling at the time of publication).
Even though male breast cancer is relatively rare, early detection and intervention is key, and can result in a longer and better quality of life.
