Male breast cancer is exceptionally rare and only accounts for less than 0.25% of male malignancies and ~0.5-1% of all breast cancer (both genders). The diagnosis is sometimes delayed due to the patient's hesitancy to seek advice. Workup from a radiological point of view is the same as for women, including the use of needle biopsy to confirm the diagnosis.
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Epidemiology
The average age of diagnosis of male breast cancer is 60-70 years, which is later than female breast cancer.
Clinical presentation
Most commonly, men present with a painless subareolar mass. Male breast cancer is also reported to present at a relatively advanced stage compared with female breast cancer 8.
Pathology
Histologically, the vast majority are invasive ductal carcinoma (85-90%) or ductal carcinoma in situ. It should be noted that invasive lobular carcinoma is extremely rare in male patients because lobules and acini are not found in normal male breast tissue 11.
Risk factors
Recognized risk factors include 9:
exposure to ionizing radiation: especially to the chest wall
testicular injury / infectious orchitis
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increased levels of estradiol
consider this risk in transgender patients
liver dysfunction: cirrhosis
family history: ~30% of cases can have a positive family history
chest trauma
longevity 10
certain racial groups: may have a comparatively higher incidence
BRCA2 gene mutation 2
Please note gynecomastia is not a risk factor per se.
Location
can occur anywhere within the breast but favors the subareolar area or the upper outer quadrant
favors a slightly eccentric location relative to the nipple 7
Genetics
The genetic predisposition for breast cancer can be inherited from both mother and father. First line family history includes both genders.
Men with BRCA1/2 mutations are at increased risk for breast, prostate, pancreatic and some other cancers. The average man has a 0.1% breast cancer risk, although the risk is significantly increased to 7-8% with a BRCA2 mutation and 1% with a BRCA1 mutation 12,13.
Radiographic features
Mammography
Typically seen as a subareolar mass (often round, oval, or lobulated) and at times can be masked by the presence of concurrent gynecomastia 3. Calcifications tend to be fewer in number and coarser than in female breast cancer 1.
Treatment and prognosis
The overall prognosis tends to be worse than for female breast cancer, possibly due to the fact that men seek medical attention for the mass at later stages (i.e. when the mass has already become palpable).
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