What is the proportion of breast cancer in men compared to all breast cancers?
Dr Alessandro Viansone: Male breast cancer remains uncommon, less than 1 to 2% of all breast cancers. These statistics mainly come from Western countries, including North America. In less developed countries, it is still underdiagnosed because it is not systematically considered and diagnostic resources are lacking.
Which men are affected by breast cancer?
They are generally over 60 years old, which contrasts with women where screening focuses on the 50 – 70 year old age group. However, this possibility should not be excluded in young men.
The risk factors are known, such as alcohol consumption, particularly in cases of cirrhosis. This can damage the liver, increase estrogen levels and lower androgen levels, which increases the risk of breast cancer. Furthermore, gynecomastia, or excessive development of the breasts in men, is a risk factor, like obesity or certain testicular problems such as cryptorchidism (undescended testicle).
The increase in certain risk factors coupled with better detection means that the absolute number of breast cancers in men will probably increase.
Do genetics play a major role in the occurrence of breast cancer in men?
Genetic mutations indeed seem to play an important role in this type of cancer, and a priori even more than in women. Around 15 to 20% of breast cancers in men are linked to genetic mutations. But the exact rate is still being determined.
Let me explain: until recently, genetic testing was limited to certain types of patients, notably young women or triple negative cancers.
Since 2022, and the arrival of treatments targeting genetic mutations, tests have been prescribed to most patients with breast cancer. Consequently, within five years, we will have a more precise idea of the incidence of these mutations in the general population. And therefore also in humans.
Are male breast cancers the same as in women?
The main histological type of breast cancer in men is infiltrating ductal carcinoma, which accounts for approximately 85% of cases. This type of cancer is also common in women, where it constitutes the majority of breast cancers, but in different proportions. In women, approximately 70 to 75% of breast cancers are infiltrating ductal carcinomas, while the remaining 25 to 30% include lobular carcinomas, carcinomas in situ, and other types of cancers. 90% of these cancers are hormone-dependent.
Why is ductal carcinoma so common?
It appears that much of this has to do with the biological characteristics of breast tissue – both male and female. Regardless, the distinction between cancer types (ductal or lobular) does not yet have a major impact on current treatments, but research is ongoing. Male or female, treatment is mainly determined by the expression of hormonal receptors, HER2 status and so-called “triple negative” cancers.
So we treat male breast cancer the same way as female breast cancer?
In terms of treatment and therefore linked to the hormonal profile, we consider the man as a pre-menopausal woman, prescribing mainly tamoxifen, an anti-estrogen. When it comes to chemotherapy or targeted therapies, for example in the case of triple negative or HER2 positive cancers, they are the same
treatments for men and women. When a man presents symptoms suggestive of breast cancer, the diagnostic process necessarily includes a search for genetic mutations.
It is on the surgical level that there is a difference: in women, we often favor lumpectomy, which consists of removing only the tumor while preserving the rest of the breast. In men, on the other hand, mastectomy is generally chosen from the start, because the mammary gland is smaller, which allows it to be removed in its entirety with less impactful aesthetic results than in women.
What about the prognosis of breast cancer in men?
The prognosis essentially depends on the type of cancer treated, just as in women. Recent treatments targeting genetic mutations (targeted therapies) have a considerable impact on the prognosis of breast cancer. These therapeutic advances not only reduce the risk of recurrence, but also improve the overall survival of patients. Both in men and women.
Figures vary depending on histology and stage of disease at diagnosis. For breast cancers detected at an early stage (stages I and II), overall survival can reach between 60 and 98%, depending on the histological subtypes, whether they are HER2-positive cancers (most common in man), triple negative or hormone dependent.
However, for metastatic breast cancers, the situation is more worrying, with an overall survival of around 30% – 50% over five years, all subtypes combined. This difference highlights the crucial importance of early detection, whether you are a woman or a man.
What are the signs in men?
In men, although systematic screening does not exist, since the mammary gland is less developed, palpation of a mass or lump is often more obvious. This is also why we have fewer cancers discovered at the metastatic stage in men. The symptoms are identical to those in women: a mass, nipple discharge, redness in the breast.
If this is the case, go to the general practitioner, because there is no “gynecologist” equivalent for men. The care pathway will then be identical and in the same centers as those following the women. Once in remission, the follow-up is also identical to that of women: an annual mammogram on the “contralateral” breast (which has not been affected by the cancer).
It is therefore essential that any man, especially over the age of 60, who notices a breast mass, consults a health professional quickly. An ultrasound can help determine the nature of this mass (cysts, benign abnormalities, tumor). In addition, an MRI can help clarify the nature of these abnormalities. If a mass is suspected, a biopsy will be performed to confirm the diagnosis by histological analysis. And a cytopuncture of the lymph nodes in the armpit, possibly if metastases are suspected.
Do the children of a woman who has had breast cancer with a genetic mutation present the same risks, whether they are girls or boys?
Yes. If a mother who has had breast cancer carries a genetic mutation, such as that of the BRCA1 or BRCA2 genes, the probability of passing it on to her children is the same (50%), whether it is a girl or a mother. ‘a boy. The latter have an increased susceptibility to breast cancer.
In practice, when a mutation is detected in the mother, the genetics service recommends discussing this situation with the children. The latter, between 18 and 25 years old, can, if they wish, take the initiative of consulting the genetics service to assess their own risk.
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