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Symptoms of
Male Breast Cancer
A painless lump, usually
discovered by the patient himself, is by far the most common
first symptom of male breast cancer. Typically the lump
appears beneath the areola, where breast tissue is
concentrated.
However, a lump is
seldom the only symptom.3 Men are more likely than women to
have nipple discharge (sometimes bloody) and sign of local
spread, including nipple retraction, fixation to the skin or
the underlying tissues, and skin ulceration. About half the
men with breast cancer have palpable axillary lymph nodes.3
Most male breast
cancers are not large. One study that reviewed a large number
of cases found that 51 percent of the tumors were less than 3
centimeters in diameter. The largest, however, measured 28 by
16 centimeters.7
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The
Male Breast
The breast of the adult male
is similar to the breast of a preadolescent girl.4 It
consists primarily of a few branching ducts lined by
flattened cells and surrounded by connective tissue. In
girls, these cells and ducts develop in response to
hormones secreted during puberty.
In males, too, breast
tissues are capable of responding to hormonal stimulation.
Enlargment of the male breast due to growth of the ducts
and supporting tissues is known as gynecomastia.
Approximately 40 percent of all adolescent boys experience
temporary breast enlargement, probably in response to
hormones being secreted by the testes. Adolescent
gynecomastia typically disappears within a year or two.
In older men the growth of
breast tissue can be stimulated by several commonly used
drugs and a number of diseases.5 In addition to the
hormone estrogen, which is used to treat cancer of the
prostate, gynecomastia can be cause by non-hormonal drugs
widely prescribed for cardiovascular disorders
(digitalis), high blood pressure (reserpine,
spironolactone), migraines (ergotamine), and seizures (phenytoin).
Gynecomastia can also occur in conjuction with cancer of
the testes or the adrenal glands, cirrhosis of the liver,
chronic renal dialysis, and a chromosomal disorder known
as Klinefelter's syndrome. There is no evidence that forms
of gynecomastia that are not estrogen-induced
substantially alter the risk of male breast cancer.
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Delayed
Diagnosis
The fact that breast
cancer in men has often spread locally before it is diagnosed
- even though the small male breast should facilitate early
diagnosis - has been attributed to several factors. Indeed,
the very smallness of the male breast could be a factor.
Lacking the bulk of the typical female breast, even a small
carcinoma in a male lies close to the skin above it and the
tissues of the chest wall beneath it. Consequently, the cancer
can more readily invade these nearby structures.8 It has also
been suggested that the location of male tumors, centered
around the areola as most of them are, may facilitate the
spread of cancer. Such centrally located tumors are thought by
some to have easy access to internal mammary lymph pathways.
However, many people
are unaware that men can develop breast cancer, and neither
individual men themselves nor their physicians regularly
examine men's breasts. Furthermore, when men discover signs of
breast cancer they tend to delay before seeing a physician.8 A
1972 review of cases diagnosed since 1900 showed that men
waited 18 months, on the average, before seeking medical
advice; for men diagnosed since 1951, this dropped to 10
months,9 such a delay may in part occur because some men
perceive breast cancer as a flaw in their masculinity and are
reluctant to acknowledge its presence.3
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