Dr. Susan Love Research Foundation

Breast cancer in men is a rare disease that accounts for less than 1 percent of all cancers in men and less than 1 percent of all diagnosed breast cancers. Ductal carcinoma in situ (DCIS) is even rarer in men than is breast cancer.

Many of the men who get breast cancer seem to have a family history on their father's or their mother's side. Risk factors for women, such as early exposure to radiation and higher estrogen exposure in utero, also seem to be relevant to men.

For a time there was concern that men who got estrogen treatments for prostate cancer were more vulnerable to breast cancer, but this doesn't seem to be the case. Rather, prostate cancer can metastasize to the breast. (Remember that it remains prostate cancer; the cancer cells are prostate cancer cells, not breast cancer cells.)

Breast cancer in men shows itself in all the ways it does in women—usually as a lump—but it tends to be discovered later because men aren't usually very conscious of their breasts. The treatments are the same as well. Men can undergo sentinel node biopsy. And they can have a lumpectomy and radiation or a mastectomy. There is a tendency to overtreat men with post-mastectomy radiation because surgeons see these cancers so rarely. Recent data demonstrate that local recurrences in men are rare even in Stage III disease, and that the same indications should be used as are employed in women.

One issue that is often not addressed is the fact that the cosmetic implications are somewhat different for men. Men don't tend to regard breasts as crucial to their sexuality the way women do. But their naked chests are more likely to be visible, which can make it more awkward for a man to have a scar, to lack a nipple, or to have a deformed chest.

The one extra consideration is hair. After radiation therapy a man loses most of his hair on that side. If he is very hairy, a mastectomy with the scar hidden in hair may prove more cosmetic. Depending on where the tumor is, the nipple can often be conserved. If it can't be conserved, a new one can be created by a plastic surgeon.

Treatment in terms of chemotherapy and axillary nodes is exactly the same as for women. Tamoxifen works in men with estrogen receptor (ER)-positive tumors, as do the aromatase inhibitors.