Breast cancer in men is rare and is often treated like breast cancer in women, but research is showing that there are some differences.  More research is needed.

Research into the causes, prevention, and treatment of breast cancer is under way in many medical centers throughout the world. However, most breast cancer clinical trials and research are done in women. See What's New In Breast Cancer Research? (in women) for more information on advances in breast cancer treatment.

Causes of breast cancer and breast cancer prevention

Studies continue to uncover lifestyle factors and habits that alter breast cancer risk. Ongoing studies are looking at the effect of exercise, weight gain or loss, and diet on breast cancer risk. Research is also looking to see if being overweight or obese as a teenager increases breast cancer risk in men as it does for breast cancer in women. 

Research has identified several genetic variations associated with breast cancer risk. It shows that these genetic variations affect breast cancer risk in different ways for men and women. This suggests differences in the biology of breast cancer in men and women. More research is being done on this. Scientists are also exploring how common gene variations may affect breast cancer risk. Each gene variant has only a modest effect on risk (10% to 20%), but when taken together they may possibly have a large impact.

New laboratory tests

Circulating tumor cells/tumor DNA

Researchers have found that in many breast cancers, cells may break away from the tumor and enter the blood. These circulating tumor cells (CTCs) and the DNA from these cancer cells (circulating tumor DNA [ctDNA]) can be detected with sensitive lab tests. It is thought that these “liquid biopsies” may help monitor patients while they are getting treatment. This might also be an easy way to collect tumor cells to test for new drugs or sensitivities to currently available drugs before actually giving them. Although these tests are available for general use, and the research is promsing, more studies are needed.

Treatment

Radiation therapy

Men with breast cancer tend to be diagnosed with larger tumors and often have mastectomies. But it's not clear whether these men should have radiation therapy after surgery, as well. Most doctors follow the same guidelines set for women with breast cancer who have mastectomies, but it is not clear if these recommendations should be the same for men. More studies are needed to define the role of radiation after mastectomy in men with breast cancer.

Immunotherapy

Recent studies in a few types of cancer  have shown a promising new way to get immune cells called T cells (a type of white blood cell) to fight cancer by changing them in the lab so they can find and destroy cancer cells. Research for this type of treatment in breast cancer is being investigated. 

Medical history and physical exam

If there is a chance you have breast cancer, your doctor will want to get a complete personal and family medical history. This may give some clues about the cause of any symptoms you are having and if you might be at increased risk for breast cancer.

A complete breast exam will be done to find any lumps or suspicious areas and to feel their texture, size, and relationship to the skin and muscle. The doctor may also examine the rest of your body to look for any evidence of possible spread, such as enlarged lymph nodes (especially under the arm).

Imaging tests for breast cancer in men

If you have signs or symptoms that could mean breast cancer or another breast disease, your doctor might recommend one or more or the following imaging tests.

Diagnostic mammogram

A mammogram is a low dose x-ray exam of the breast that allows doctors called radiologists to look for changes in breast tissue. It is called a diagnostic mammogram when it is done because problems are present.

A mammogram uses a machine designed to look only at breast tissue. The breast is pressed between 2 plates to flatten and spread the tissue. The compression only lasts a few seconds and may be uncomfortable briefly, but it is necessary to get a better picture. In some cases, special images known as cone or spot views with magnification are taken to make a small area of abnormal breast tissue easier to evaluate.

The results of this test might suggest that a biopsy is needed to tell if the abnormal area is cancer. Mammography is often more accurate in men than women, since men do not have dense breasts or other common breast changes that might interfere with the test.

Breast ultrasound

Breast ultrasound is often used to examine some types of breast changes.

Breast ultrasound uses sound waves to make a computer picture of the inside of the breast. A gel is put on the skin of the breast, and a wand-like instrument called a transducer is moved over the skin. The transducer sends out sound waves and picks up the echoes as they bounce off body tissues. The echoes are made into a picture on a computer screen. You might feel some pressure as the transducer is moved across the breast, but it should not be painful.

This test does not expose you to radiation.

Breast ultrasound is often used to look at breast changes that are found during a mammogram or physical exam. It is useful because it can often tell the difference between fluid-filled cysts (which are unlikely to be cancer) and solid masses (which might need further testing to be sure they're not cancer).

In someone with a breast tumor, ultrasound can also be used to check if the lymph nodes under the arm are enlarged. If they are, ultrasound can be used to guide a needle to take a sample (a biopsy) to look for cancer cells there and in the breast tissue.

Nipple discharge test

Fluid leaking from the nipple is called nipple discharge. It can look clear, cloudy or bloody. If you have nipple discharge, you should have it checked by your doctor. If there is blood in this fluid, you might need more tests. One test collects some of the fluid to look at it in the lab to see if cancer cells are there. This test is often not helpful, since a breast cancer can still be there even when no cancer cells are found in the nipple discharge. Other tests, such as a mammogram or breast ultrasound, may be more helpful. If you have a breast mass, you will probably need a biopsy, even if the nipple discharge does not contain cancer cells or blood.

Breast Biopsy

When other tests show that you might have breast cancer, you will probably need to have a biopsy. Needing a breast biopsy doesn’t necessarily mean you have cancer. Most biopsy results are not cancer, but a biopsy is the only way to find out. During a biopsy, a doctor will remove cells from the suspicious area so they can be looked at in the lab to see if cancer cells are present. It typically takes at least a few days for you to find out the results.

If your doctor thinks you don’t need a biopsy, but you still feel there’s something wrong with your breast, follow your instincts. Don’t be afraid to talk to your doctor about this or go to another doctor for a second opinion. A biopsy is the only sure way to diagnose breast cancer.

There are different types of breast biopsies. The type you have depends on your situation.

Fine needle aspiration biopsy (FNA): This type of biopsy is often used to look for cancer spread in the nearby lymph nodes. The doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue or fluid from a suspicious area. A local anesthetic (numbing medicine) may or may not be used. The biopsy sample is then checked to see if there are cancer cells in it.

If the area to be biopsied can be felt, the needle can be guided into it while the doctor is feeling it. If the lump can't be felt easily, the doctor might watch the needle on an ultrasound screen as it moves into the area. This is called an ultrasound-guided biopsy.

An FNA biopsy is the easiest type of biopsy to have, but it can sometimes miss a cancer if the needle does not go into the cancer cells.

If the results of the FNA biopsy do not give a clear diagnosis, or your doctor still has concerns, you might need to have a second biopsy or a different type of biopsy.

Core needle biopsy (CNB): This is the most common type of biopsy used to make a breast cancer diagnosis. The doctor uses a wide, hollow needle to take out pieces of breast tissue from a suspicious area.  The needle used in this technique is larger than that used for FNA and allows the doctor to remove larger cylinders (cores) of tissue. Several cylinders are often removed. The biopsy is done with local numbing medicine and with the doctor either feeling the abnormal area or using an imaging test (like ultrasound or MRI) to find the spot to biopsy.  

In addition to the standard CNB, there are two other types of CNBs: 

• Stereotactic core needle biopsy
• Vacuum-assisted core biopsy

If the results of the CNB do not give a clear diagnosis, or your doctor still has concerns, you might need to have a second biopsy or a different type of biopsy.

Surgical (open) biopsy: Most breast cancer can be diagnosed with a needle biopsy. Rarely, surgery is needed to remove all or part of the lump for testing. Most often, the surgeon removes the entire mass or abnormal area, as well as a surrounding margin of normal-appearing breast tissue.

There are 2 types of surgical biopsies:

• An incisional biopsy removes only part of the suspicious area, enough to make a diagnosis.
• An excisional biopsy removes the entire tumor or abnormal area, with or without trying to take out an edge of normal breast tissue (depending on the reason for the biopsy).

Lymph node biopsy: The doctor may also need to biopsy the lymph nodes under the arm to check them for cancer spread. This might be done at the same time as biopsy of the breast tumor, or during surgery to remove the breast tumor. This is done by needle biopsy, or with a sentinel lymph node biopsy and/or an axillary lymph node dissection.

The American Cancer Society estimates for breast cancer in men in the United States for 2018 are:

• About 2,550 new cases of invasive breast cancer will be diagnosed
• About 480 men will die from breast cancer

Breast cancer is about 100 times less common among white men than among white women.  It is about 70 times less common among black men than black women . Like black women, black men with breast cancer tend to have a worse prognosis (outlook). For men, the lifetime risk of getting breast cancer is about 1 in 833 .

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.

A risk factor is anything that affects your chance of getting a disease, such as breast cancer.

But having a risk factor, or even many, does not mean that you are sure to get the disease. Some men with one or more breast cancer risk factors never develop the disease, while most men with breast cancer have no apparent risk factors.

We don't yet completely understand the causes of breast cancer in men, but researchers have found several factors that may increase the risk of getting it. As with female breast cancer, many of these factors are related to your body's sex hormone levels.

Aging

Aging is an important risk factor for the development of breast cancer in men. The risk of breast cancer goes up as a man ages. On average, men with breast cancer are about 72 years old when they are diagnosed.

Family history of breast cancer

Breast cancer risk is increased if other members of the family (blood relatives) have had breast cancer. About 1 out of 5 men with breast cancer have a close relative, male or female, with the disease.

Inherited gene mutations

Men with a mutation (defect) in the BRCA2 gene have an increased risk of breast cancer, with a lifetime risk of about 6 in 100. BRCA1 mutations can also cause breast cancer in men, but the risk is lower, about 1 in 100.

Although mutations in these genes most often are found in members of families with many cases of breast and/or ovarian cancer, they have also been found in men with breast cancer who did not have a strong family history.

Mutations in CHEK2, PTEN and PALB2 genes might also be responsible for some breast cancers in men.

Klinefelter syndrome

Klinefelter syndrome is a congenital (present at birth) condition that affects about 1 in 1,000 men. Normally the cells in men's bodies have a single X chromosome along with a Y chromosome, while women's cells have two X chromosomes. Men with Klinefelter syndrome have cells with a Y chromosome plus at least two X chromosomes (but sometimes more).

Men with Klinefelter syndrome also have small testicles and oftenare infertile because they are unable to produce functioning sperm cells. Compared with other men, they have lower levels of androgens (male hormones) and more estrogens (female hormones). For this reason, they often develop gynecomastia (benign male breast growth).

Men with Klinefelter syndrome are more likely to get breast cancer than other men. Having this condition can increase the risk anywhere between 20 - 60 times the risk of a man in the general population. 

Radiation exposure

A man whose chest area has been treated with radiation (such as for the treatment of a cancer in the chest, like lymphoma) has an increased risk of developing breast cancer.

Alcohol

Heavy drinking (of alcoholic beverages) increases the risk of breast cancer in men. This may be because of its effects on the liver (see next paragraph).

Liver disease

The liver plays an important role in balancing the levels of sex hormones. In cases of severe liver disease, such as cirrhosis, the liver is not working well and the hormone levels are uneven, causing lower levels of androgens and higher levels of estrogen. Men with liver disease can alsohave a higher chance of developing benign male breast growth (gynecomastia) and also have an higher risk of developing breast cancer.

Estrogen treatment

Estrogen-related drugs were once used in hormonal therapy for men with prostate cancer. This treatment may slightly increase breast cancer risk.

There is concern that transgender/transsexual individuals who take high doses of estrogens as part of sex reassignment could also have a higher breast cancer risk. Still, there haven’t been any studies of breast cancer risk in transgendered individuals, so it isn’t clear what their breast cancer risk is.

Obesity

Studies have shown that women's breast cancer risk is increased by obesity (being extremely overweight) after menopause. Obesity is also a risk factor for male breast cancer as well. The reason is that fat cells in the body convert male hormones (androgens) into female hormones (estrogens). This means that obese men have higher levels of estrogens in their body.

Testicular conditions

Certain conditions, such as having an undescended testicle, having mumps as an adult, or having one or both testicles surgically removed (orchiectomy) may increase male breast cancer risk.

Finding breast cancer early improves the chances that male breast cancer can be treated successfully. However, because breast cancer is so uncommon in men, there is unlikely to be any benefit in screening men in the general population for breast cancer with mammograms or other tests.

Differences in early detection of breast cancers in men and women

There are many similarities between breast cancer in men and women, but there are some important differences that affect finding it early.

Breast size

The most obvious difference between the male and female breast is size. Because men have very little breast tissue, it is easier for men and their health care professionals to feel small masses (tumors). On the other hand, because men have so little breast tissue, cancers do not need to grow very far to reach the nipple, the skin covering the breast, or the muscles underneath the breast. So even though breast cancers in men tend to be slightly smaller than in women when they are first found, more often have already spread to nearby tissues or lymph nodes. The extent of spread is one of the most important factors in the prognosis (outcome) of a breast cancer.

Lack of awareness

Another difference is that breast cancer is common among women and rare among men. Women tend to be aware of this disease and its possible warning signs, but many men do not think that they can get it at all. Some men ignore breast lumps or think they are caused by an infection or some other reason, and don't get medical treatment until the mass has had a chance to grow. Some men are embarrassed when they find a breast lump and worry that someone might question their masculinity. This could also delay diagnosis and reduce a man's chances for successful treatment.

For men who are or may be at high risk

Careful breast exams might be useful for screening men with a strong family history of breast cancer and/or with BRCA mutations found by genetic testing. Screening men for breast cancer has not been studied to know if it is helpful, and mammography (x-rays of the breast) and ultrasound is usually only done if a lump is found. Men who are at high risk for breast cancer should discuss how to manage their risk with their doctor.

Genetic counseling and testing

If you have a strong family history of breast cancer (in men or women), ovarian cancer, pancreatic cancer, and/or prostate cancer that might be caused by a BRCA mutation, and/or if someone else in your family is known to have a BRCA mutation, you might want to consider genetic testing to determine if you have inherited a mutated BRCA gene. If the test detects a mutated BRCA gene, you and your health care team can watch carefully for early signs of cancer. Other cancers including prostate cancer, pancreatic cancer, and testicular cancer have been linked to BRCA mutations. .

Because breast cancer in men can be caused by BRCA mutations, men with breast cancer should also consider genetic testing.

If you are thinking about having genetic testing, it is strongly recommended that you talk first to a professional qualified to explain and interpret these tests, such as a genetic counselor or a nurse or doctor with special training. It is very important to understand what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before having it done. Test results are not always clear cut, and even if they are, it's not always clear what should be done about them. There may be other concerns as well, such as what the results might mean for other family members.

For many men with breast cancer, treatment can remove or destroy the cancer. The end of treatment can be both stressful and exciting. You may be relieved to finish treatment, but it's hard not to worry about cancer coming back. This is very common if you've had cancer.

For other people, the cancer may never go away completely. Some people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful.

Follow-up care

Even after you have completed breast cancer treatment, your doctors will want to watch you closely. It’s very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems. They may do exams and lab tests or imaging tests to look for signs of cancer or treatment side effects.

Almost any cancer treatment can have side effects. Some might only last for a few days or weeks, but others might last a long time. Some side effects might not even show up until years after you have finished treatment. Visits with your doctor are a good time for you to ask questions and talk about any changes or problems you notice or concerns you have. However, if you have additional concerns about your cancer, you do not have to wait until your next scheduled visit. You can call your doctor immediately.

Typical follow-up schedules

Doctor visits: At first, your follow-up doctor visits will probably be scheduled for every few months. The longer you have been free of cancer, the less often the appointments are needed. After 5 years, they are typically done about once a year.

Mammograms: Routine screening mammograms, even after a breast cancer diagnosis in a man, is not common, and it is unclear how helpful they are.

Bone density tests: If you are taking an aromatase inhibitor or a luteinizing hormone-releasing hormone (LHRH) analog, you may be at increased risk for osteoporosis (thinning of the bones). Your doctor may want to monitor your bone health and may consider testing your bone density.

Other tests: Other tests such as blood tumor marker studies, blood tests of liver function, bone scans, and chest x-rays are not a standard part of follow-up. Getting these tests doesn’t help someone treated with breast cancer live longer. They will be done (as indicated) if you have symptoms or physical exam findings that suggest that the cancer has recurred. These and other tests may be done as part of evaluating new treatments by clinical trials.

If symptoms, exams, or tests suggest cancer may have recurred, imaging tests such as a chest x-ray, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done. Your doctor may also measure levels of blood tumor markers such as CA15-3, CEA or CA27-29. The blood levels of these substances go up in some men if their cancer has spread. They are not elevated in everyone with recurrence, so these tests aren't always helpful. However, if your are elevated, they may help your doctor monitor the results of treatment.

Men who have had breast cancer can also still get other types of cancer. Talk to your doctor about genetic testing to see if you have a hereditary cancer syndrome that might put youat a very high risk for other cancers.  Male breast cancer survivors also have a normal risk for other types of cancers. Because of this, it’s important to follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal cancer and prostate. To learn more about the risks of second cancers and what you can do about them, see Second Cancers After Male Breast Cancer.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include:

• A suggested schedule for follow-up exams and tests
• A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• Diet and physical activity suggestions

• Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care

Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think about their cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Can I lower my risk of breast cancer progressing or coming back?

If you have (or have had) breast cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Research has shown that some things that might be helpful but the studies have been done in women with breast cancer, since breast cancer in men is so rare. Many of the recommendations, however, have been shown to help reduce a person’s risk of developing cancer, in general.

Staying as healthy as possible is more important than ever after breast cancer treatment. Controlling your weight, exercising, and eating right may help you lower your risk of your breast cancer coming back, and may help protect you from other health problems.

Getting to a healthy weight

If you have had breast cancer, getting to and staying at a healthy weight might help lower your risk. A lot of research suggests that being overweight or obese (very overweight) raises the risk of breast cancer coming back. It has also been linked with a higher risk of getting lymphedema, as well as a higher risk of dying from breast cancer.

Of course, for men who are overweight, getting to a healthy weight can also have other health benefits. Getting to a healthy weight might also lower your risk of getting some other cancers, as well as some other chronic diseases.

Because of the possible health benefits of losing weight, many health care providers now encourage men who are overweight to get to and stay at a healthy weight. Still, it’s important to discuss this with your doctor before trying to lose weight, especially if you are still getting treatment or have just finished it. Your health care team can help you create a plan to lose weight safely.

Being physically active

Among female breast cancer survivors, studies have found a consistent link between physical activity and a lower risk of breast cancer coming back and of dying from breast cancer. This has not been well studied in men, but may also apply. Physical activity has also been linked to improvements in quality of life, physical functioning, and fewer fatigue symptoms.

It’s not clear exactly how much activity might be needed, but more seems to be better. More vigorous activity may also be more helpful than less vigorous activity. But further studies are needed to follow up on these findings.

Some people used to think that breast cancer survivors with lymphedema should avoid certain arm exercises and vigorous activities. But studies have found that such physical activity is safe. In fact, it might actually lower the risk of lymphedema, or improve lymphedema for someone who already has it.

As with other types of lifestyle changes, it’s important to talk with your treatment team before starting a new physical activity program. This will likely include meeting with a physical therapist as well. Your team can help you plan a program that can be both safe and effective for you.

Eating a healthy diet

Most research on possible links between diet and the risk of breast cancer coming back has looked at broad dietary patterns, rather than specific foods. In general, it’s not clear if eating any specific type of diet can help lower your risk of breast cancer coming back. Studies have found that female breast cancer survivors who eat diets high in vegetables, fruits, whole grains, chicken, and fish tend to live longer than those who eat diets that have more refined sugars, fats, red meats (such as beef, pork, and lamb), and processed meats (such as bacon, sausage, luncheon meats, and hot dogs). But it’s not clear if this is due to effects on breast cancer or possibly to other health benefits of eating a healthy diet.

Many people have questions about whether soy products are safe to eat after a diagnosis of breast cancer. Soy foods are rich sources of compounds called isoflavones that can have estrogen-like properties in the body. However, some recent large studies have not found that soy food intake affects breast cancer coming back or survival rates. While eating soy foods doesn’t seem to pose a risk, the evidence regarding the effects of taking soy or isoflavone supplements is not as clear. Soy in your regular diet is likely safe, but if you are thinking about consuming high levels of soy you should discuss this with your physician.

While the links between specific types of diets and breast cancer coming back are not certain, there are clearly health benefits to eating well. For example, diets that are rich in plant sources are often an important part of getting to and staying at a healthy weight. Eating a healthy diet can also help lower your risk for some other health problems, such as heart disease and diabetes.

Dietary supplements

Some people  want to know if there are any dietary or nutritional supplements they can take to help lower their risk. So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of female breast cancer progressing or coming back. This doesn’t mean that none will help, but it’s important to know that none have been proven to do so.

Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you're thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that might be harmful.

Alcohol

It’s clear that alcohol – even as little as a few drinks a week – increases a woman’s risk of getting breast cancer. But whether alcohol affects the risk of breast cancer coming back is not as clear. Drinking alcohol can raise the levels of estrogen in the body, which in theory could increase the risk of breast cancer coming back. But there is no strong evidence from studies to support this.

Although there is no specific research in men with breast cancer and alcohol, as part of its guidelines on nutrition and physical activity for cancer prevention, the American Cancer Society recommends that men who drink alcohol limit their intake to no more than 2 drinks a day to help lower their risk of getting certain types of cancer.

Because this issue is complex, it’s important to discuss it with your health care team, taking into account your risk of breast cancer coming back (or getting a new breast cancer), your risk of heart disease, and your risk of other health issues linked to alcohol use.

If the cancer comes back

If cancer does return, your treatment options will depend on where it comes back, what treatments you've had before, and your current health and preferences. For more information on how recurrent cancer is treated, see Treatment of Breast Cancer in Men, by Stage. 

Second cancers after treatment

Men who have had breast cancer can also still get other types of cancer. Men with breast cancer should be offered genetic testing to see if they have a hereditary cancer syndrome and could be at a very high risk for other cancers.  They also have a normal risk for other types of cancers. Learn more in Second Cancers After Male Breast Cancer.

Getting emotional support

Some amount of feeling depressed, anxious, or worried is normal when breast cancer is a part of your life. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Life After Cancer.