Skip to Content

Published on September 05, 2019

Low Patient Awareness Hinders Male Breast Cancer Diagnosis

More than 30 years after Breast Cancer Awareness Month was established, October has become synonymous with early breast cancer detection and treatment. Breast cancer mortality declined 39% in the U.S. from 1989-2015, according to the Susan G. Komen Foundation.

The incidence of breast cancer in men is rare compared to the incidence in women, with less than 1% of all breast cancers occurring in men. (See table.) Breast cancer in men is typically identified at a more advanced stage. Jon S. Gengler, MD, FACS, and Mangesh D. Oza, MD, FACS, surgeons with Meritas Health Surgery & Trauma and Meritas Health Comprehensive Surgery, respectively, treat men with breast cancer.

Lack of Awareness

They agree late-stage diagnosis is due to several issues: lack of awareness about male breast cancer, patient procrastination in seeking medical care and male embarrassment about physicalchanges in the breast or chest areas.

“Most people don’t think male breast cancer is a real disease,” Dr. Oza said. “When men present with breast cancer, it’s typically advanced by the time they feel a painless mass under their areola or an axillary mass.”

According to Dr. Gengler, women know to see their physician if they feel a lump. “Men tend to ignore their symptoms, and I think that is due to a lack of awareness,” Dr. Gengler said.

  • In addition to feeling a painless lump, other symptoms include:
  • Breast dimpling, puckering or redness
  • Change in breast size or shape
  • Itchy, scaly sore or rash on the nipple
  • Inverted nipple or other parts of the breast
  • Nipple discharge
  • Thickening in the breast, chest or underarm

Age-Adjusted U.S. Breast Cancer Incidence and Mortality

Men Women
Incidence 1.2 per 100,000 127.5 per 100,000
Mortality 0.3 per 100,000 20.6 per 100,000

Source: National Cancer Institute, 2012-2016

Risk Factors

Having a BRCA1 or BRCA2 gene mutation is one risk factor, and both physicians advise men who have a family history of breast, prostate, pancreatic or ovarian cancer to seek genetic counseling and testing

“If they have a family history and specifically a genetic mutation within their family, they ought to have a discussion with their primary care physician,” Dr. Oza said. “If a man is genetically tested and found to be ‘BRCA-positive,’ he needs to go down the same path as a woman and seek consultation with a medical oncologist and breast surgeon to consider preventive surgery.” (See Genetic Counseling.)

Such knowledge is paramount for family members. “If a man is found to have a BRCA1 or BRCA2 mutation, he can notify his female family members so they can consider genetic testing,” Dr. Gengler added.

In addition to the BRCA1 and BRCA2 gene mutations, Drs. Oza and Gengler pointed to these risk factors for men:

  • Family history of breast cancer
  • Gynecomastia
  • Klinefelter’s syndrome
  • Older age
  • Overweight or obesity

“Only about 14% of male breast cancers are ‘BRCA-positive’ so more than 80% of all male breast cancers have nothing to do with an inherited genetic syndrome,” Dr. Oza added.

Treatment

Given the late stage of diagnosis, primary treatment is mastectomy for men. Some will undergo neoadjuvant chemotherapy and radiation. Both surgeons work closely with medical oncologists and radiologists at NKCH on behalf of these patients.

Survival rates for men and women are similar when the stages of diagnosis are the same. “If they are estrogen-positive, they have a better prognosis because they can be put on tamoxifen,” Dr. Oza said. “Generally, it’s a treatable disease, and men have an equally good prognosis as women.”

Genetic Counseling

Alisdair Philp

Alisdair “Rod” Philp, PhD

NKCH patients can seek genetic counseling with. Alisdair Philp, PhD, a board-certified genetic counselor with The University of Kansas Cancer Center, who provides the service on the NKCH campus.

“We know 85% of breast, ovarian, prostate and colon cancers are random events,” Dr. Philp said. “On the other hand, this means about 10%-15% of cancers are caused by a gene — technically a mutation in a gene — that can be passed down the family. This can have a dramatic effect. For example, some genetic variants raise the risk of breast cancer from a 12.5% average for a woman to 75%-80%."

It also is important to understand that 10 years ago, Dr. Philp added, taht we were looking mainly at two genes: BRCA1 and BRCA2 (commonly referred to as 'BRCA").

"As a standard in the clinic I now cover 46 genes, which are generally referred to as 'common cancer genes," Dr. Philp said. "A disease-causing change in any of these genes can have serious risk implications, but also can guide us in how we can take preventive measures. The scientist who discovered BRCA1 would would tell you that around one in eight to one in 10 breast, colon, prostate and ovarian cancers are actually preventable or can be detected at a very early stage."

Dr. Philp helps patients understand their risk factors for hereditary cancers so they may make informed healthcare decisions. In a typical consult, he will:

  • Review up to three generations of the patient’s family history
  • Discuss cancer risk factors for the patient and immediate family members
  • Provide information on cost of testing/insurance coverage
  • Test comprehensive panels of genes associated with inherited cancer syndromes
  • Follow up with the patient and physician about the results

If an individual has no information about their family history whatsoever, this does not exclude them from genetic testing.

With each patient, Dr. Philp explains cancer genetics and what he is looking to find. “If we have a positive result, we discuss their and their family members’ health implications,” he said. “These are important considerations for the patient to make informed decisions about whether to pursue testing."

Some patients will opt out of testing. If a patient doesn’t want to get tested, I’m completely supportive of that. We want to provide good service to our patients.”

Patients do not need referral to see most genetic counselors. To direct a patient for a genetic counseling appointment at NKCH, call 913.574.1050.

Jon S. Gengler, MD, FACS

Jon Gengler, MDDr. Gengler earned his medical degree from the University of South Dakota and was a resident in surgery at Creighton University.

Mangesh D. Oza, MD, FACS

Mangesh Oza, MDDr. Oza completed his medical degree from the University of Missouri-Kansas City and was a surgery resident at the Alton Ochsner Medical Foundation Hospital.