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Gynecomastia & breast cancer?

Though often overlooked, breast cancer afflicts men too

By ROD HARMON - Knight Ridder Newspapers
Date: 10/06/00 22:15

BRADENTON, Fla. -- When you say the words ''breast cancer,'' the image that immediately comes to mind is that of a woman.

That's understandable because women make up 99 percent of all breast cancer cases every year. But that remaining 1 percent -- the type that afflicts men -- tends to be overlooked. And the results are usually fatal.

The American Cancer Society estimates that 1,400 new cases of male breast carcinoma will be diagnosed this year in the United States.

About one-quarter of the victims will die.

''When they go to the doctor, they go late, because males aren't as aware as women,'' said Jose Estigarribia, a general surgeon with Manatee Memorial Hospital in Florida. ''Usually their wives get them to come.''

Although breast cancer is 100 times more common among women, it's usually caught at a later stage in men. That's partly because it's harder to detect in males, and partly because men tend to ignore the symptoms until the cancer has spread to other parts of the body. They just don't think it can happen to them.

''Breast cancer in men can spread very quickly, because the distance between the breast and the chest wall is shorter, allowing for the cancer to spread to the lymph nodes and the rest of the body at a faster rate,'' said A. Samir Hassan, a general and vascular surgeon with Manatee Surgical Specialists.

''Just because you have a lump in your breast doesn't mean you have breast cancer, but any changes in your breast should be looked at by a physician as soon as you notice them,'' he said.

Male breast cancer is most common among those 60 and older, because the breasts tend to become enlarged with age. As with women, hormonal changes play a key role in the development of the disease -- men with higher than normal estrogen activity are at greater risk.

Alcoholics are also in the high-risk category, because they are more likely to develop cirrhosis of the liver, resulting in higher estrogen levels. Radiation exposure to the chest, common to treat lymphoma, increases risk of breast cancer.

Family history is also a factor -- about 20 percent of men with breast cancer have close male or female relatives with the disease, according to the American Cancer Society.

In younger males and older men, breast cancer is typically associated with gynecomastia, a condition that results in overdeveloped breasts. It can be caused by high estrogen levels or certain medications and steroids.

By itself, gynecomastia is not cancerous; however, males who have it are at higher risk of developing breast cancer because it can be the result of a hormonal imbalance.

''Forty percent of men with gynecomastia develop breast cancer, but it is not a cause-effect relationship,'' Hassan said. ''Gynecomastia does not cause the cancer, but those who have it are more at risk.''

Symptoms of male breast cancer are the same as in women: a lump in the breast (generally in the center behind the areola in men), discharge from the nipple, retraction of the nipple, or an ulceration on the breast. Lumps are often painless, which is why a lot of men tend to ignore them. Nipple discharge is the most ominous sign in a man, as 75 percent of all cases involving this symptom turn out to be cancerous.

Diagnosis and treatment are also similar to that used on women. A mammogram is performed (as in small-breasted women, it is possible, although more difficult), accompanied by an ultrasound, a physical exam and a biopsy. If cancer is detected, a mastectomy is usually performed -- unlike with women, attempts to preserve male breasts are rare. If the cancer has spread, radiation therapy and chemotherapy might be needed.

Until recently some men with breast cancer were castrated to eliminate hormones that can support cancer growth. Now, physicians use the estrogen-blocking drug tamoxifen, no doubt to the relief of men everywhere.

The best way to prevent the progression of the disease is to detect it early. For that to happen, men have to take matters in their own hands -- literally -- just as women do. Because there is less tissue present, self-examination is easier for men. Simply rub the chest area with your hand and feel for any changes in the breast.

''Any lump could be cancerous, and the sooner you detect it and take care of it, the better the prognosis,'' Estigarribia said.


Things to look for:

  • Lumps in the breast

  • Soreness or discharge from the nipple

  • Retraction of the nipple

  • Ulcerations on the breast tissue

    Method: Use your right hand to examine your left breast, pressing firmly. Massage the breast in a circular motion, being extra cognizant of the center. Squeeze the nipples to check for discharge. Repeat using your left hand on your right breast.


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