Breast cancer in men: It’s rare, but it happens

September 29, 2016 Providence Health Team

It was a July morning in 2013, and Rob Hutchison was in his doctor’s office at Providence Portland Medical Center, having blood drawn for a health condition they’d been monitoring, when Rob mentioned the lump. “I said, ‘You know, I’ve noticed this lump on my right side, kind of under my arm, near the armpit,’” says Rob. “The doctor felt it and said, ‘That might be something we need to check. I want to send you downstairs for a mammogram and some tests.’ And by 5 that night, I found out I had breast cancer.”

Breast cancer in men is rare – only 1 in 1,000 men get it, compared to 1 in 8 women. But it does happen, and Rob wants other men to know that.

Rob hopes that sharing his story will help raise awareness about the signs of breast cancer in men. Alison Conlin, M.D., Rob’s medical oncologist, hopes so, too. Dr. Conlin focuses her practice at Providence Cancer Center in Portland exclusively on breast cancer.

“Men’s breast cancers tend to be diagnosed in later stages than women’s, possibly because of a lack of awareness – not just among men, but among others, too, including clinicians,” she says. “No one jumps to the thought that it could be breast cancer, as they do with women.”

And a lump might not be the first sign of breast cancer.

“When I walked in for my mammogram that day and took off my shirt,” says Rob, “the first thing the mammogram technician said was, ‘How long have you had that inverted nipple?’ I said, ‘Quite a while, probably at least a couple of years. Why?’ And she said, ‘That’s a sign of breast cancer.’”

The lump was a recent discovery – “Everyone knows that lumps aren’t good,” Rob says. But the inverted nipple had been there long before the lump. “I’d noticed it,” he says. “It was basically an innie, not an outie. But it didn’t hurt, and no one had ever said anything about it, so I just thought, eh – I’m a good-sized guy and I’ve got some breast tissue, so maybe it’s just kind of squished or something.”

Rob’s treatment – Round 1

By the time of Rob’s diagnosis, his breast cancer had spread from just behind his right nipple to multiple lymph nodes, including the ones under his arm, where the lump was found.

Rob’s cancer was classified as stage IIB, meaning the tumor was larger than 2 centimeters (a little more than three-quarters of an inch) but smaller than 5 centimeters, and had reached the lymph nodes. [EV1] His was the most common type of breast cancer in men: infiltrating ductal carcinoma, a cancer that starts and spreads from the milk ducts – which men do have, although they don’t produce milk.

Treatment would require a full mastectomy on his right side, plus removal of 43 lymph nodes. Because of the extensive lymph node removal, Rob has lymphedema, a painful, chronic condition that causes fluid to build up in his arm.

Next, he had chemotherapy under the care of Dr. Conlin. “During the first round, I came to work every day and did OK,” says Rob, who works in the sales and marketing division of an electronics company, “but the second one knocked me on my butt.”

Radiation completed his active treatment, and by the spring of 2014, he got the “all clear” and began taking tamoxifen, the preferred anti-estrogen hormonal therapy for men.

Then, last November, Rob started having severe back pain. An MRI revealed that his breast cancer had returned and spread to his bones.

Rob’s treatment – Round 2

Rob’s breast cancer is now considered stage 4 – still treatable, but no longer curable. “The goal of his treatment now is to keep his disease stable,” says Dr. Conlin, “and he’s doing well. We remain hopeful that his disease will stay controlled.”

In addition to a different anti-estrogen therapy, Rob is getting a brand-new targeted therapy called Ibrance (palbociclib), the first approved drug in a class called selective CDK4/6 inhibitors. In clinical trials of women with the same type of cancer as Rob’s, Ibrance improved survival by inhibiting cancer cells from spreading.

“A lot of research is happening now in breast cancer, and Rob is already benefiting from it,” says Dr. Conlin. “But many studies have not included men. We’d like to see more men included. Ultimately, we’ll extrapolate any research that happens in women to him, but wouldn’t it be nice to allow him and other men to be a part of it?”

What men need to know about breast cancer

While men can develop breast cancer even without any risk factors, certain factors do increase the chances of developing the disease. They include:

  • Older age: “Men tend to be about a decade older than women when they’re diagnosed,” says Dr. Conlin. The average age at diagnosis for men is 68. Rob was diagnosed at 57. “I guess I was an early bird,” he says.
  • Family history: “As with women, 15 to 20 percent of men with breast cancer have family members who had it,” says Dr. Conlin, “but that doesn’t mean that they’ve inherited it.” Rob’s mother had breast cancer, but he tested negative for the inherited BRCA1 and BRCA2 gene mutations associated with high risk.
  • Increased estrogen: “Any condition that increases the female hormone estrogen and reduces the male hormone androgen will increase men’s risk of breast cancer,” says Dr. Conlin. That includes taking hormonal therapies or testosterone; having the genetic condition Klinefelter's syndrome; and liver disease or obesity, both of which increase  estrogen levels. “Even using marijuana alters your estrogen-androgen ratio, which can increase your risk,” says Dr. Conlin.
  • Heavy alcohol use: The connection here may be related to alcohol’s effect on the liver.
  • Radiation exposure: Radiation treatment to the chest increases the chance of developing breast cancer later.
  • Testicular conditions: Certain conditions affecting the testicles are associated with slightly higher risk.

Know the signs

According to the American Cancer Society, signs of breast cancer in men include:

  • A lump or swelling – usually, but not always, painless – on the breast, or in the lymph nodes under the arm or around the collar bone
  • A nipple that turns inward
  • Skin dimpling or puckering
  • Redness or scaliness of the nipple or breast skin
  • Discharge from the nipple

Like women, men should see their doctor about any changes in or around their breast tissue.

A message for men going through breast cancer

Rob offers two pieces of advice for men coping with this disease.

First, he says, “Positive attitude, I think, is big. I really do.” Naturally, he has concerns about the future – especially about his wife, Jan, a musician who, he says, is “my favorite person.” But other than that, says Rob, “I’ve got a smile on my face, and I come to work and it’s ‘Good morning and how are ya,’ and then we go out, hear some music, stay out late and enjoy life.”

Second: “Be open and talk about it. That helps me,” says Rob. Men may not have as many support groups as women with breast cancer, but Rob will talk about his condition with anyone, and he’s found everyone, from his co-workers to his friends in the music community, extremely supportive.

“It’s not something to hide or be ashamed of. It’s something to be open about,” he says. “I mean, people look at me and I’ve got breast tissue on one side and nothing on the other, and I’m wearing a compression bandage on my arm, so it’s pretty obvious something’s going on. Instead of letting people wonder about it, I just say, yeah, I have breast cancer, and I’m hanging in there.”

Learn more about breast cancer in men here.

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