Friday 11 March 2011

Why Breast Cancer Occurs in Men

When we think of breast cancer, we automatically visualize the pink ribbons, the extensive awareness efforts and campaigns through various media channels, and the fund-raising walk-a-thons that remind us of how breast cancer is a malignant disease that affects thousands of women every year.
Due to its high incidence among the female population, breast cancer is mostly thought to be a woman's health concern. The concept that breast cancer can actually be diagnosed in men is puzzling for some. Breast cancer in men accounts for less than 1% of all cases of breast cancer, but it can be fatal if left undetected and untreated. In 2009, it was estimated that 1,910 men were diagnosed with breast cancer and 440 lost the battle in that same year.
How is it possible for men to develop breast cancer is a legitimate question considering that the term is associated with the upper frontal area of the torso on a woman. In women, this body part is called the breasts, while for men it is called the chest. The answer to the previous question is found in the anatomical structure of the breast. The breast contains three distinct parts: lobules - milk-producing glands (in women), ducts - tiny tubes that carry the milk from lobules to nipples, and stroma - fatty and connective tissues surrounding the ducts and lobules, and the blood and lymphatic vessels. Before puberty, both females and males have a small amount of breast tissue and a few ducts. Once puberty is reached, differences in the breast anatomy become obvious in both sexes. In women, the increased production of female hormones (estrogen and progesterone) causes the ducts to grow, the lobules to form, and the amount of stroma to increase. In men, the breast tissue is prevented from growing by the male hormones, but the initial ducts and lobules from birth are still present.
Breast cancer develops in the inner lining tissue of the milk ducts and that of the lobules. Due to the fact that men also have ducts and a few lobules, it is possible for cancer to develop in these tissues. The low incidence of breast cancer in men is attributed to the reduced amount of male's breast tissue compared to that of a woman's breast. The advantage of having a reduced amount of breast tissue is that any abnormal growths or lumps can be easily noticed. Unfortunately, because breast cancer is so rare in men and most consider the disease to affect only women, men will often ignore the early signs or attribute them to erroneous causes (such as infections or injuries).
Cancer, in general, results when the normal growing and dying process of the body's cells is impaired. The consequence of this dysfunction is that old cells don't die when they should, but new cells keep growing when the body does not need them. When this disturbance occurs, the new cells form a tissue mass which in time becomes tumor. The abnormal growth of new cells is attributed to genetic mutations. What causes these mutations is still a mystery for the medical field, but several connections between the disease and internal (genetic) and external (environmental) factors were established. Some of the risk factors associated with breast cancer in men are: radiation exposure, hyperestrogenism, Klinefelter's syndrome, cirrhosis of the liver, family predisposition, and age (men with age between 60 and 70 years old are at an increased risk of developing breast cancer).
When considering radiation exposure, the risk is higher in men that have been treated with ionizing radiation for various forms of cancer in the chest area. Hyperestrogenism refers to the increased production of estrogen which in men causes breast tissue to grow - a condition known as gynecomastia. A similar situation is present in men diagnosed with Klinefelter's syndrome. This syndrome is a rare inherited condition in which the chromosomal make-up of the man consists of XXY instead of the normal XY (the chromosome X is inherited from the mother, while the chromosome Y is inherited from the father). The extra chromosome X determines an increased production of estrogen which causes men to develop breasts, to have less body and facial hair, small testes, and the inability to produce sperm. The risk of developing breast cancer in men affected by this syndrome is up to 50 percent higher when compared to the normal male population.
The link between breast cancer and cirrhosis of the liver can sound baffling at first. Cirrhosis of the liver is caused by genetic disorders, but most commonly results from chronic alcohol abuse or chronic viral hepatitis. The role of the liver is to produce binding proteins that regulate the deliverance and transportation of the male and female hormones via the bloodstream. When the normal functioning of the liver is affected by cirrhosis, toxic substances tend to accumulate within the liver which compromises its natural function. Cirrhotic men have higher levels of estrogen within their bloodstream which increases the risk of developing breast tumors.
The familial predisposition refers to a history of breast cancer in the female relatives of the affected man. Men can also inherit the genetic mutation (particularly the BRCA-2 gene) responsible with the development of breast cancer in women. This gene is also linked to ovarian cancer in women and prostate cancer in men.
Although all these facts can sound scary and feel beyond our power to control (especially the genetic factors), it is important for a man to get familiarized with the early signs of breast cancer. One of the clues that a tumor might be developing is the presence of a non-painful mass (usually of 2.5 inches in diameter, on average) bellow the nipple. The skin around the nipple might undergo noticeable changes such as ulceration, dimpling/puckering, redness of the nipple, and even the nipple retracts. In some cases, a bloody or opaque discharge from the nipple might be noticed.
Breast cancer in men can be effectively treated if detected in its early stages of development and before it spreads to other parts of the body. The treatment options vary from surgery to chemotherapy, radiation therapy, and hormonal therapy. The treatment methods depends on the stage of the cancer, the age of the patient and his general health, and the extent of the cancer (whether it is present in both breasts or only one, or if it spread to adjacent areas), which can only be decided by the medical team in collaboration with the patient.

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