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Breast Diseases in Males

  • Darryl Schuitevoerder
  • John T. VettoEmail author
Chapter

Abstract

Breast tissue in males is susceptible to many of the same disorders as breast tissue in females. The differential diagnosis of a breast lump in males is broad and includes gynecomastia, primary breast cancer, metastasis, primary lymphoma, sarcomas, and fibroadenomas, among others. The mainstays of diagnosis are physical examination, imaging, and needle biopsy. The utility of mammography is variable and ultrasound is the imaging modality of choice for a dominant mass. The most common benign breast disease in males is gynecomastia. Breast cancer in males (BCM) is one of the oldest diseases in recorded history. BCM accounts for approximately 1 % of all breast cancer cases and, matched for stage, carries the same prognosis as breast cancer in females (BCF). Associated risk factors for BCM include increased age, conditions of hyperestrogeny, and genetic mutations. As the normal male breast contains only ductal tissue, up to 90 % of BCM is ductal type. The majority of BCM is hormone (both estrogen and/or progesterone) receptor positive, while less likely to express HER2 neu (1.7–55 %). Surgical treatment is the mainstay for resectable BCM. While traditionally radical mastectomy was performed, lumpectomy or total mastectomy with sentinel lymph node biopsy is now more commonly performed, especially given that over half of BCM cases are node negative. Indications for radiotherapy and chemotherapy are similar to those for BCF. Also similar to BCF, the most significant prognostic factors for BCM are the AJCC stage and its elements, tumor size, and lymph node status. Patients with BCM are a relative minority faced with a disease for which information and support is usually aimed at women. Accordingly, many men with breast cancer have expressed difficulty facing their diagnosis. As such it is important to emphasize education and support for this often underserved patient population.

Keywords

Male breast disease Male breast cancer Gynecomastia Hormone therapy Genetic inheritance Support Risk factors 

Notes

Acknowledgments

The authors gratefully acknowledge the assistance of Si-Youl Jun, MD, Darius Paduch, MD, Heidi Eppich, and Richard Shih for their assistance in collection of the Oregon data on BCM; Waldemar Schmidt, MD, PhD, Rodney Pommier, MD, John DiTomasso, MD, Heidi Eppich, William Wood, MD, and Dane Moseson, MD, for their contribution to the diagnostic test data for the evaluation of breast masses in males; and Elsevier for granting permission to reprint parts of the resulting publications [9, 241]. The assistance of Irene Perez Vetto, RN, MN, ANP in reviewing and editing the manuscript is also gratefully acknowledged.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryOregon Health & Science UniversityPortlandUSA
  2. 2.Department of Surgery, Division of Surgical OncologyOregon Health & Science UniversityPortlandUSA

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