Abstract

Breast Cancer that forms in tissues of the breast. The most common type of breast cancer is ductal carcinoma, which begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Types of breast cancer are male and female breast cancer. Breast cancer that forms in tissues of the breast in men. Most male breast cancer begins in cells lining the ducts. It is very rare and usually affects older men. When discussing the etiology of male breast cancer, one must uncover the potential genetic or environmental risk factors. Signs and symptoms of male breast cancer are a painless lump or thickening of the skin on the chest, changes to the skin covering the chest, such as dimpling, puckering, scaling or changes in the colour of the skin, discharge or bleeding from the nipple. Some complications are destruction of the breast, destruction of the chest wall surrounding of the breast, mastitis, nipple discharge, chest pain. Male breast cancer treatment usually starts with surgery. Other common treatments include chemotherapy, hormone therapy and radiation therapy. Mostly used drug in male breast cancer is Tamoxifen. Patient counselling is defined as providing medication information orally or in written form to the patients or their representatives on directions of use, advice on side effects, precautions, storage, diet and life style modifications.

Keywords

Introduction

       
           
       
Fig 1: Inflammatory breast cancer in men

Difference Between Male Breast Cancer And Gynecomastia

One of the biggest differentiating factors between a male with breast cancer and a male with gynecomastia is symmetry. For instance, men who have gynecomastia almost always exhibit swelling in both of their breasts. Whereas men who have breast cancer, typically only find a lump or swelling in one of their breasts.

Male breast cancer (male breast neoplasm) is a rare cancer in males that originates from the breast. Many males with breast cancer have inherited a BRCA mutation (BRCA gene 1 & 2 present on chromosome 17 and 13 respectively), but there are other causes, including alcohol use disorder and exposure to certain hormones and ionizing radiation. ^[2]

Etiology

When discussing the etiology of male breast cancer, one must uncover the potential genetic or environmental risk factors. It is also important to be mindful that the majority of males diagnosed with MBC have no identifiable risk other than increasing age (average age of diagnosis of 71 years).  Similarly to women, males have a higher risk of breast cancer if they have a first- or second-degree relative with breast cancer. Studies have shown that an affected sibling or parent of either gender may increase the risk of breast cancer in either the males or females in the family.

Factors that may increase the risk of breast cancer include, a family history of breast cancer, a personal history of breast cancer, a personal history of breast conditions. The alterations in oestrogen-to-androgen ratios are important to note when discussing the etiology of male breast cancer. Oestrogen, which stimulates ductal development in breasts, has also been implicated as a potential risk factor for MBC, similar to women. Klinefelter syndrome, as previously mentioned, may increase the risk of MBC through excess oestrogen stimulation. Other potential triggers have also been identified and include obesity, marijuana use, hepatic dysfunction, thyroid disease, and oestrogen-containing medications.^[3]

Epidemiology

Breast cancer in men is a relatively rare malignancy when compared to breast cancer in women, with a known ratio of 1 case in men to 100 in women, and occurs in about 1% of all breast cancer.  Breast cancers in men, in general, account for 0.5% of all cancer diagnoses in men, but there has been recent concern about the rising incidence in the past few decades. Studies have facilitated the hypothesis that in addition to obesity and alcohol, dietary factors may be exacerbating the incidence of MBC, but concrete research and evidence regarding specific dietary patterns have yet to be established. Despite these plausible associations, many individuals who are diagnosed with male breast cancer have no identifiable risk factors.^[4]

Pathophysiology

Breast cancer can result from genetic mutations and DNA damage. The inheritance of defects in the DNA and genes like BRCA1, BRCA2, and P53 and those with a family history of breast cancer are at risk of developing breast cancer. The immune system fails to reverse the effects of mutant genes.  Breast cancer invades locally and spreads through the regional lymph nodes, bloodstreams, or both. The lungs, liver, bone, brain, and skin are the most common organs that metastatic breast cancer can affect.^[5]

Signs And Symptoms

• A painless lump or thickening of the skin on the chest.
• Changes to the skin covering the chest, such as dimpling, puckering, scaling or changes in the colour of the skin.
• Changes to the nipple, such as changes in the skin colour or scaling, or a nipple that begins to turn inward.
• Discharge or bleeding from the nipple.
•  sores or a rash on the nipple and areola (the dark area around the nipple).
• changes to the breast skin, such as irritation, redness, dimpling, or puckering.
• change in the size or shape of the breast. ^[6]                  

Risk Factors

• Older age
• Hormone therapy for prostate cancer or medicines containing oestrogen
• Family history of breast cancer
• Inherited DNA changes that increase breast cancer rise
• Klinefelter syndrome

• Liver disease
• Obesity
• Testicle disease or surgery ^[5]

Complication

• Destruction of the breast
• Destruction of the chest wall surrounding of the breast.
• Mastitis
• Nipple discharge
• Chest pain
• Most women will have aches or pains from time to time in the treated breast even years after treatment.
• Hair loss after radiation therapy and chemotherapy.
• Blocked blood vessels, bone fractures, and pressure on the spinal cord. ^[7]

Diagnosis

Tests and procedures to diagnose male breast cancer might include:

1. Clinical breast exam: During this exam, a health care professional feels the breasts and surrounding areas for lumps or other changes. This exam helps the health professional understand how large the lumps are, how they feel, and how close they are to skin and muscles.
2. Imaging tests: Imaging tests can create pictures of breast tissue to look for signs of      cancer. Tests may include a breast X-ray, called a mammogram, an ultrasound or an MRI scan.
3. Removing a sample of breast cells for testing, called a biopsy: To determine whether you have cancer, you might have a procedure to remove a sample of cells for testing in a lab. This procedure is called a biopsy. To get the sample, a health care professional puts a needle through the skin on your chest. The health professional guides the needle using a mammogram or another imaging test.
4. In the lab, specialists examine the cells under a microscope to see if they're cancer. Other tests can tell whether your cancer cells have hormone receptors or certain DNA changes. The test results help your health care team create a treatment plan.^[8]

Treatment

Male breast cancer treatment usually starts with surgery. Other common treatments include chemotherapy, hormone therapy and radiation therapy. To create a treatment plan, your health care team looks at your cancer's stage, your overall health and what you prefer.

Pharmacological Therapy

Surgery

The goal of surgery is to remove the cancer and some of the healthy tissue around it. Operations used to treat male breast cancer include:

• Removing all the breast tissue, called a mastectomy: A mastectomy involves removing all the breast tissue from one side of your chest. This includes removing the nipple and the skin around it, called the areola. This is the most common type of surgery for male breast cancer.
• Removing the cancer and some healthy tissue: A lumpectomy involves removing the cancer and some of the healthy tissue around it.  
• The rest of the breast tissue isn't removed. Sometimes doctors call this breast-conserving surgery. Often, radiation therapy is recommended after lumpectomy
• Removing a few lymph nodes for testing, called a sentinel lymph node biopsy: The surgeon removes the lymph nodes most likely to be the first place your cancer cells would spread. Those few lymph nodes, called sentinel nodes, are sent to a lab for testing.
• If there are no cancer cells, there is a good chance that your breast cancer hasn't spread past your breast tissue. If cancer is found, more lymph nodes are removed for testing.

Radiation therapy

Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. In male breast cancer, radiation therapy may be used after surgery to kill any cancer cells that might be left behind. The radiation is often aimed at the chest and armpit.

Hormone therapy

Most male breast cancers have cells that rely on hormones to grow, called hormone sensitive. If your cancer is hormone sensitive, hormone therapy might be an option. Hormone therapy can keep cancer from coming back after surgery. If the cancer spreads to other parts of the body, hormone therapy may help slow its growth. Hormone therapy for male breast cancer often involves the medicine tamoxifen. Other hormone therapy medicines might be an option if you can't take tamoxifen.

Chemotherapy

Chemotherapy uses strong medicines to kill cancer cells. These medicines are often given through a vein. Some chemotherapy medicines are available in pill form. Chemotherapy might be used after surgery to kill any cancer cells that might be left in the body. Chemotherapy also may be an option for treating cancer that spreads to other parts of the body.

Targeted therapy

Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy might be used after surgery to kill any cancer cells that might be left in the body. It also might be an option if the cancer spreads to other parts of the body.

DURGS USED ARE:

Tamoxifen

Tamoxifen (Nolvadex® or Soltamox®) is a drug that treats hormone receptor-positive (hormone-positive) breast cancer. (Hormone-positive breast cancer is a type of cancer that needs oestrogen and/or progesterone to grow.) Healthcare providers also use tamoxifen to help prevent breast cancer in people over 35 who have a high risk of the disease. Since the U.S. Food and Drug Administration (FDA) approved tamoxifen in 1998, it has become one of the most widely used breast cancer treatments.

Aromatase Inhibitors                                                                                                     

Aromatase inhibitors are a hormone therapy (also called endocrine therapy). They are used to treat hormone receptor-positive early, locally advance and metastatic breast cancers. Hormone receptor-positive breast cancers need oestrogen (a female hormone) to grow. Aromatase inhibitors lower oestrogen levels in the body by blocking aromatase, an enzyme that converts other hormones into oestrogen. This slows or stops the growth of the tumour by preventing the cancer cells from getting the hormones they need to grow.

Aromatase inhibitors: Anastrozole (Arimidex), Exemestane (Aromasin), Letrozole (Femara)

Non-Pharmacological Therapy

5. Acupuncture
5. Meditation
5. Physical activity
5. Music therapy
5. Massages
5. Yoga
5. Relaxation ^[8]

Prevention

• Get to and stay at a healthy weight
• Avoid or limit alcohol
• Choose healthy eating
• Pick nutrient-dense foods with vitamins, minerals, proteins, and healthy fats to help prevent cancer. These include: Dark green vegetables, coloured fruits and vegetables whole grains, nuts, seeds, and beans, lean proteins like fish, poultry, and tofu. ^[9]

PATIENT COUNSELLING

Patient counselling about Disease

Physicians should counsel patients about the symptoms of recurrence including new lumps, bone pain, chest pain, dyspnoea, abdominal pain, or persistent headaches. The risk of breast cancer recurrence continues through 15 years after primary treatment and beyond.

Patient counselling about drug

Tamoxifen (ta-MOX-i-fen) is a drug that is used to treat many types of cancers. Some cancers are hormone sensitive (oestrogen or progesterone receptor positive) and their growth can be affected by blocking the effect of the hormone oestrogen. Tamoxifen blocks the effect of oestrogen produced by your body and decreases the growth of hormone sensitive tumours. Tamoxifen may also have anti-cancer effects not related to the hormone oestrogen. It is a tablet that you take by mouth. Tell your doctor if you have ever had an unusual or allergic reaction to tamoxifen before taking tamoxifen.

 It is important to take tamoxifen exactly as directed by your doctor.

• Tamoxifen may be taken with food or on an empty stomach with a glass of water or juice. o If you take tamoxifen once a day: Your dose may be taken at any time of the day but should be taken about the same time each day.
• If you take tamoxifen two times a day: Take your doses at evenly spaced times during the day (about 12 hours apart). o If you take tamoxifen once every other day: Your dose may be taken at any time of the day but should be taken at about the same time of day on each treatment day.

  If you miss a dose of tamoxifen:

• If you take tamoxifen once a day: Take your dose as soon as you can if it is within 12 hours of the missed dose. If it is more than 12 hours since your missed dose, skip the missed dose and go back to your usual dosing times.
• If you take tamoxifen two times a day: Take your dose as soon as you can. Take your next dose at your usual time. If you remember at the time for your next dose, take both doses and then go back to your usual dosing times.
• If you take tamoxifen once every other day: Take your dose as soon as you can if it is within 24 hours of the missed dose. If it is more than 24 hours ince your missed dose, skip the missed dose and go back to your usual dosing times.
• The drinking of alcohol (in small amounts) does not appear to affect the safety or usefulness of tamoxifen.
• Tamoxifen is usually well tolerated and serious side effects are rare.

Patient counselling about life style

There is strong evidence to suggest that adopting a healthy lifestyle, including regular exercise, a balanced diet, and stress reduction techniques, can help reduce the risk of breast cancer recurrence and improve overall health.

What role does exercise play?

Regular exercise has been shown to improve physical function and quality of life, and may also reduce the risk of recurrence in breast cancer patients. A study found that breast cancer patients who engaged in regular moderate-intensity exercise had a lower risk of cancer recurrence and improved survival rates.

What role does diet play?

A balanced diet that includes a variety of nutrient-rich foods, such as fruits, vegetables, whole grains, and lean protein, can help maintain a healthy weight and reduce the risk of chronic diseases, including breast cancer. ^[10]

CONCLUSION

Breast cancer is a rare disease among men and the number of cases included in studies is small. It may be confounded with benign diseases, and both patients and physicians may underestimate its signs. Since its detection is delayed, the disease is usually at advanced stages at the time of diagnosis. Breast cancer behaves differently in males. There is a need for multi-center studies with more patients that focus on the treatment, prognosis, tumour biology and parameters influencing survival. ^[11]

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