Male Breast Cancer

[BBC3]

Doc Scally please.

I know you published some good studies in my recent thread regarding similar matters. But I am a somewhat of a quandry.

It would seem that in normal males with no history of hormone supplementation of any type, that if they turn up a lump or leaker, they are pretty much in for trouble. And very possibly cancer.

(1) I think it is established that breast cancer can only form in "breast tissue".

Obviously all the guys with lumps, discharge, or breast cancer, developed their breast tissue due to hormonal imbalances (at a minimum). Again, Aren't we doing the same?? After 4 years of reading here, it just seems common place to have a lump. I have seen so many posters who eventually turn up with a "bb sized lump", or "fluid comming out". IT JUST SEEMS "NORMAL" for this game. And thus, DISCOUNTED GREATLY. So whats the deal?

(2) Is gyno the MOST UNDERRATED SIDE EFFECT OF AAS?
You always hear of the "risk of Gyno". THAT IS ALL. If breast cancer is so common in normal men (that dont supp test) once a lump is found. Then why the hell isn't that the main sounding board for all the anti-steroid, and medical awareness groups?

(3) Is a "bb sized" lump a real concern from a medical standpoint?
What would you do if a patient came in with a lump and possible small abount of clear, stick, perhaps even "whitish" fluid that could be expressed ( if really squeezing)?
Would that protocol change for a TRT or AAS user, and why?

(4) Is there really a difference?
Would studies suggest that these regular folks with no AAS or TRT history just have an inclination to develop breast cancer? Does our removal of the hormones, as supplementers, place us back in a normal risk profile, and can this be used to satisfy a negative situation?

It would seem that at a min. We have now created breast tissue, which is at risk for breast cancer. A cancer we would have otherwise never have worried about. Which may infact, be a significant difference is what may, or may not, have developed down the road.

Could you please present a clinical response as a general scenario as fellow MDs would approach the situation both ways, by training. You may apply personal professional standards as well if you want. It seems like more cause for alarm than ANYONE has EVER published.

 

[CubbieBlue]

Re: Male Breast Cancer. Underrated??

Doc Scally please.

I know you published some good studies in my recent thread regarding similar matters. But I am a somewhat of a quandry.

It would seem that in normal males with no history of hormone supplementation of any type, that if they turn up a lump or leaker, they are pretty much in for trouble. And very possibly cancer.

(1) I think it is established that breast cancer can only form in "breast tissue".

Obviously all the guys with lumps, discharge, or breast cancer, developed their breast tissue due to hormonal imbalances (at a minimum). Again, Aren't we doing the same?? After 4 years of reading here, it just seems common place to have a lump. I have seen so many posters who eventually turn up with a "bb sized lump", or "fluid comming out". IT JUST SEEMS "NORMAL" for this game. And thus, DISCOUNTED GREATLY. So whats the deal?

(2) Is gyno the MOST UNDERRATED SIDE EFFECT OF AAS?
You always hear of the "risk of Gyno". THAT IS ALL. If breast cancer is so common in normal men (that dont supp test) once a lump is found. Then why the hell isn't that the main sounding board for all the anti-steroid, and medical awareness groups?

(3) Is a "bb sized" lump a real concern from a medical standpoint?
What would you do if a patient came in with a lump and possible small abount of clear, stick, perhaps even "whitish" fluid that could be expressed ( if really squeezing)?
Would that protocol change for a TRT or AAS user, and why?

(4) Is there really a difference?
Would studies suggest that these regular folks with no AAS or TRT history just have an inclination to develop breast cancer? Does our removal of the hormones, as supplementers, place us back in a normal risk profile, and can this be used to satisfy a negative situation?

It would seem that at a min. We have now created breast tissue, which is at risk for breast cancer. A cancer we would have otherwise never have worried about. Which may infact, be a significant difference is what may, or may not, have developed down the road.

Could you please present a clinical response as a general scenario as fellow MDs would approach the situation both ways, by training. You may apply personal professional standards as well if you want. It seems like more cause for alarm than ANYONE has EVER published.

Hey BBC,

It's pretty obvious you think you have breast cancer.

How about you go to a fucking doctor?

Love,

Cubbie

 

[BBC3]

Re: Male Breast Cancer. Underrated??

No, I don't want to be heard like someone who has an issue he is unclear or hesitating to handle. I have a small "bb" sized lump under a nipple. It gets larger with excessive Test/E2, and shrinks down to barely negligeable when the extra hormones are removed.

Gynomastia is the development of "breast tissue", which it appears is defined as ducts and glands associated. Puffiness is a common complaint the is merely a pre-indication that conditions are right for this development to occur. So I developed a little tissue apparently, it would seem. It would not shrink when hormones removed if cancer (most likely). NO doc is going to biopsy something that clearly has a cause, and "instant" remission when cause removed. So what do you do. ( I have spoken with doc). Also, it appears that generally any fluid expression would be abnormal in appearance or had bad smell if cancer.

The whole point was that steroid "abusers" who consistantly take enought roids to develop gynomastia are obviously putting themselves at a RISK that seems greatly understated in the field. After all, one has to first have "breast" tissue, to have breast cancer. And who knows how ever slight the degree is, that EVERYONE may be developing breast tissue with AAS or TRT use. Even considering a short cycle. It also turns out that any males with breast tissue development would seem to be at an incredible risk for BC. Males with any fluids comming out of their chest, would appear to have a good chance of having BC. Yet MANY AAS, as well as some TRT people, are developing breast tissue as a side effect of usage?!?!

It would just seem to me that the most obvious high risk of steroid abuse is being GREATLY understated for some unknown reason. If the real potential risk associated with Gynomastia were property stated and warned, it would clearly make many think. Its one thing to "juice up" thinking if I get gyno sign I'll back off. Its a whole other thing to realize you are risking developing breast tissue, whick in men, appears to be a far worse situation than commonly stated. I can only assume that men with BC have a genetic propensity which is difficult to combat any way you slice it. I would like to think there are studies done indicating steroid induced gyno does not usually result in cancer. But does anyone really think a fair study could have even been conducted, as surely not many would own up to it, historically speaking.

Again, more evidence that there is little known at this time again DUE TO IGNORANCE PROPAGATED BY DEMONIZATION of the field.

 

[Michael Scally MD]

Re: Male Breast Cancer. Underrated??

Genetic Mutation Linked To Breast Cancer In Women May Predispose Men To The Disease.

Bloomberg News (7/6, Cortez - Breast Cancer Gene Hits Men, Causes Tumors for 1 in 12 Carriers in Study - Bloomberg ) reports, "A genetic mutation linked to breast cancer in women also predisposes men to the disease, with 1 in 12 male carriers developing tumors by age 80, researchers said." The study of "321 families with faulty BRCA2 genes" sought "to pinpoint the risk for men who have the mutation" and found that "the lifetime risk" for men "is as great as 9 percent, they said."


Evans DGR, Susnerwala I, Dawson J, Woodward E, Maher ER, Lalloo F. Risk of breast cancer in male BRCA2 carriers. Journal of Medical Genetics:-.

The risk of breast cancer for unaffected men who test positive for a BRCA2 mutation is based on very few retrospective studies. We have used both retrospective and prospective analysis in 321 families with pathogenic BRCA2 mutations. Three breast cancers occurred in male first-degree relatives after family ascertainment in 4140 years of follow-up suggesting a risk of breast cancer to 80 years of 8.9%. A second analysis excluding index cases identified 16 breast cancers in 905 first-degree male relatives on which Kaplan–Meier analysis was performed after assigning carrier status. This analysis confirmed that breast cancer risk in men was 7.1% (SE 5.2–8.6%) by age 70 years and 8.4% (SE 6.2–10.6%) by age 80 years.

 

[Michael Scally MD]

Re: Male Breast Cancer. Underrated??

Breast cancer in men is rare, but they have mastectomies too
Breast cancer in men is rare, but they have mastectomies too - Los Angeles Times

September 23, 2010

Pink ribbons, really anything pink, have become powerful symbols in the fight against breast cancer in which women need to be on the lookout for early signs of the disease. But what about men? This year an estimated 210,000 women in the United States will be diagnosed with breast cancer — a diagnosis 2,000 men also will receive, according to a story in the Chicago Tribune.

"It never occurs to men that we can get breast cancer," said Val Lucier, who had a fast-growing cancer and underwent a mastectomy. "We're oblivious, and that's what's so dangerous. You don't expect it." Read the Chicago Tribune's full story at "The manly side of breast cancer." The manly side of a woman's disease Low awareness that men can get breast cancer may result in delayed treatment and poorer outcomes - Chicago Tribune

Duke Garner of Portsmouth, Va., also had a mastectomy after medication he was taking led to tumors in his breast tissue. The biopsy results were inconclusive, but he opted for removal as a precautionary measure. The Health Notes blog of the Newport News Daily Press reports the hardest part for Garner was having a mammogram. "People looked at me like, 'Does he know where he is?'" he said in a statement. The experience prompted Garner, president of a motorcycle club, to organize an Oct. 2 ride to raise funds for the Virginia Breast Cancer Foundation. Read the full Health Notes blog post at "Man who underwent mastectomy organizes breast cancer benefit ride." http://weblogs.dailypress.com/health/peninsula-health-notes/2010/09/man_who_underwent_mastectomy_p_1.html

 

[GregP]

Re: Male Breast Cancer. Underrated??

My previous Dr. passed away in June. He had male breast cancer from what his office manager told me. Couldn't figure out why he abrubtly shut down his practice.

Dr. Michael Gomez
Katy, TX
Rest in Peace.

http://www.katytimes.com/articles/2010/07/15/obituaries/doc4c3cd5e1b7a3d005694535.txt

 

[BBC3]

Re: Male Breast Cancer. Underrated??

Just to add back to this one. I quit my "high side TRT" experiment 8-10 weeks ago, and of course within two weeks of backing off, the "BB" sized lump was resided and appearing inactive. OF COURSE, the little bastard is still there to some kind of really small hard bump in there. I really wonder what that is.?!?!? You hear guys talk about 2 issues with Gyno. One being the swollen puffy tits, and the second being the "BB" sized lump. Clearly they are different. At first I assumed the lump was a blocked duct of some sort in development, but I am really thinking that I was simply harvesting a tumor. My wife's tits dont have any lumps in them like that, nothing that hard. Nor do any other chicks tits I have ever bounced around. So really what have I done? Now what is in place for later in life when my body might want to grow a breast cancer as a natural state of old age (If I am proned)? It also points out just how involved hormones are in growths we cant really qualify or quantify. What have I done to my prostate.? How important is good hormonal profile, and how hard will it really be to maintain it as everything else gets old and doesn't work right? Got me wondering... How many people with "temporary gyno" or flares wind up with a hard type prize to walk away with?

 

[musclesta]

Re: Male Breast Cancer. Underrated??

Have you considered surgery? It's a minor procedure I don't think there's anyone fat free over 250 who hasn't done it jet.

 

[Michael Scally MD]

Song YN, Geng JS, Liu T, et al. Long CAG Repeat Sequence and Protein Expression of Androgen Receptor Considered as Prognostic Indicators in Male Breast Carcinoma. PLoS One 2012;7(12):e52271. PLOS ONE: Long CAG Repeat Sequence and Protein Expression of Androgen Receptor Considered as Prognostic Indicators in Male Breast Carcinoma

BACKGROUND: The androgen receptor (AR) expression and the CAG repeat length within the AR gene appear to be involved in the carcinogenesis of male breast carcinoma (MBC). Although phenotypic differences have been observed between MBC and normal control group in AR gene, there is lack of correlation analysis between AR expression and CAG repeat length in MBC. The purpose of the study was to investigate the prognostic value of CAG repeat lengths and AR protein expression.

METHODS: 81 tumor tissues were used for immunostaining for AR expression and CAG repeat length determination and 80 normal controls were analyzed with CAG repeat length in AR gene. The CAG repeat length and AR expression were analyzed in relation to clinicopathological factors and prognostic indicators.

RESULTS: AR gene in many MBCs has long CAG repeat sequence compared with that in control group (P = 0.001) and controls are more likely to exhibit short CAG repeat sequence than MBCs. There was statistically significant difference in long CAG repeat sequence between AR status for MBC patients (P = 0.004). The presence of long CAG repeat sequence and AR-positive expression were associated with shorter survival of MBC patients (CAG repeat: P = 0.050 for 5y-OS; P = 0.035 for 5y-DFS AR status: P = 0.048 for 5y-OS; P = 0.029 for 5y-DFS, respectively).

CONCLUSION: The CAG repeat length within the AR gene might be one useful molecular biomarker to identify males at increased risk of breast cancer development. The presence of long CAG repeat sequence and AR protein expression were in relation to survival of MBC patients. The CAG repeat length and AR expression were two independent prognostic indicators in MBC patients.

 

[Michael Scally MD]

[Open Access] The Clinical Manifestations and Treatment of Male Breast Cancer: A Report of Three Cases

Male breast cancer is an extremely rare malignancy. We treated three male breast cancer patients. All three patients showed clinical N0 and received sentinel lymph node biopsy. Because the sentinel lymph node was positive for metastasis in one patient, a total mastectomy with axillary lymph node dissection was performed.

The other two patients were negative for sentinel lymph node metastasis, and a simple mastectomy was performed.

Two of the patients were postoperatively treated with tamoxifen; another patient was treated with adjuvant chemotherapy using taxotere and cyclophosphamide before tamoxifen.

There was no recurrence in any of the three patients during an average follow-up period of 56.7 months (range 11.8-80.3).

A sentinel lymph node biopsy is recommended for node staging in both male and female breast cancer patients as it is associated with a lower incidence of complications.

Suehiro S, Abe M, Takumi Y, et al. The clinical manifestations and treatment of male breast cancer: a report of three cases. Surg Case Rep 2015;1(1):92. The clinical manifestations and treatment of male breast cancer: a report of three cases

 

[Dr JIM]

TRT does NOT "feed" prostate CA and neither do AAS "feed" male breast CA.

To the contrary as male breast tissue predominantly is E-2 dependent if anything the use of AAS would more likely be protective. In fact some of the earliest studies on female BREAST CA revealed a protective effect from both Nandrolone and Masteron.

Your comparing two entirely different processes breast HYPERTROPHY (AKA Gynecomastia) from aromatizable AAS to that of METAPLASIA. The latter is a result of defective DNA replication and one in which hormones are not the genesis of.

There is absolutely no evidence GCM is a precursor to male breast CA, and this association has been reasonably well investigated and REFUTED. Moreover if such a relationship was noted bc of the "increased use of AAS" it would have published by now.

 

[Michael Scally MD]

[OA] Male Breast Cancer: Epidemiology and Risk Factors

Male breast cancer is a rare malignancy that accounts for less than1% of all cancers in men and less than 1% of all breast cancers. But the incidence is rising and in some patient groups reaching 15% over the course of their lives.

The major risk factors for the development of male breast cancer include advancing age, hormonal imbalance, radiation exposure and a family history for breast cancer. Regarding the latter it can be linked to mutations in high or low penetrance genes. The most relevant risk factor for the development of male breast cancer is a mutation in the BRCA2 gene.

Most of the cases present late due to a lack of awareness of the existence of such a malignancy in males and ignorance of the related risk factors. Additionally, males with breast cancer are at special risk for developing a second cancer. This review highlights in depth the epidemiology and risk factors for male breast cancer development.

Abdelwahab Yousef AJ. Male Breast Cancer: Epidemiology and Risk Factors. Seminars in Oncology. Male Breast Cancer: Epidemiology and Risk Factors - ScienceDirect

 

[Dr JIM]

^^^^^
Interesting Doc S

 

[Just Fish]

Re: Male Breast Cancer. Underrated??

No, I don't want to be heard like someone who has an issue he is unclear or hesitating to handle. I have a small "bb" sized lump under a nipple. It gets larger with excessive Test/E2, and shrinks down to barely negligeable when the extra hormones are removed.

Gynomastia is the development of "breast tissue", which it appears is defined as ducts and glands associated. Puffiness is a common complaint the is merely a pre-indication that conditions are right for this development to occur. So I developed a little tissue apparently, it would seem. It would not shrink when hormones removed if cancer (most likely). NO doc is going to biopsy something that clearly has a cause, and "instant" remission when cause removed. So what do you do. ( I have spoken with doc). Also, it appears that generally any fluid expression would be abnormal in appearance or had bad smell if cancer.

The whole point was that steroid "abusers" who consistantly take enought roids to develop gynomastia are obviously putting themselves at a RISK that seems greatly understated in the field. After all, one has to first have "breast" tissue, to have breast cancer. And who knows how ever slight the degree is, that EVERYONE may be developing breast tissue with AAS or TRT use. Even considering a short cycle. It also turns out that any males with breast tissue development would seem to be at an incredible risk for BC. Males with any fluids comming out of their chest, would appear to have a good chance of having BC. Yet MANY AAS, as well as some TRT people, are developing breast tissue as a side effect of usage?!?!

It would just seem to me that the most obvious high risk of steroid abuse is being GREATLY understated for some unknown reason. If the real potential risk associated with Gynomastia were property stated and warned, it would clearly make many think. Its one thing to "juice up" thinking if I get gyno sign I'll back off. Its a whole other thing to realize you are risking developing breast tissue, whick in men, appears to be a far worse situation than commonly stated. I can only assume that men with BC have a genetic propensity which is difficult to combat any way you slice it. I would like to think there are studies done indicating steroid induced gyno does not usually result in cancer. But does anyone really think a fair study could have even been conducted, as surely not many would own up to it, historically speaking.

Again, more evidence that there is little known at this time again DUE TO IGNORANCE PROPAGATED BY DEMONIZATION of the field.

If you do regular bloodwork and keep e2 in check with an AI you won't develop breast tissue. Get some raloxifene to get rid of the lump before it is too late. It's also good to have just in case of flareups

 

[Just Fish]

Re: Male Breast Cancer. Underrated??

Just to add back to this one. I quit my "high side TRT" experiment 8-10 weeks ago, and of course within two weeks of backing off, the "BB" sized lump was resided and appearing inactive. OF COURSE, the little bastard is still there to some kind of really small hard bump in there. I really wonder what that is.?!?!? You hear guys talk about 2 issues with Gyno. One being the swollen puffy tits, and the second being the "BB" sized lump. Clearly they are different. At first I assumed the lump was a blocked duct of some sort in development, but I am really thinking that I was simply harvesting a tumor. My wife's tits dont have any lumps in them like that, nothing that hard. Nor do any other chicks tits I have ever bounced around. So really what have I done? Now what is in place for later in life when my body might want to grow a breast cancer as a natural state of old age (If I am proned)? It also points out just how involved hormones are in growths we cant really qualify or quantify. What have I done to my prostate.? How important is good hormonal profile, and how hard will it really be to maintain it as everything else gets old and doesn't work right? Got me wondering... How many people with "temporary gyno" or flares wind up with a hard type prize to walk away with?

Your nips swell, get puffy, and sensitive when gyno is in very early stages. If untreated you will slowly begin to develop fibroglandular tissue that is hard to the touch. Refer to my previous post for treatment and prevention

 

[Michael Scally MD]

[OA] Jafari M, Olfatbakhsh A, Rezaei-Kalantari K. Male Breast Cancer; A Review of Risk Factors and Clinical and Radiological Features. MCI. 2017;1(4):1-6. Male Breast Cancer; A Review of Risk Factors and Clinical and Radiological Features - Multidisciplinary Cancer Investigation

While male breast cancer (MBC) consists only 1% of all breast cancers in the United States, approximately 2000 men are diagnosed annually and the incidence seems to be slowly increasing. About 50% of men have axillary nodal metastasis at the time of diagnosis. A mean delay of 6 to 10 months occurs in the diagnosis of MBC, which leads to the progression of the disease before presentation. More than 40% of MBCs present with stage III/IV disease. Therefore, men with MBC have a worse prognosis compared with women. Additionally, as a result of the paucity of breast tissue in males, early chest wall spread occurs. Therefore, it seems that recognition of the symptoms and radiologic features of MBC can improve early detection, the prognosis and survival rate of the disease. A few researches focused on male breast cancer; however, there are many similarities with female breast cancer and some differences. The current study aimed to review the latest information on risk factors, clinical, and radiological features of MBC.

 

[Michael Scally MD]

[OA] Fentiman IS. The endocrinology of male breast cancer. Endocr Relat Cancer 2018;25:R365-r73. The endocrinology of male breast cancer

Male breast cancer (MBC) is a rare disease but, as a result of epidemiological collaborations, there is now greater clarity concerning endocrine risk factors. The significant rise in global age-standardised mean BMI in men is likely to lead to increases in incidence of maturity-onset diabetes and MBC.

The metabolic changes accompanying obesity decrease androgens and sex hormone-binding globulin (SHBG), thereby increasing available oestrogens. The higher rates of MBC in North and Equatorial Africa are largely due to liver damage from endemic bilharziasis and hepatitis B causing elevated oestradiol (E2) levels from hepatic conversion of androgen. Klinefelter's syndrome (XXY) is associated with a 50-fold increase in incidence of MBC compared with XY males, and this is the most pronounced evidence for testicular malfunction amplifying risk.

Delay in presentation means that up to 40% of cases have stage III or stage IV disease at diagnosis. No randomised controlled trials have been reported on endocrine treatment of advanced disease or adjuvant/neoadjuvant therapy following or preceding surgery.

Tamoxifen is the most effective endocrine therapy, but side effects can lead to non-compliance in a substantial number of men.

Aromatase Inhibitors Are Less Effective Because They Do Not Inhibit Testicular Oestrogen Production.

There is an urgent need for collaborative trials to provide an evidence base for the most effective endocrine and least toxic therapies for men with breast cancer.

 

[Michael Scally MD]

[OA] Breast Cancer Screening in High-Risk Men

Background - Male breast cancer incidence is rising. There may be a potential role in selective screening in men at elevated risk for breast cancer, but the effectiveness of such screening remains unexplored.

Purpose - To evaluate patterns of male breast imaging utilization, to determine high-risk screening outcomes, and to delineate risk factors associated with cancer diagnosis.

Materials and Methods - This retrospective study reviewed consecutive male breast imaging examinations over a 12-year period (between 2005–2017). Examination indications, biopsy recommendations, and pathologic results were correlated with patient characteristics. Fisher exact test, Mann-Whitney test, Spearman correlation, and logistic regression were used for statistical analysis.

Results - A total of 1869 men (median age, 55 years; range, 18–96 years) underwent 2052 examinations yielding 2304 breast lesions and resulting in 149 (6.5%) biopsies in 133 men; 41 (27.5%) were malignant and 108 (72.5%) were benign.

There were 1781 (86.8%) diagnostic and 271 (13.2%) screening examinations. All men undergoing screening had personal or family history of breast cancer and/or genetic mutations. There was a significant increase in the number of examinations in men relative to the number of examinations in women over time (Spearman correlation, r = 0.85; P < .001).

Five node-negative cancers resulted from screening mammography, yielding a cancer detection rate of 18 per 1000 examinations (95% confidence interval [CI]: 7, 41), with cancers diagnosed on average after 4 person-years of screening (range, 1–10 person-years). Mammographic screening sensitivity, specificity, and positive predictive value of biopsy were 100% (95% CI: 50%, 100%), 95.0% (95% CI: 93.1%, 98%), and 50% (95% CI: 22.2%, 77.8%).

Older age (P < .001), Ashkenazi descent (P < .001), genetic mutations (P = .006), personal history (P < .001), and first-degree family history (P = .03) were associated with breast cancer. Non–first-degree family history was not associated with cancer (P = .09).

Conclusion - There is potential benefit in screening men at high risk for developing breast cancer. Such screening may have increased over time.

Gao Y, Goldberg JE, Young TK, Babb JS, Moy L, Heller SL. Breast Cancer Screening in High-Risk Men: A 12-Year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes. Radiology 2019:190971. https://pubs.rsna.org/doi/pdf/10.1148/radiol.2019190971

 

[Michael Scally MD]

[OA] Breast Cancer in a 53-year-old Obese Male

Male breast cancer (MBC) represents <1% of all breast cancers and little is known about its true etiology. The known risk factors associated with MBC are age, Klinefelter syndrome, BRCA2 mutation, high estrogen levels, gynecomastia, and cirrhosis of any cause.

Obesity has been documented as a risk factor to MBC in some studies even though it is not officially recognized as a risk factor. Herein, we present a 53-year-old obese male with estrogen receptor-positive (ER+) breast cancer.

Although this patient has a strong family history of ovarian cancer, obesity could have been an additive predisposing factor. As more cases of MBC in obese patients are explored, we might be able to gain a better understanding of its true etiology and mechanism.

Robinette J, Olexo R. Breast Cancer in a 53-year-old Obese Male. Cureus. 2019;11(11):e6194. Published 2019 Nov 19. Breast Cancer in a 53-year-old Obese Male