This conversation has been edited for length and clarity. For an unabridged version, please listen to the audio file attached to this article.
Alexis Allison: So Dr. Tower, typically when we think about breast cancer, it’s associated with women, but men can get breast cancer, too. Can you tell us a little bit about that?
Dr. Amelia Tower: Yes. Absolutely men can get breast cancer. Men have the same anatomic units of the female breast, but those units are not functional as they are in a female breast. And so whenever we look at cancer of the male breast, it has not been fully characterized, but both environmental influences and also some genetic factors that are inherited, likely play a role in its development.
There are some health risk factors for the development of breast cancer in men that have been identified and well studied. And some of the most common are, if a male has had previous radiation of the chest wall for a previous carcinoma, anything that can potentially increase levels of estrogen in men, such as a medical condition. For example, there are two known medical conditions which can have abnormally high levels of estrogen and that can increase the risk of breast cancer, and those are Klinefelter syndrome as well as cirrhosis of the liver.
There can also be an increased risk with obesity, and that’s because there’s elevated estrogen levels circulating in the male body. There’s also a component and an increased risk whenever a male may utilize anabolic steroids, and there’s some indications and studies that show certain medications such as medications for male fertility can actually increase the risk of male breast cancer. Again, all of those are factors that can increase certain levels of estrogen in the male body.
Allison: Why is estrogen associated with breast cancer?
Tower: We know that estrogen is associated with breast cancer because the majority of breast cancers that are diagnosed are what are called “hormone-positive” for estrogen. And that essentially means that, an invasive breast cancer cell has three receptors — one of which is estrogen — and a non-invasive breast cancer cell has two receptors, again, estrogen is one of them. The majority of our breast cancers that are diagnosed are positive for estrogen, meaning that they like that hormone that female bodies produce, and obviously, as we just discussed, can be excessive in certain medical conditions, and also certain factors or medications that men are exposed to.
Allison: For men, how common is breast cancer?
Tower: It’s actually very rare. For 2022, there’s approximately 2,710 new cases of invasive breast cancer predicted for men. A man’s lifetime risk of breast cancer is (about) one in 1,000. And just to put perspective on that and understand that, in comparison, one in eight women get breast cancer in the U.S. And whenever we look at our estimation cases for 2022 for women, that includes approximately 287,850 new cases of invasive breast cancer that are expected to be diagnosed in women in the U.S., along with 51,400 new cases of non-invasive breast cancer diagnosed in the U.S.
Allison: Say someone is listening to this conversation: What would you recommend that he do in terms of screening?
Tower: That’s a good question. There is no established screening protocol for male breast cancer. Whenever we educate and talk to women, we have national guidelines and recommendations for screening that include an annual screening mammogram or an annual clinical breast exam if that female is between certain ages, starting at age 40.
Obviously, there’s different screening protocols and recommendations for high-risk populations.
But whenever we look at men, we encourage every male to be self-aware — just be aware if there’s any abnormality of their chest wall and to feel comfortable and understand the importance (of bringing it) to the attention of a physician for further evaluation. One of the setbacks and obstacles we see as physicians treating men with breast cancer is, understandably, they tend to ignore the early symptoms, and essentially are less self-aware, because several men in our population just think that breast cancer is completely confined to the female population. This often leads to hesitancy in consulting a doctor or even discussing it with a loved one or their spouse. And overall, all of these factors can contribute to delay in the diagnosis of male breast cancer and timely initiation of treatment.
Allison: So, a couple of follow up questions there. You mentioned an abnormality in their chest wall. Can you elaborate on what that might look or feel like?
Tower: Yeah, so there’s a couple of what we would say common symptoms of breast cancer in men are. Most commonly they note a lump or swelling usually within the central portion of the breast or chest wall, but it can be throughout. There can also be redness or flaking of the skin, irritation or dimpling of the breast skin, there can be associated nipple discharge, or even the change in the appearance of the nipple, where it looks like it’s deviated in the direction or it’s pulling or going inside or also there can be pain associated within the nipple area. Those tend to be the more common symptoms that we see in male breast cancer.
Allison: And if a man were hesitant to discuss his concern with a spouse or a friend or a physician, what would you tell him?
Tower: I encourage all my patients, male or female, to be comfortable in their body and be comfortable with their health care (provider). Part of the fun and privilege of being a physician is trying to establish a comfortable rapport with our patients. To me, I want a patient to feel comfortable to ask me anything, and although I am a breast surgical oncologist and I specialize in breast care, oftentimes my patients will ask me — as I hope that they do feel comfortable to ask me — about other medical conditions. And I definitely will help them and guide them to getting further evaluation if necessary.
So, I would encourage all patients, men and women: Choose your physician based on your comfort. Obviously, you want to choose someone that’s in the expertise of the medical condition that you’re concerned about, but partner with someone that you feel like you could communicate with. Because health care, it truly should be a dialogue, and it should not be a monologue.
Allison: I appreciate that. Thank you. And I know that there’s this new imaging technology that helps surgeons who are performing lumpectomies. It’s my understanding that you were the first surgeon in the U.S. to use this technology in a commercial setting. Can you tell us a little bit about that, and also how you know you were the first in the U.S.?
Tower: Those are some great questions. Among the most recent advances in breast cancer care for both men and women is a new imaging technology that actually aids surgeons by allowing them to evaluate — in real time — to examine a lumpectomy specimen’s margin assessment.
This device uses optical coherence tomography, which produces images that are 10 times higher in resolution and clarity than the standard X-ray or ultrasound images and 100 times greater than that of an MRI. So, what does all this mean?
Well, it basically means that I can actually look at the tissue removed during a lumpectomy and detect if the amount removed is adequate or if additional tissue should be taken at the same time. And that leads to the possibility of the patient having to return for a second surgery to excise more tissue to be very low whenever I utilize this equipment.
One of the difficult things in being a breast cancer surgeon is that it’s very difficult to discuss with the patient the diagnosis and that this will inevitably change their life. But, unfortunately, the second-worst conversation is to tell a patient that we have to go back to surgery to take more tissue. And this device can limit that opportunity to have to have that second surgery, which can result in physical and emotional trauma of the patient.
I was actually the first in the world to use this device for commercial use. And that was done on Aug. 31, 2021 at Texas Health Harris Methodist (Hospital Fort Worth). And I definitely know that it was true that I was the first in the world for commercial usage, because (the company) told me so. I hope it was true, because I told my mother and my spouse and my children, so they definitely are excited that I can claim that title.
That being said, there are multiple surgeons and academic centers utilizing this technology, and they’re participating in some amazing clinical trials that are showcasing the value and also looking at artificial technology in conjunction with the device. And all of that is very exciting for our field and for the treatment of breast cancer.
I’m just truly privileged and excited to be part of this and to bring this new technology to everybody’s attention. I feel it’s a great asset to the surgical management of this terrible disease. It can improve our patient care on so many levels. And I truly do believe it’s going to become a new standard of care in treating breast cancer patients who undergo a lumpectomy.
Allison: Thank you, Dr. Tower. Is there anything else that you’d like to share?
Tower: Male breast cancer, it’s diagnosed, it’s staged, it’s treated the same as women who have breast cancer. And so, just like we’ve discussed, the advances in early detection, the treatment options and the innovative surgical equipment and techniques are all identical. Whenever we treat male breast cancer, we utilize a multidisciplinary approach, which means we utilize a team of experts in the field. And we’re all individualizing the treatment based on the patient and the disease. So essentially it’s all the same as we do for female patients. And just to all the listeners, men and women, early detection and self-awareness is so important and truly is the first step in treating this horrible disease.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.