Male Breast Cancer
Male Breast Cancer – Symptoms, Diagnosis and Treatment
Many people are surprised to learn that men can develop breast cancer. Both men and women have breast tissue, and cancers can arise in this tissue in men as well as women. Male breast cancer is uncommon, but because it is often not expected, diagnosis can be delayed.
At Breast & Wellness Centre in Sydney, we see men with breast changes such as lumps, nipple changes or discharge, and provide tailored assessment and treatment by a specialist breast surgeon with oncoplastic training. The aim is to diagnose early, treat effectively and support you and your family through each step.
What is male breast cancer?
Male breast cancer is a malignant tumour that arises from breast tissue in a man. Most cancers in men start in the ducts behind the nipple (invasive ductal carcinoma), similar to the most common type of breast cancer in women. Many male breast cancers are hormone receptor–positive, meaning they grow in response to hormones such as oestrogen, and can often be treated with hormone-blocking medicines as well as surgery and radiotherapy.
How common is breast cancer in men?
Breast cancer in men is rare compared with women, but it does occur:
• Male breast cancer accounts for around 1% of all breast cancers.
• In Australia, around 200–220 men are diagnosed with breast cancer each year.
• The average age at diagnosis in men is around 70–71 years, although younger men can also be affected.
Overall, survival outcomes for men are good, particularly when cancer is found at an early stage. In Australia, about 87% of men with breast cancer are alive five years after diagnosis.
What are the symptoms of male breast cancer?
Common symptoms of male breast cancer include:
• A painless lump or thickening in the breast, usually under or near the nipple
• Nipple changes – flattening, inversion (turning in) or change in shape
• Nipple discharge, especially if blood-stained
• Skin changes over the breast – redness, dimpling, puckering or an “orange peel” appearance
• Ulceration or non-healing sores on the nipple or breast skin
• Swelling or lumps in the armpit (enlarged lymph nodes)
Any new, persistent breast change in a man should be assessed, even if it is not painful.
Who is at higher risk of male breast cancer?
Most men with breast cancer have no obvious risk factor, but certain factors increase risk, including:
• Increasing age
• Strong family history of breast or ovarian cancer in women, or breast cancer in men
• Inherited gene mutations, especially BRCA2, and less commonly BRCA1
• Klinefelter syndrome (a genetic condition where a man has an extra X chromosome)
• Conditions that increase oestrogen levels or reduce testosterone, such as liver disease, some testicular disorders, obesity or certain hormone treatments
• Previous radiotherapy to the chest area
For most men, the lifetime risk of developing breast cancer is less than 1 in 1,000; for men with high-risk genetic mutations such as BRCA2, the lifetime risk is higher.
Do all breast lumps in men mean cancer?
No. Not all breast lumps in men are cancerous. Common benign (non-cancerous) causes include:
• Gynaecomastia – enlargement of male breast tissue due to hormonal changes, medications or other conditions
• Benign cysts or fatty lumps (lipomas)
However, because breast cancer does occur in men, any new or persistent breast lump or change should be assessed. It is safer to have a change checked and find it is benign, than to delay and miss an early cancer.
How is male breast cancer diagnosed?
Diagnosis follows a “triple assessment” approach similar to that used in women:
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Clinical assessment
• Detailed history, including symptoms, duration, family history and any risk factors
• Physical examination of the breast, chest wall, armpits and nearby lymph nodes
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Imaging
• Breast ultrasound and/or mammogram to assess the lump and surrounding tissue
• Breast MRI in selected cases, particularly in younger men, those with dense tissue or genetic risk, or when findings are unclear
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Biopsy
• Core needle biopsy or vacuum-assisted biopsy to obtain tissue samples from the area of concern
• Pathology confirms the diagnosis, determines tumour type, grade, hormone receptor status (oestrogen and progesterone receptors) and HER2 status
Additional scans (such as CT, PET or bone scan) may be used to check whether cancer has spread beyond the breast and nearby lymph nodes, depending on stage and symptoms.
How is male breast cancer treated?
Treatment for male breast cancer is similar to treatment for women and is tailored to the individual’s stage of disease, tumour biology and general health. It often involves a combination of:
• Surgery
• Radiotherapy (radiation treatment)
• Systemic therapy – hormone-blocking tablets, chemotherapy, and/or targeted therapy depending on tumour features
Multidisciplinary care – involving a breast surgeon, medical oncologist, radiation oncologist, breast care nurse, genetic services and allied health – is important to ensure all aspects of care are addressed.
What does surgery involve for men with breast cancer?
Because men have less breast tissue, breast-conserving surgery is less often feasible, and surgery commonly involves:
• Modified radical mastectomy – removal of the breast tissue (and usually the nipple–areola complex) together with a sample or clearance of lymph nodes under the arm, depending on whether cancer has spread
• Sentinel lymph node biopsy – sampling the first lymph node(s) that drain the breast to check for spread; if negative, further node surgery may not be required
• Axillary lymph node dissection – removal of more lymph nodes if cancer is found in sentinel nodes or there is known nodal disease
In some cases, limited breast-conserving surgery may be offered if the tumour is small relative to breast tissue. Reconstructive options, including chest wall reshaping or nipple reconstruction, can be discussed where appropriate.
What about radiotherapy?
Radiotherapy may be recommended:
• After mastectomy if there is a larger tumour, close or involved margins, or lymph node involvement
• After breast-conserving surgery
• To treat or control symptoms in advanced disease
Radiotherapy reduces the risk of cancer coming back in the treated area. The exact fields and schedule are individualised based on pathology and overall treatment plan.
What about hormone therapy, chemotherapy and targeted therapy?
Most male breast cancers are hormone receptor–positive, so endocrine (hormone-blocking) therapy is a key part of treatment:
• Tamoxifen is the standard hormone therapy for most men with hormone receptor–positive early breast cancer
• In men who cannot take tamoxifen, other options include aromatase inhibitors combined with medicines that suppress testicular hormone production, under specialist guidance
Chemotherapy may be recommended for:
• Higher-risk early breast cancer (larger tumours, involved lymph nodes, high-grade disease, triple-negative cancers)
• Locally advanced or metastatic disease
Targeted therapies such as HER2-directed drugs (for HER2-positive cancer) follow similar principles to those used in women. Clinical trial options may also be considered.
What is the outlook for men with breast cancer?
Prognosis depends primarily on stage at diagnosis (tumour size, nodal involvement and presence of metastases) and tumour biology. When matched for stage and tumour type, outcomes for men are broadly similar to those for women.
Because male breast cancer is rare and sometimes diagnosed later, awareness and early assessment of any breast change are crucial. Many men with early-stage disease are successfully treated and do not experience recurrence.
When should a man see a doctor about his breast?
You should see your GP or a breast specialist promptly if you notice:
• A new lump or thickening in either breast
• Changes in nipple shape or position, including inversion
• Nipple discharge, particularly if blood-stained
• Skin changes such as dimpling, redness, thickening or ulceration
• Persistent pain or discomfort linked to a specific area of the breast
• Swelling or lumps in the armpit
Feeling embarrassed or assuming “it can’t be cancer in a man” can delay diagnosis. Any persistent change should be assessed.
Can genetic testing help?
In some men, particularly those with a strong family history or early-onset breast cancer, genetic counselling and testing may be recommended. This can:
• Identify inherited mutations such as BRCA2 or BRCA1
• Clarify risks of other cancers (such as prostate or pancreatic cancer)
• Help inform screening and risk management for relatives
In Australia, genetic risk management guidelines exist for men with BRCA1/2 mutations and can guide tailored surveillance and prevention strategies.
Why choose a specialist breast surgeon for male breast cancer?
Male breast cancer requires the same level of expertise and multidisciplinary input as breast cancer in women. A specialist breast surgeon with oncoplastic training can:
• Perform accurate assessment and coordinate imaging and biopsy
• Discuss surgical options, including lymph node management and reconstruction where appropriate
• Integrate surgery with systemic therapy and radiotherapy in a coordinated plan
• Work closely with genetic services, medical oncologists, radiation oncologists and breast care nurses to support you and your family
At Breast & Wellness Centre in Sydney, we provide evidence-based, individualised care for men with breast cancer, aiming for safe treatment, clear communication and compassionate support from diagnosis through to survivorship.
Where is Breast & Wellness Centre located?
Breast & Wellness Centre offers assessment and treatment for male breast cancer in Sydney, with consultations available at Westmead Private, Lakeview Private and Sydney Adventist Hospitals and associated rooms. Men and their families attend from across Greater Sydney and regional New South Wales. If you or someone you care about has noticed a breast lump or change, a specialist review can clarify what is happening and outline the most appropriate next steps.