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Male Breast Cancer: Confronting the Hidden Crisis in Men’s Health

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dr. Karunia Valeriani Japar

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Introduction

Male breast cancer, though rare, is a significant health concern that remains widely underrecognized, accounting for less than 1% of all breast cancer cases globally. In 2025, approximately 2,800 men in the United States alone are expected to be diagnosed with invasive breast cancer, with an estimated 510 deaths resulting from this disease. This comparatively low incidence leads to a pervasive misconception that breast cancer is exclusively a woman’s disease, often resulting in delayed diagnosis, advanced stage at presentation, and higher mortality rates for men [1,2,3,4,5,6].

Men possess breast tissue and are susceptible to malignant transformation, yet many remain unaware of their risk and do not routinely examine themselves for early signs. The lack of public and clinical awareness is compounded by psychological stigma and social barriers that discourage open discussion and timely medical consultation when symptoms arise. Large cohort data demonstrate that male patients typically present with more advance disease and have a 19% higher mortality rate compared to women, with survival rates showing little improvement over recent decades [2,4,6].

Awareness campaigns focused on male breast cancer are crucial for changing these trends. Increasing knowledge among men, clinicians, and the broader community facilitates earlier detection, empowers proactive health choices, and reduces disparity in outcomes-ultimately saving lives [1,4,5,6].

Epidemiology and Incidence in Men

Male breast cancer represents a rare but clinically significant subset of breast cancer cases, accounting for less than 1% of all diagnoses worldwide. In the United States, it is projected that approximately 2,800 men will be diagnosed with invasive breast cancer in 2025, with an estimated 510 deaths attribute to the disease. The lifetime risk for an American man developing breast cancer is about 1 in 726, substantially lower than the 1 in 8 risk faced by women. However, this low incidence leads to unique epidemiological challenges, including delayed recognition, limited public awareness, and poorer clinical outcomes for affected men [6].

Male breast cancer disproportionally affects older men, with most cases diagnosed after age 60. Compared to women, male patients exhibit later stage at diagnosis and a 19% higher mortality rate, as documented in population based studies analyzing both survival and staging data. Incidence varies by ethnicity, with black men experiencing worse prognoses than white men. Epidemiologically, invasive ductal carcinoma is the most common histological subtype with most tumors showing estrogen receptor (ER) positivity, which inform treatment decisions [5,6].

Despite its rarity, the incidence of male breast cancer has remained relatively stable over recent decades, but improvements in survival seen in women have not been matched in men, highlighting research  gaps and clinical disparities. Risk factors include genetic predisposition (particularly Breast Cancer gene 2 (BRCA2) mutations) , advancing age, hormone imbalance due to obesity or liver disease, prior chest irradiation and family history. Recent studies emphasize the importance of increasing awareness, expanding research on male-specific cancer biology, and improving access to early detection and tailored therapies to address the unique epidemiological burden faced by men with breast cancer [5,6].

Risk Factors Unique to Male Breast Cancer

Male breast cancer (MBC) exhibits unique and multifactorial risk factors that distinguish it from female breast cancer, with contributions from genetic mutations, endocrine and metabolic dysfunctions, and rare medical syndromes [7,8,9].

Genetic Factors

Pathogenic germline mutations, predominantly in the BRCA2 gene, represent the most significant risk factor in men. The lifetime risk for breast cancer in male BRCA2 mutation carriers is estimated between 6-8%, far exceeding that of the general male population, whereas BRCA1 mutations impart a somewhat lower, yet substantially elevated risk. Other moderate, penetrance genes, including Partner and localizer of BRCA2 (PALB2), Checkpoint kinase 2 (CHEK2), and Ataxia-Telangiectasia Mutated (ATM), have also been implicated. Family history of breast (or related) cancers remains a strong predictor, accounting for approximately 15-20% of MBC cases [8,9,10,11,12,13,14].

Hormonal and Chromosomal Syndromes

Klinefelter syndrome (47,XXY karyotype) amplifies breast cancer risk by 20-50 fold compared to unaffected men, attributed to increased lifetime exposure to circulating estrogen and gonadal dysgenesis. Other conditions associated with hyperestrogenism such as testicular disorders, liver cirrhosis, and exogenous estrogen exposure are similarly implicated in increased MBC risk [8,9,14,15].

Endocrine Metabolic Factors

Obesity and metabolic syndrome have emerged as recognized risk enhancers for MBC. Adipose tissue increases peripheral aromatization of androgens to estrogens, producing an estrogen-dominant milieu that promotes malignant transformation in breast epithelium. Epidemiological analyses show obese men generate nearly double the amount of estrogen as men with normal BMI, and large cohort studies document a 30% increased MBC risk among obese males [7,16,17].

Liver dysfunction, particularly steatotic and cirrhotic states, further amplifies the risk by disrupting estrogen metabolism and clearance. Chronic alcohol consumption, while less studied specifically in MBC, is also suspected to contribute through liver mediated endocrine disruption [15,16,17,18].

Additional Risk Modifiers

  • Age: The risk of MBC increases with advancing age, peaking in the seventh decade [14,19].
  • Radiation: Therapeutic or environmental chest irradiation predisposes to MBC, especially if exposure occurred during adolescence or early adulthood [8,14].
  • Ethnicity: Black men have a higher incidence and worse outcomes than other demographic groups [8].

In summary, MBC risk is driven by a complex interplay between inherited susceptibility (especially BRCA2 and other high/moderate penetrance mutations), hormonal exposures, metabolic health, age, and specific chromosomal abnormalities such as Klinefelter syndrome. Preventive strategies and targeted surveillance should prioritize at-risk populations identified through these unique risk profiles [7,8,14,16,17,18,19].

Figure 1. Risk Factors of MBC [30]

BRCA mutation and family history are the cornerstone genetic risk factors for male breast cancer, with BRCA2 playing the most prominent role. Pathogenic variants in several other moderate-risk genes and syndromic genetic backgrounds further modulate individual and familial susceptibility.

BRCA Mutations: Mechanisms and Impact

MBC constitutes less than 1% of all breast cancer cases globally, with germline mutations identified in cancer predisposition genes accounting for about 15-20% of cases. The BRCA2 gene is the predominant high-penetrance susceptibility gene for MBC; pathogenic BRAC2 variants confer a relative risk of approximately 44-fold compared to the general population, while BRCA1 confers a 4-6 fold increased risk. Up to 14% of men diagnosed with breast cancer harbor a BRCA2 mutation, representing a cumulative lifetime risk of 7-8%; for BRCA1, the risk is about 1-4%. These mutations are inherited is an autosomal dominant fashion. BRCA1 and BRCA2 encode tumor suppressor proteins crucial for DNA repair, and loss of function due to a pathogenic variant predisposes carriers to breast, prostate, pancreatic, and other cancers [8,11,20,21,22].

The majority of BRCA2-associated MBCs present as hormone receptor positive, high grade tumors, and frequently exhibit lymph node involvement. BRCA1 mutation carriers can also develop MBC, albeit less frequently. In clinical practice, universal genetic testing for BRCA1/2 (and other key genes) is recommended in all MBC cases, facilitating tailored management and preventive strategies [8,11,21,22].

Expanding Genetic Landscape

While BRCA1/2 remain dominant, pathology driven genetic research highlights additional moderate risk genes such as PALB2,CHEK2 and ATM. PALB2 variants increase MBC risk about sevenfold, ATM by about fivefold, and CHEK2 by around fivefold as well. Klinefelter syndrome (47,XXY) also dramatically increases risk due to estrogen dysregulation. In about 5% of cases, other hereditary syndromes including those involving PTEN (Cowden Syndrome). TP53 (Li-Fraumeni syndrome), and mismatch repair genes account for further familial clustering [8,20,22].

Family History and Cancer Risk

A strong family history significantly increases MBC susceptibility. Risk is particularly elevated when multiple first or second-degree relatives are affected, especially when diagnoses occur at younger ages (<45 years). Even in men lacking BRCA1/2 mutations, a family history of breast cancer multiplies risk fourfold (OR 4.7, with risk amplified to 7.8-fold when two or more first degree relatives are affected, and nearly eighteen-fold if another male relative is diagnosed. Approximately 15-20% of MBC cases have a family member with breast cancer, compared to 7% of the general male population. Family history-based risk assessment tools (e,g., BRCA Probability (BRCAPRO), Ontario Family Health Team (FHAT)) are employed in clinical genetics to identify high risk men for further testing [8,20,23].

Hormonal Imbalances and Metabolic Health Connections

Hormonal imbalances particularly elevated estrogen and reduced androgen levels are deeply implicated in the pathogenesis of MBC, closely intertwining with metabolic health disturbances such as obesity, diabetes, and components of metabolic syndrome [24,25,26].

Hormonal Imbalance: Estrogen, Androgen, and Breast Cancer

MBC is strongly driven by a disproportion between estrogen and androgen actions. Approximately 90% of MBC tumor express estrogen receptors (ER), which means they are responsive to estrogenic stimulation. Risk factors that shift the balance toward estrogen excess such as Klinefelter syndrome (XXY karyotype, testicular dysgenesis), testicular disorders (mumps orchitis, undescended testes, injury), or cirrhosis (impaired hepatic estrogen metabolism) substantially elevate MBC risk. Klinefelter syndrome alone is associated with a 20 to 50 fold increased risk of MBC due to marked androgen deficiency and consequent hyperestrogenemia [20,24,25,26].

Metabolic Health: Obesity, Diabetes, and Insulin Resistance

Obesity and metabolic syndrome are established independent risk factors for breast cancer and are mechanistically linked through chronic low-grade inflammation, hyperinsulinemia, and insulin resistance. These pathways not only elevate local and systemic estrogen levels but also drive tumorigenesis via the insulin/IGF axis, increasing cell proliferation in estrogen responsive tissues. Men with metabolic syndrome or type 2 diabetes mellitus experience decreased sex hormone-binding globulin (SHBG) and androgens, further increasing bioavailable estrogen [20,24,25,26].

Chronic liver diseases, common in metabolic syndrome, impair estrogen clearance and exacerbate hyperestrogenemia. The cumulative impact of these metabolic alterations appears to explain steadily increasing MBC incidence in parallel with rising obesity and diabetes prevalence globally [24,25,26].

Clinical and Epidemiological Correlations

Multiple studies confirm higher prevalence of metabolic syndrome among breast cancer patients compared to controls, independent of obesity status. Obesity and its metabolic sequelae (hypertension, hyperglycemia, dyslipidemia) are particularly important in men, who show increased risk of both incident and aggressive forms of breast cancer with escalating metabolic disturbance [24,27,28,29].

Lifestyle Factors: Obesity, Alcohol, and Smoking

Obesity, alcohol consumption, and smoking are key modifiable lifestyle factors with varying degrees of association with MBC risk. Recent large-scale epidemiological research gives nuanced insight into these links, emphasizing obesity as a primary risk driver, while the role of alcohol and smoking remain less conclusive.

Obesity and Male Breast Cancer

Obesity is strongly associated with increased risk of MBC, with recent evidence showing that both overall body mass index (BMI) and abdominal obesity independently increase risk. Large pooled studies found that men experiencing weight gain or central adiposity from adolescence through adulthood have a significantly higher like hood of developing breast cancer, with about a 30% increased risk observed in obese men versus normal weight controls. The biological mechanisms is considered to be the aromatization of androgens to estrogen in adipose tissue, leading to higher circulating estrogen, a central element in MBC pathogenesis. In addition, obesity is often associated with chronic inflammation, insulin resistance, and metabolic syndrome, further enhancing cancer risk through increased levels of insulin-insulin like growth factor 1 (IGF-1), and inflammatory cytokines. The association appears even stronger for certain male breast cancer subtypes, especially those expressing HER2 and estrogen receptors [30,31,32,33,34].

Alcohol Consumption

The relationship between alcohol intake and MBC risk is less clear but potentially relevant, particularly with heavy prolonged consumption. While most large studies do not show significant associations between moderate alcohol intake and MBC risk, some evidence suggests that very high levels of alcohol consumption may have a modest positive association (OR >1.29 for heavy intake). Alcohol raises breast cancer risk by elevating estrogen levels via hepatotoxicity and impaired liver metabolism and causing direct DNA damage to breast tissue. Prolonged heavy drinking is considered a risk factor, particularly if it leads to liver dysfunction and chronic hormonal imbalance [14,35,36,37,38,39].

Smoking

For tobacco exposure, robust pooled analyses demonstrate no statistically significant increase in risk for MBC, regardless of smoking status, duration, or intensity. Neither cigarette, cigar, nor pipe smoking showed meaningful associations with male breast cancer in the largest consortia to date. Unlike female breast cancer, where some studies link smoking to elevated risk, the male data remain consistently null on this point [35].

Additional Lifestyle Factors

FactorRisk AssociationMechanism (Summary)
ObesityStrong, 30%+ increased riskEstrogen via aromatase, metabolic inflammation [30,38]
AlcoholPossible, esp. prolonged/ heavy intakeHepatic estrogen increase, DNA damage [34,35,36]
SmokingNo significant associationNot established [35]
Table 1. Lifestyle Factors and Risk

This evidence strongly support the encouragement of healthy weight maintenance, moderation of of alcohol intake, and overall lifestyle improvements as primary population level strategies for decreasing MBC risk [30,34,38].

Clinical Presentation and Early Signs to Watch For

MBC often presents insidiously, with early signs frequently missed due to low awareness and the rarity of the disease. Clinical vigilance and prompt evaluation of suspicious findings are critical for timely diagnosis and improved outcomes [20,40].

Common Clinical Presentations

The most common presenting symptom of MBC is a painless, first lump or mass, typically located subaerolarly (beneath the nipple-aerola complex). In most cases, the lump grows slowly and is unilateral; bilateral cases are uncommon. Because men have less breast tissue than women, even small masses are usually close to the skin and more easily palpable. Other classic presentations include [20,40];

  • Nipple changes: inversion (retraction), erythema, crusting, scaling, ulceration , or persistent rash on or around the nipple [20,40].
  • Nipple discharge, which may be clear, serous, or bloody; any nipple discharge in a man is considered suspicious and warrants urgent evaluation [40,41].
  • Changes in breast skin: dimpling, puckering, thickening, redness, irritation, or changes in skin color over the chest area [40,41].
  • Sores or non-healing ulcers on the chest wall [40].

Additional Early Warning Signs

  • A lump or swelling in the armpit (axillary adenopathy), suggesting possible lymph node involvement [40,42].
  • Asymmetry in breast shape or contour, or unilateral enlargement [42].
  • Unexplained local pain or tenderness, though this is uncommon in early stages [40].

Systemic and Advanced Signs

As the disease advances or metastasizes, men may report:

  • Unexplained weight loss, loss of appetite, persistent fatigue, or malaise [43].
  • Symptoms related to metastatic disease, such as bone pain, cough, or neurological deficits if there is distant spread [43].

Clinical Differentiation & Urgency

Differentiating MBC from benign conditions such as gynecomastia is important. Gynecomastia is characterized by diffuse, symmetrical and often tender enhancement beneath the nipple compared to the typically hard, irregular, fixed, and non-tender mass of MBC [40].

Any firm, fixed, painless, or progressively enlarging chest lump, new onset nipple discharge, or skin/nipple change in a man should prompt urgent specialist review. Early detection improves treatment outcomes, as MBC is often diagnosed at a more advanced stage than in women due to delayed recognition [20,40,41].

Sign/SymptomTypical FeaturesNotes
Painless lump/massSubareolar, unilateral, firm, fixedMost common initial sign [20]
Nipple changesRetraction, rash, scaling, ulcerationStrongly suspicious if new-onset [40]
Nipple dischargeClear, bloody, or any type in male,Always abnormal; requires workup [40]
Breast skin changesDimpling, puckering, rednessMay mimic infection or dermatitis [41]
Axillary swellingLump or swelling in armpitSuggest nodal involvement [42]
Systemic symptomsWeight loss, fatigueLate stage/metastatic disease [43]
Table 2. Early Signs of MBC

Awareness of these early warning signs and routine self-examination can foster earlier detection and better prognosis for men at risk of breast cancer.

Diagnostic Pathways: Imaging and Biopsy in Men

The diagnostic pathway for MBC mirrors that in female breast cancer but is tailored for the anatomical and epidemiological differences in men. It relies on systematic clinical assessment, multimodal imaging, and confirmatory tissue biopsy to secure diagnosis and guide management [20.30].

Clinical Assessment and Initial Evaluation

Clinical breast examination is the starting point, assessing for masses skin changes, nipple discharge, and regional lymphadenopathy. Suspicious findings prompts referral for imaging [41,44].

Imaging Modalities

  • Mammography is the first line imaging for men age ≥25 with a palpable mass or abnormal findings. It is highly sensitive (92-100%) and specific (90-96%) for distinguishing benign and malignant breast lesions. Typical MBC findings include irregular, high density, retroaeolar masses with spiculated or lobulated margins; calcifications are less frequent than in females. Bilateral mammography aids in pattern recognition and exclusion of gynecomastia [8,30,45].
  • Ultrasound is valuable for men under 25 and as an adjunct to mammography or for further characterization of indeterminate findings. On ultrasound, MBC typically appears as a hypoechoic lesion with irregular, microlobulated, or spiculated margins. It excels at distinguishing solid from cystic masses and guiding biopsy procedures [8,45,46,47,48].
  • Magnetic Resonance Imaging (MRI) is reserved for complex cases or when multifocal disease is suspected, offering high sensitivity but limited specificity in the initial assessment [44,48].

Biopsy Techniques and Confirmatory Testing

Any suspicious imaging or clinical finding mandates tissue diagnosis, typically by image guided core needle biopsy (CNB). CNB provides sufficient tissue for histopathology, receptor testing, and molecular profiling for hormone receptors (ER/PR) and HER2 status [30,46,49].

  • Fine Needle Aspiration (FNA) may be considered for cystic or small solid lesions, but CNB is preferred as it yields larger tissue samples and offers more reliable diagnostic information [49,50].
  • Excisional or Incisional biopsy may be used occasionally when CNB is non diagnostic or technically challenging but this is less common due to potential surgical morbidity, especially in older or comorbid patients [44,49].

Pathological analysis confirms malignancy, histological subtype (usually invasive ductal carcinoma), and molecular characteristics critical for therapeutic planning. Emerging modalities such as liquid biopsy (circulating tumor DNA, ctDNA analysis) are being explored for disease monitoring and therapeutic stratification in research settings [44,49].

StepModality/ProcedureDiagnostic Role
Clinical ExamHistory, palpation, node checkInitial screening
MammographyBilateral, ≥25 yearsHigh sensitivity, pattern recognition
Ultrasound<25 years, adjunctLesion characterization, biopsy guide
MRISelect casesComplex/ multifocal disease, staging
Core needle biopsyUltrasound/ mammogram guidedHistopathology, receptor profiling
FNACystic/ small lesions (limited use)Preliminary cytology
Excisional/incisional biopsyRare, if neededFull tissue diagnosis
PathologyImmunohistochemistry, geneticsSubtype, ER/PR/HER2, molecular strat
Table 3. Diagnostic Pathway in Male Breast Cancer

Difference Between Male and Female Breast Cancer

MBC and female breast cancer (FBC) share major pathological and clinical features but also differ in epidemiology, risk factors, tumor biology, clinical presentation, and outcomes. The table below summarizes key differences, integrating population level and clinopathologic data from recent research.

FeatureMale Breast CancerFemale Breast Cancer
Incidence~0.5-1% of all casesDominates breast cancer statistics [51]
Age at DiagnosisOlder (Median ~ 60years)Younger (Median ~48-55 years) [51,52,53]
Main Risk FactorsGenetic predisposition (BRCA2>BRCA1), age, obesity, Klinefelter’s syndrome, liver/ testicular diseaseFamily history, hormonal exposures (early menarche, late menopause, parity), obesity, BRCA mutations [51, 54,55]
Clinical PresentationPainless subareolar mass, nipple involvement, discharge, ulceration, mostly unilateral, often advancedMass commonly in upper outer quadrant, detected by screening, less nipple involvement [51,56,57]
Pathological TypeInvasive ductal carcinoma (>80%)Invasive ductal, lobular, and variants [51]
Tumor BiologyMore ER/PR positive (>90%) less HER2/ER-SubtypesER/PR positive ~80%, more HER2/ER-variance [56,57]
Stage at DiagnosisHigher (more advanced, larger tumors, skin/chest wall infiltration)More likely early stage due to screening[56,57]
Nodal InvolvementFrequent at presentationFrequent, but detected earlier [56,57]
Prognosis/SurvivalWorse overall survival; 5 year OS 40-77%; higher stage and ageBetter overall survival; 5 year OS 85-86% [56,57]
Awareness and ScreeningRare, not routinely screened, delayed diagnosisEstablished screening, earlier detection [56,57]
Treatment ApproachSimilar protocols but total mastectomy more common, endocrine therapy for hormone positive diseaseSurgery, adjuvant therapy, breast conservation favored [56,57]
Genetic InfluenceHigher dependence, more frequent familial clusteringImportant but less predominant [56,57]
Table 4. Difference of MBC and FBC

MBC occurs in less than 1% of cases and is diagnosed at a significantly older age than FBC, typically in the sixth decade, with most men presenting at more advanced stages due to lack of screening and low awareness. Compared to women, men are much more likely to have ER/PR-positive tumors, with fewer high-grade, HER2-positive, or triple negative subtypes. While both genders share invasive ductal carcinoma as the primary histology, men rarely have lobular or other special types due to rudimentary breast tissue. Prognosis is generally worse among men, with 5 year overall survival ranging from 40%-77% compared to ~85-86% in women, partly due to later stage at presentation and older age [51,52,53,54,55,56,57].

Familial and genetic risk contributors, especially BRCA2 mutations and Klinefelter syndrome, play a larger role in men than women. Screening protocols for FBC further drive the difference, as men typically present with a palpable, often nipple-centered mass, versus incidentally detected lesion in women. Therapeutic protocols mirror those in females, with mastectomy commonly elected for men and breast conservation favored for women. This distinction underscore the need for gender-specific awareness, research and tailored clinical strategies in breast cancer management [51,52,53,54,55,56,57].

Treatment Modalities: Surgery, Chemotherapy, Radiation, Hormonal Therapy

The treatment of MBC is based on multidisciplinary principles and guidelines largely extrapolated from FBC trials, but with adaptations for anatomic and biological differences seen in men. Core modalities include surgery, chemotherapy, radiation therapy, and hormonal therapy, each tailored to tumor stage, biology, and patient comorbidities [58,59,60,61,62].

Surgery

Surgical intervention is the cornerstone of MBC management. Most men undergo total mastectomy, given the limited breast tissue and central (subareolar) tumor location, modified radical mastectomy (removal of the breast, axillary lymph nodes, and some part of chest muscle) predominates, though breast conserving surgery (lumpectomy) may be considered in select early-stage cases. Sentinel lymph node biopsy or axillary dissection is used for staging and management of nodal disease, paralleling FBC protocols. Multiple cohort studies show equivalent survival in men undergoing breast conserving surgery compared to mastectomy, if combined with adjuvant radiotherapy [63,64].

Chemotherapy

Adjuvant or neoadjuvant chemotherapy is advised for MBC with high-risk features: node positivity, large tumors, aggressive biology, or metastatic disease. Agents and regimens mirror those in FBC, including anthracyclines, taxanes, and cyclophosphamide. In metastatic or rapidly progressing disease, chemotherapy is the standard initial approach. Chemotherapy also plays a role preoperatively to downstage locally advanced tumors and postoperatively to reduce recurrence and improve survival [62,63,65].

Radiation Therapy

Postoperative radiotherapy is commonly employed after breast conserving surgery or mastectomy in the presence of adverse features (large tumor, involved margins, nodal burden). Radiation decreases the risk of local recurrence and improves outcomes, particularly when the tumor invades the skin, chest wall, or ≥4 lymph nodes. Palliative radiotherapy is also valuable for symptom management in metastatic disease [20,36,58,63].

Hormonal Therapy

Given the high prevalence of hormone receptor positive MBC (>90%), endocrine therapy is fundamental. Tamoxifen, a selective estrogen receptor modulator, is the standard and improves survival in both early and advanced disease. Aromatase inhibitors and GnRH agonist may be considered if tamoxifen is contraindicated. Fulvestrant or other endocrine agents are options in metastatic/refractory cases. Adherence is essential due to survival benefit; side effects (hot flashes, thromboembolic events, sexual dysfunction) require proactive management [8,58,63].

Other Therapies

Targeted therapies (e.g., trastuzumab for HER2-positive disease) and CDK4/6 inhibitors are used when indicated, based on tumor biology and aligned with FBC approaches. All men with MBC are recommended to undergo genetic testing, as familial syndromes are more common in this population [8,58,63].

ModalityMain RoleKey Points
SurgeryPrimary treatment, stagingMost undergo mastectomy; breast conservation possible [36,63]
ChemotherapyAdjuvant, neoadjuvant, metastaticSame regimens as FBC; for node+, high-risk disease [58,63]
Radiation TherapyAdjuvant and palliativeAfter surgery for high-risk or breast conservation [20,58,63]
Hormonal TherapyAdjuvant, metastaticTamoxifen standard; consider AI+ GnRH, fulvestrant [20,58,63]
Targeted TherapyHER2+, advanced/metastatic casesAs per FBC (transtuzumab, CDK4/6 inhibitors, etc.) [58]
Table 5. Core Modalities in MBC

Current therapeutic strategies for MBC aim for optimal local control, reduced recurrence, and maximized survival, requiring individualized plans based on tumor and patient characteristics [63].

Prognosis and Survival Rates in Male Breast Cancer

Prognosis and survival rates in MBC have improved in recent years, but outcomes remain less favorable than in FBC. The overall 5 year relative survival rate for men diagnosed with breast cancer is approximately 84-85% though survival varies significantly depending on stage at diagnosis and other factors [66,67].

Survival by Stage

  • Localized disease (confined to the breast): 5 year survival rates exceed 95-97% [67,68].
  • Regional disease (spread to nearby lymph nodes): 5 year survival drops to 83-86% [67,68].
  • Distant metastatic disease: 5 year survival falls dramatically to around 25-31% [69].

Comparative Perspective: Male vs Female

Men tend to be diagnosed at an older age and at a later stage, leading to poorer overall outcomes. Studies show that the overall 5 year survival in MBC is consistently lower than in FBC, where women average 86-91%. Mortality rates in men are higher, especially in the first five years post diagnosis, even after adjusting for age, stage, and treatment potentially due to later presentation, undertreatment, and biological differences [70,71,72].

Prognostic Factors

Prognosis in MBC is strongly influenced by:

  • Stage at diagnosis (most critical factor for long term survival)
  • Tumor size and grade
  • Nodal involvement
  • Hormone receptor status: Most MBCs are ER/PR positive, which is associated with better outcomes [73].
  • Comorbidities and age: Older age at diagnosis and significant comorbidity diminish prognosis [74].

Long Term Outcomes

Conditional and real time survival analyses reveal that survival rates for men improve with time after survivorship milestones , patients who reach 5 years post diagnosis have survival probabilities that steadily increase, up to about 93% at later timepoints. However risk can still persist for decades, particularly in hormone receptor positive disease.

Stage5-Year Survival Rate (%)
Localized95-97
Regional83-86
Distant/Metastatic25-31
Overall (all stages)84-85
Table 6. 5-Year Survival Rates in MBC [68,75]

Prevention and Early Detection Strategies for Men

Prevention and early detection of MBC hinge on risk reduction strategies, prompt recognition of warning signs, and the adoption of self-examination practices especially in men with elevated genetic or familial risk. The rarity and low awareness in men often result in later stage diagnosis, making proactive measures especially critical for improving outcomes [76,77,78,79].

Prevention strategies

There is no definitive way to prevent MBC, but several lifestyle modifications lower risk:

  • Maintain a healthy body weight: Obesity increases MBC risk via estrogen excess from aromatization in adipose tissue [77].
  • Limit alcohol intake: Regular alcohol consumption is linked with higher cancer risk; zero or minimal intake is recommended [77].
  • Engage in regular physical activity: at least 150-300 minutes of moderate or 75-150 minutes of vigorous exercise per week supports lower cancer risk [77].
  • Plant based diet: mediterranean diet is clinically proven for reducing breast cancer incidence and recurrence in women, while broad plant-based approaches are more universally endorsed for men due to limited direct evidence but well-established benefits in hormone balance, metabolic regulation, and overall cancer prevention. Future research could clarify whether men would gain equal benefit from a strict Mediterranean pattern, but until then, plant-based dietary recommendations remain the foundation for dietary prevention in MBC [81].
  • Manage chronic disease: control metabolic syndrome, diabetes, and limit exposure to ionizing radiation [80].

Men with a strong family history or genetic predisposition should consider counseling and may benefit from genetic testing for BRCA1/2 or other key mutations. For men with proven high risk mutations (e.g., BRCA carriers), annual mammographic screening may be considered starting from age 50 or earlier, based on the latest guidelines [48].

Early Detection Strategies

Routine screening mammography I not recommended for most average, risk men due to low incidence. However, men with high risk features (BRCA1/2. First degree relative with breast cancer, history of chest irradiation, Klinefelter’s syndrome) are considered for regular imaging and closer clinical monitoring [48].

Clinical breast examination by a healthcare provider should be performed annually for high-risk men, or whenever new symptoms arise. Awareness campaigns and health education initiatives have shown effectiveness in increasing early detection [78].

Importance and Method of Self-Examination

Monthly breast self-examination (MBSE) is increasingly endorsed for all men, particularly those over 60 years or with increased risk. Key steps of MBSE include:

  • Visual inspection in a mirror for symmetry, dimpling, skin changes, or nipple retraction [82,83].
  • Palpation of each breast and armpit using flat fingers in circular motions to detect lumps, thickening, or texture changes [83].
  • Nipple examination for discharge, retraction or puckering [84]
  • Scheduling MBSE once per month to facilitate rapid recognition of abnormal changes [84].
Figure 2. Breast Self-Exam for Men [68]

If any new mass, change in skin/ nipple or discharge is noticed, prompt medical evaluation is advised, as early stage MBC is highly curable and intervention at symptom onset substantially improves survival [84].

Conclusion

MBC is a rare but clinically and public health-significant disease, accounting for less than 1% of all breast cancer cases globally. Its rarity often leads to delayed diagnosis, advanced stage at presentation, and higher mortality compared to FBC. Key risk factors include BRCA2 mutation, family history, advancing age, endocrine and metabolic disturbances (such as obesity, diabetes, and liver disease), and unique syndromes like Klinefelter syndrome. Most MBCs are hormone receptor-positive and present as painless subareolar masses, but men typically lack awareness and regular screening, resulting in more advanced disease at discovery.

Current treatment protocols for MBC largely mirror those for FBC, multimodal strategies including surgery, chemotherapy, radiation, and hormonal therapy, but total mastectomy is more common in men. Survival rates have gradually improved, yet remain lower than those of women, mainly due to later-stage diagnosis and limited awareness. Five-year survival rates vary significantly by stage, from over 95% in localized cases to as low as 25-31% in metastatic disease.

Prevention and early detection are challenging due to low incidence, but focused should be placed on controlling modifiable risks (such as obesity and alcohol intake), raising awareness, facilitating monthly self-examination, and encouraging genetic counseling for those at high risk. Improving education among the public, healthcare providers, and high-risk male population is critical for promoting earlier diagnosis, tailored research, and equitable outcomes.

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