Diagnosing Male Breast Cancer

NYU Langone doctors have extensive experience diagnosing male breast cancer, a rare condition. They use sophisticated imaging and other tests to determine what type of breast cancer is present.

Risk Factors for Male Breast Cancer

You may be at increased risk of developing male breast cancer if you have a family history of breast cancer or an inherited mutation, or alteration, in BRCA1 and BRCA2, the “breast cancer genes.” Breast cancer gene mutations are rare in men, but male breast cancers can be associated with them.

Normally, BRCA1 and BRCA2 produce proteins that help prevent cancer growth. When either one of these genes mutates, or becomes abnormal, it raises a person’s risk of developing breast cancer.

These gene mutations are rare in the general population. They occur more often in people of Ashkenazi Jewish descent. BRCA1 and BRCA2 testing, which involves a blood test, is available at NYU Langone.

If you have been diagnosed with male breast cancer, your NYU Langone doctor may encourage you to be tested for these gene mutations. If the test is positive, your doctor may recommend that your family members be tested. If other men in your family have BRCA1 or BRCA2 mutations, your doctor can discuss breast cancer screening options with them. NYU Langone also offers a screening and prevention program for women at high risk of developing breast cancer.

Older age also increases breast cancer risk in men. Most men who are diagnosed are 60 to 70 years old.

Symptoms of male breast cancer may include a painless lump in the breast; thickening, scaling, or redness around the nipple; or nipple discharge.

NYU Langone doctors ask about your symptoms and family history and conduct a physical exam of the breasts, checking for masses, or growths, and fluid leaking from the nipple. They also examine the texture of the skin and lymph nodes under the arm to see if they’re enlarged. Lymph nodes are small glands that make and store lymphocytes, white blood cells that help fight infection. Male breast cancer may spread to the lymph nodes first.

After a physical exam, NYU Langone doctors may perform one or more diagnostic tests.

Mammogram

Your NYU Langone doctor may use a mammogram, an X-ray of the breasts, to help diagnose male breast cancer.

During this procedure, your breasts are gently compressed between two plates that are attached to a special X-ray machine. The mammography unit flattens breast tissue, making a mass easier to identify. A technician takes multiple two-dimensional images of the breasts.

At NYU Langone, breast images are digitized and stored on a computer. This enables doctors to enhance and magnify the images while reviewing them.

Ultrasound

In ultrasound imaging, sound waves create images of the breasts. Ultrasound can help determine whether a breast mass found on a mammogram or a physical exam is solid or a cyst, meaning it’s fluid filled.

Core Needle Biopsy

If a suspicious mass is found, your NYU Langone doctor may use a core needle biopsy to determine whether the growth is breast cancer. During this test, the doctor uses a needle to remove a small amount of tissue from the mass. Tissue may also be taken from an enlarged lymph node.

A core needle biopsy can be performed in a doctor’s office using local anesthesia. Your doctor may use imaging techniques, such as ultrasound and mammography, to guide the needle.

Tissue Evaluation

NYU Langone pathologists, specialists who study diseases in a laboratory, examine tumor tissue under a microscope to determine whether breast cancer is present and, if it is, what type it is. They can also evaluate lymph node tissue to determine whether the cancer has spread beyond the breast.

Pathologists test tumor tissue for certain hormonal and genetic features, which can help your doctors decide how best to treat the cancer.

Estrogen and Progesterone Status

Estrogen and progesterone are often thought of as female hormones, but they are also present in men. These hormones can fuel the growth of male breast cancer.

In most men, breast cancer cells have receptors, or proteins, on their surface that attach to estrogen, progesterone, or both. Breast cancers that test positive for these receptors rely on these hormones to grow and are called estrogen-receptor positive or progesterone-receptor positive.

Knowing whether a cancer has estrogen, progesterone, or both receptors—a designation called hormone receptor status—helps the doctor predict whether the cancer might return after treatment. Hormone-receptor negative cancer is more likely to recur, or come back. Your doctor can tailor your treatment to lower this risk.

Hormone therapy can help prevent cancer from returning in people who have cancer that is estrogen-receptor positive, progesterone-receptor positive, or both. Older men often have hormone-receptor positive breast cancer, for reasons that are not completely understood. It may be related to the aging process.

HER2 Status

Pathologists at NYU Langone also determine whether a mass is positive for HER2, a protein that encourages breast cancer cells to grow. Sometimes breast cancer cells produce high levels of HER2 due to gene amplification, meaning there has been an increase in the number of copies of the HER2 gene. These proteins can be detected on the surface of breast cancer cells.

HER2-positive breast cancer is not common in older men. However, men whose cancers test positive for high levels of HER2 may be candidates for targeted therapies, which are medications that target this protein.

Triple Negative Status

If NYU Langone pathologists find that the tumor tissue contains no estrogen receptors, progesterone receptors, or HER2, the cancer is referred to as “triple negative.” Although rare, triple negative cancers are more common in men with BRCA gene mutations than in those without these mutations.

Triple negative breast cancer tends to be more aggressive than estrogen-receptor positive, progesterone-receptor positive, and HER2-positive cancers, and does not respond to therapies designed to treat those cancers. However, chemotherapy may be a treatment option.

Ki-67 Status

Ki-67 is a marker—a substance found in tumor tissue—that is associated with the growth rate of cancer cells.

A high Ki-67 level tells pathologists that breast cancer cells are rapidly growing and dividing, meaning the cancer is aggressive. Some estrogen-receptor positive cancers with high Ki-67 levels may not respond well to targeted therapies but can be managed with chemotherapy.