When baby boys and baby girls are born, they have similar breast tissue and breast size. As boys develop especially during puberty, their breast growth ceases to be as complex as that of girls. High testosterone and low estrogen levels stop the development in boys. Their breasts have similar features: milk ducts and lobules as the girls’ breasts, but boys’ breasts remain under developed but both have breast tissue. This is why, breast problems, including breast cancer can occur in men.

Breast cancer in men is rare, but it does happen. It is estimated that 1% of all cancer cases occur in men compared to 83% of all cancer cases in women worldwide.

Survival rates for men are the same as for women with the same stage of cancer at the time of diagnosis. In Rwanda, East Africa and the entire continent, due to lack of access to life-saving information, sustainable cancer services, specialized care and/or fear and stigma many patients present their breast cancer at late stages when the disease is advanced and therefore difficult or impossible to treat. Men may be less likely than women to acknowledge, later on report symptoms which may lead to delays in diagnosis.

Warning signs of breast cancer in men: The most common sign of male breast cancer is a painless lump or thickening in the breast or chest area. Any change in the breast or nipple can be a warning sign for breast cancer including:

• Lump, hard knot in the breast, chest or underarm area; this may be painless, but may be tender.

• Change in the size or shape of the breast

• Dimpling, puckering or redness of the breast skin

• Itchy, scaly sore or rash on the nipple

• Pulling in the nipple (inverted nipple) or other parts of the breast

• Nipple discharge — this is rare

These symptoms may also be signs of a benign (non cancerous) breast condition. Men tend to have much less breast tissue compared to women; some of these signs can be easier to notice in men than in women. The key is being familiar with your body so that when there is any change, you are to notice it.

Early Detection is the Best Protection.

Don’t delay seeing your doctor. Some men are embarrassed about the change in their breast or chest area and they procrastinate seeing their doctor. This may result in a delay in diagnosis — Survival is highest when breast cancer is found early. If you notice any of the aforementioned signs or other changes in your breast, chest or nipple go to your doctor right away. If you do not have a doctor, call BCIEA’s office on 250788557865 for help with a referral or go to the nearest clinic or hospital.

Types of Male Breast Cancer.

For men (as well as women), most breast cancers begin in the milk ducts of the breast (these cancers are known as invasive ductal carcinomas). Less than 2% of breast cancer in men begins in the lobules (tiny parts of the breast that make milk) and this cancer is called invasive lobular carcinoma.

In rare cases, men can be diagnosed with ductal carcinoma in situ (a non invasive breast cancer), inflammatory breast cancer or Paget disease of the breast (Paget of disease of the nipple). Paget disease of the breast begins in the duct of the breast tissue, but spreads to the skin of the nipple. It can cause a scaly rash on the skin of the nipple. Although Paget disease of the breast is rare, it occurs more often in men than in women.

Benign breast conditions in men are non cancer lumps that occur in both women and men. Most common benign breast conditions in women such as cysts, and fibroadenomas are very rare in men. Gynecomastia (enlargement of the breast tissue) is the most common benign condition in men. It results from a hormone imbalance in the body caused by certain diseases, hormone use, obesity and other hormone changes that can cause this imbalance.

Sometimes, boys can get temporary form of gynecomastia during puberty. If gynecomastia causes pain, it can be treated with hormone therapy or surgery. Evidence suggests that gynecomastia increases the risk of breast cancer in men.

Risk factors for male breast cancer

Although some factors have been found to increase the risk of breast cancer in men, most men who are diagnosed have no known risk factors.

-Age is the most common risk factor for breast cancer in men and women. Men tend to be diagnosed at a slightly older age 68 than women 61.

-  BRAC2 Gene mutations: men and women with an inherited BRAC2 (Breast Cancer 2) gene mutation have an increased risk of breast cancer. Men can inherit a BRAC2 mutation from either parent. A man who has a BRAC2 mutation can pass the mutation to both his sons and daughters. Breast cancer in men is more likely than breast cancer in women to be related to an inherited gene mutation.

Evidence suggests that up to 40% of breast cancer in men may be related to BRAC2 mutations, while 5 to 10% of breast cancers in women are considered to be due to a gene mutation. This is why it is recommended that men diagnosed with breast cancer have genetic testing for possible BRACA2 mutations. Men who have a BRACA2 mutation have about 7% chance of developing breast cancer by age 70 in comparison, women with a BRAC2 mutation have a 40 t0 60% chance of developing breast cancer by age 70. Men with a BRAC2 mutation are also at an increased risk of other types cancer, such as prostate cancer. Other genes like BCRA1are under study for a possible link to breast cancer in men.

- Family history of breast cancer, whether or not carrying a BCRA2 mutation, having a family member with breast cancer increases chances of developing breast cancer.

- Gynecomastia (enlargement of breast tissue, a benign non cancer condition); evidence suggests that increases the risk of breast cancer in men.

- Klinefelter’s syndrome, a rare condition that occurs when men are born with 2 X

chromosomes instead of one (XXY instead of XY). This is related to high levels of estrogen in the body. It also increases the chance of developing gynecomastia. Men with Klinefelter’s syndrome have a higher risk of breast cancer compared to men without this condition.

- Overweight and obesity increase the risk of breast cancer in men and women. Being overweight can increase estrogen levels in the body and in turn high estrogen levels increase breast cancer risk.

- Other risk factors are under study for their possible link to breast cancer:

These include hormone drugs used to treat prostate cancer, Diabetes, Exposure to large amount of radiation at early age for treatment, some conditions that affect

testicles such as orchitis (swelling of one or both testicles) or undescended testicles).

Breast cancer knows no boundaries, it does not discriminate; women and men must work together to fight it.

Philippa Kibugu-Decuir Founder, Director Breast Cancer Initiative East Africa Inc.

info@breastcancerafrica.org