(May 6, 2009 - Insidermedicine) In this video, Dr. William Goodson MD, discusses what he would do if he was a male with a family history of breast cancer. Dr. Goodson is a Senior Clinical Research Scientist at the California Pacific Medical Center Research Institute.
At the 2008 San Antonio Breast Cancer Symposium, we spoke with Dr. William Goodson, Senior Clinical Research Scientist at the California Pacific Medical Center Research Institute.
If I am male with a family history of breast cancer...
Dr. Goodson: If a man has a risk of breast cancer its pretty much like a woman with a risk of breast cancer. You have the association that comes with one, or perhaps even two relatives with breast cancer versus the association that comes with multiple family members with breast cancer. You have to look at it those two ways.
If you have a strong family history of breast cancer, the first thing to recognize is that men can inherit the breast cancer gene. Men can pass the breast cancer gene on to his daughter or to his son. He can pass it through his son to his granddaughter. Men are not exempt from carrying the breast cancer gene. If a man carries the breast cancer gene the important thing to realize is that in men the breast cancer gene is not that likely to cause breast cancer because men, in total, get about 1 / 100th the breast cancer of women. A man with the breast cancer gene has a lifetime risk somewhere between 6% and 8%. What does go up is his risk of pancreatic cancer, his risk of colon cancer. And also his risk of prostate cancer probably goes up. The risk of men getting other solid tumors goes up with the BRCA mutation. The biggest risk for a man who has a family history of breast cancer is that he is probably at increased risk of other cancers that are not directly breast related.
Now having said, that the biggest risk in male breast cancer is that we do not do screening mammography on men. I don't think I would do screening mammograms on a man with a family history either. But I think that it is important that if a man notices a change in the breast area, particularly if he notices a nodule, he should seek help. Now the important thing is that a lot of men, particularly as they hit the middle of life, will develop breast changes. They'll develop little bits of breast tissue called gynecomastia. It is like little tiny teenage sized breast, which actually a lot of men also experience when they were adolescent.
What causes gynecomastia?
Dr. Goodson: Gynecomastia is actually associated most of the time with some decrease in the level of testosterone or some increase in the level of estrogen. The place where the person can actually do something about that is to realize that a man who gets big and gains weight, starts cranking out more estrogen. Because fatty tissue makes estrogen. If you go to the beach and see a man who weighs 250 pounds and it looks like he has breast tissue, its because he does. His fat tissue is making estrogen and the ability of those cells on the chest wall to grow and to make a breast is the same in a man as it is in a woman. So its very important when somebody takes the message out of this video; a man who has a family history has really got to worry about things like keeping his weight down, exercising and limiting his alcohol. Its basically a variation of what women go through because exercise, weight reduction, and limiting alcohol will have an effect not only on breast cancer but really on most cancers that are out there.
What if I had BRCA positive status?
Dr. Goodson: If a man were a descendant of someone with the BRCA mutation, then getting tested would be a reasonable thing. If he is BRCA positive then I think that the biggest thing that he should be aware of is probably not so much breast cancer as the increased risk of prostate and pancreatic cancer, and somewhat colon cancer. The same issues in lifestyle really pertain. He wants to maintain a reasonable weight. He wants to limit his alcohol and he wants to get exercise. Those things, they change the metabolism of the body and that seems to have an effect on reducing the risk of malignancy.
How does treatment of male breast cancer differ from female breast cancer?
Dr. Goodson: The general feeling is that male breast cancer is just about the same as female breast cancer. It tends to be more likely to be hormone receptor positive. You treat it about the same way. The biggest difference is that by and large people don't try to do breast conservation in male breast cancer because the presence of the breast is not that important and because in order to get an adequate margin around it. Most of these cancers are pretty close to the nipple so that you end up taking the nipple in most situations. Once you have done that, to leave breast tissue and radiate it after you have removed the nipple, doesn't seem to make sense. There is a much higher proportion of male breast cancer, at least that I would choose, to treat with a mastectomy. But you do sentinel node, you do node dissection, if the node is positive you do hormone treatment. If it is hormone receptor positive you do chemotherapy if you have positive nodes. Those are pretty much the same way you would treat a woman.
The other thing is that male breast cancer tends to be ignored a bit. Tends to be noticed when it is a little bit more advanced. People tend to come in and say "well I have been thinking about this for six or eight months and looking at this bump...” so the important thing is that men should be aware that if something changes they should have somebody look at it too. And yet if you look at it, a big tumor in a man and a big tumor in a woman have about the same prognosis. A small tumor in a man and a small tumor in a woman have about the same prognosis. If you match tumors up by size, there is not much difference between men and women.