The disease men rarely see coming

Every October, pink ribbons return to shop windows, hospital corridors and social media feeds. With them come the familiar reminders to get screened, recognize the symptoms and encourage the women in our lives to do the same. We think of our mothers, sisters, grandmothers and aunts, often with the quiet fear that breast cancer could one day become part of our own family’s story.

But how often do we think of our fathers or brothers? Breast cancer awareness has become so closely associated with women that an important fact is easily overlooked: men can develop the disease too.

“Breast cancer in males represents 0.5 to 1% of all breast cancers,” Dr. Georges Abi Saad, a breast and general surgeon, told The Beiruter, adding that it also accounts for approximately 0.5% of cancers diagnosed in men.

The percentage may seem insignificant, but it represents thousands of lives. Behind these figures are fathers, husbands, brothers and sons facing a diagnosis they may never have imagined receiving.

In Lebanon, the number of men affected remains unknown. Dr. Abi Saad explained that comprehensive national statistics on male breast cancer were unavailable, although the frequency was likely similar to international patterns.

“Over the years, there is probably worldwide a slight increase in numbers that parallels the rise we see in females,” he said.

Dr. Abi Saad also pointed to research reporting a 26% increase in male breast cancer incidence over a 25-year period, although that historical finding does not establish the current trend in Lebanon.

“Men are generally diagnosed at an older age than women, with the average age at diagnosis approximately five to ten years higher”, he added.

The warning signs men overlook

For Dr. Abi Saad, the greatest challenge was the widespread belief that men could not develop it.

The most important issue is lack of awareness because people think that it is only a disease of women.

Unlike the stigma or embarrassment sometimes associated with male breast cancer, he explained that delayed medical consultations were more often linked to men failing to recognize suspicious symptoms.

 “They tend to think it is a fat lump (lipoma), a cyst, an infection or an abscess,” he explained.

The most common warning sign, according to Dr. Abi Saad, was a painless, firm lump beneath the nipple. He said the nipple was affected in approximately 40 to 50% of cases, with changes potentially including retraction, ulceration or a mass becoming attached to the underlying muscle.

He also noted that the disease appeared slightly more frequently in the left breast than the right and that nearby lymph nodes under the arm could be affected.

Another source of confusion was gynecomastia, a benign enlargement of male breast tissue that can sometimes be associated with hormonal substances used in gyms.

Although gynecomastia is not cancer, Dr. Abi Saad explained that the two conditions could be mistaken for one another, reinforcing the importance of a medical assessment rather than self-diagnosis.

Who is at risk?

While many men diagnosed with breast cancer have no clearly identifiable cause, Dr. Abi Saad outlined several factors associated with an increased risk.

He emphasized the importance of family history and genetic assessment, referring to a 15 to 20% figure in connection with patients who have a first-degree relative affected by breast cancer.

Other risk factors include increased estrogen exposure, particularly through certain hormonal treatments, liver dysfunction, obesity and previous radiation exposure to the chest. Thyroid disease, marijuana use and inflammation of the testicles, known as orchitis, have also been investigated as possible risk factors, although the evidence for these associations is less established. Klinefelter syndrome, a rare genetic condition affecting males, is another recognized risk factor.

Having one or more of these risk factors does not necessarily mean a man will develop breast cancer, but understanding them can help identify those who may be more vulnerable.

Diagnosis and treatment

Despite its rarity, male breast cancer is diagnosed and treated much like breast cancer in women, although some differences influence the medical approach.

“Diagnosis, like in females, should be with ultrasound, mammography and biopsy to document the type and extent of the disease,” Dr. Abi Saad explained.

The most common type is invasive ductal carcinoma, which begins in the breast ducts and spreads into surrounding tissue. Other forms, such as ductal carcinoma in situ and lobular carcinoma, are considerably less common in men.

Treatment largely follows the same approach used for women, often involving surgery, chemotherapy, radiation or hormonal therapy, depending on the stage and characteristics of the cancer.

Surgery typically involves a simple mastectomy, which removes the affected breast tissue, along with an assessment of nearby lymph nodes to determine whether the cancer has spread. Because men generally have less breast tissue, preserving part of the breast can be more difficult, although breast-conserving surgery remains an option in selected cases.

When the cancer is more advanced, chemotherapy may be given before surgery to shrink the tumor and improve the chances of a successful operation.

“If it is advanced and neglected, we do like with females and give chemotherapy before surgery to downstage the tumor and make surgery feasible and less disfiguring,” Dr. Abi Saad said.

Depending on the patient's condition and the extent of the disease, radiation therapy may also be recommended after surgery. Hormonal therapy is another important treatment option, as most male breast cancers are hormone-sensitive, with medications such as tamoxifen commonly used to help prevent the cancer from returning.

Why early detection matters

Unlike women, who are encouraged to undergo regular breast cancer screening according to their age and individual risk, men are not generally advised to undergo routine mammograms.

“Male breast screening at present is not recommended like for females,” Dr. Abi Saad said.

This makes recognizing unusual changes and seeking medical advice particularly important.

Dr. Abi Saad stressed that the chances of successful treatment were significantly greater when the disease was identified early, citing cure rates exceeding 90% in early-detected cases. Outcomes, however, depend on the stage of the cancer and other clinical factors.

His message to men was straightforward.

Males should seek medical attention when they feel a lump in the breast or chest wall and stop assuming that it can never happen to men.

That assumption may be one of the greatest barriers to timely diagnosis.