Breast Cancer Awareness Month: Insights on Male Breast Cancer and Mammograms

“It’s not uncommon to have male patients come through our mammography department,” says Karl Nichols, diagnostic imaging director at Penn Highlands Brookville. Dr. Suzanne Iorfido, breast radiologist at Penn Highlands DuBois, agrees: “It certainly occurs.”

Iorfido says male breast cancer is a topic that doesn’t receive the attention it should, especially when it should: at the earliest hint of symptom. “You might read that it’s rare,” she explains, “but when I think of something that's very rare in the medical sense, that suggests we don't encounter it and can't think of multiple cases in past few years.” That “rareness” doesn’t quite apply to male breast cancer, says Nichols. “One in 1,000 men will develop breast cancer,” he explains. “They just aren’t aware of the fact that men can get it, especially if they have family history.” Specific to our area, Iorfido notes, “We’ve had at least two cases in the three years that I’ve been here.”

What is unfortunately rare about male breast cancer is conversation about it. This week Iorfido unpacked a lot of wisdom on this topic, beginning with a key point: “One of the things that's particularly concerning and sad is that the diagnosis tends to be delayed,” Iorfido says, which she believes is the case because “men are hesitant to seek medical care. There’s a tendency to think it’s just a cyst; that men don't have to worry about things like breast cancer—or many people aren't familiar with it, so they might brush it off or delay in asking a physician about it.”

Nichols says he and his staff at PH Brookville recognize two main reasons men put off coming in. “One, they didn’t realize men can have mammograms, and two, they’re often embarrassed because they don’t realize this can be a male thing as well as a female thing.”

Iorfido educates us about the diagnostic process in these cases. “When a man comes with a lump or breast concern, if they are over 25 years old, we always start with a mammogram and then also usually add a sonogram targeted to the area of concern.” She continues, “Mammograms are excellent for looking at the male breast, just as in the female breast. A mammogram gives a great initial full breast picture and can usually easily give the diagnosis. An ultrasound helps take a closer look to make sure everything is being seen completely.” She says both only take a matter of minutes to complete.

Iorfido goes on to say that many misconceptions about male breast cancer exist among the public due to the lack of familiarity. “That can lead to a delay in diagnosis,” she says, which can lead to potential danger because approximately half of the men who are diagnosed with male breast cancer already have metastatic disease, which means the cancer has spread to their lymph nodes and possibly other sites in the body. To better educate our community about male breast cancer, Iorfido offers her expertise:

• Male breast cancer typically occurs in men between the ages of 60 and 70 years. “This is the main decade that men have to worry about,” she says. “The important thing about that timeframe is that it’s also when we encounter gynecomastia,” which Iorfido describes as “a completely benign process where you have breast tissue that’s forming in the male breast.” She says this can happen for a variety of reasons as men get older, such as a side effect of certain heart and prostate medications. “For clinicians, this can make it a confusing picture in men,” Iorfido says, but she distinguishes between the two by stating that “gynecomastia tends to be tender, whereas cancer tends to be non-painful.” Still, only medical imaging and possibly a biopsy can help determine this.
• The most noticeable symptom of male breast cancer is simply a change in the body. “Anything that's different in the breast that the man is appreciating really deserves further attention and evaluation,” Iorfido asserts, while simultaneously acknowledging that it can be easy to overlook our own body parts. “Since men don't get screening mammograms, there's not going to be a time when we're incidentally going to discover cancer,” Iorfido says. That leaves it up to the individual to bring any change in the breast to their doctor’s attention. Iorfido says for women as well as men, often those incidental encounters when a patient stumbles upon something different in the shower, when they put on a t-shirt, or look at themselves in the mirror and notice some asymmetry. “It’s really about encouraging men that when they do notice something like that, have your doctor take a look at it and come to radiology to have a quick set of pictures taken. It's quick, painless, and sometimes I think men get embarrassed, but we actually have a lot of male patients, and most cases end up being that benign entity.”
• Look to history. “As in women, the majority of men do not have family history,” Iorfido says, with this important caveat: if any first degree-relative has had breast cancer, including a male or female sibling or either of a man’s parents—yes, including Mom—that can be a significant factor that can lead to male breast cancer.
• Listen to your partner. Iorfido gives a nod to the statistical trend that we in healthcare know too well: the woman of the household is often the one who nudges the rest of the family to seek medical care. Iorfido recalls a case where a patient’s spouse had noticed something different in the breast and encouraged the patient to see the PCP. Fortunately, they caught the cancer in time to remove it in surgery. “That patient did really well,” she says.
• Practice “patient persistence.” Iorfido credits many primary care physicians for working to increase their own knowledge base about male breast cancer in recent years. Still, when an issue is ongoing, sometimes the patient knows best. Iorfido references a case from earlier in her career when over time, a patient recognized that his lump wasn’t going away. “Ultimately, that brought him into radiology,” she says. “Sometimes doctors want to reassure the patient, but this was a case that speaks to that idea of ‘patient persistence.’”
• Try to put pride aside. Iorfido makes clear that even though actual male breast cancer diagnoses aren’t common, rule-out cases are. She reassures patients: “You're not the only man in the mammography department; we have lots who come through,” she says. “We’re set up so that men are not in the same waiting area as the women,” along with other considerations, she says.

Seeking care for early symptoms is more important than ever. To learn more about our efforts to address breast cancer across our health system or to schedule your own imaging appointment, visit www.phhealthcare.org/pink.