When you think of breast cancer, you likely think of it as a disease that primarily affects women.
However, men are not immune to breast cancer, even though it is exceedingly rare.
“It may come as a surprise that men can develop breast cancer,” said Dr Lizanne Langehoven, a breast cancer treatment specialist.
“About 1% of all breast cancer cases are diagnosed in men. Unfortunately, men often present with more advanced disease, because they are not aware that they can develop breast cancer in the first place.”
As we approach Breast Cancer Awareness Month— celebrated every October — it's crucial to shine a light on the men who are part of this 1%.
While breast cancer in men and women has many similarities, there are some key differences when it comes to awareness, diagnosis, and treatment.
Awareness gap
One of the biggest challenges for men diagnosed with breast cancer is the lack of awareness.
While women are often taught from a young age to check their breasts for lumps or other changes, men are not usually given the same guidance. As a result, many men don’t know they’re at risk until it's too late.
Men also tend to be diagnosed at a later stage than women, which complicates treatment and can lower survival rates.
"Men often come to us with more advanced disease because they don't expect to get breast cancer, and they don't recognise the symptoms early enough," Langehoven explained.
Diagnosis: How it’s different for men
Dr Salomine Theron, a radiologist at SCP Radiology, emphasised the important role radiology plays in diagnosing breast cancer in both men and women. However, the approach to screening is quite different between the sexes.
“In women over 40, we recommend an annual mammography,” Theron said. “In other words, we screen for cancers that are asymptomatic, meaning that even if there are no visible changes or lumps, we still check for anything that might develop into breast cancer.”
For men, however, routine screening is not standard practice. "In men, radiology is diagnostic rather than screening-based.
The referral usually happens because of a lump in the breast, under the arm, or other symptoms like nipple pain or puckering," she explained.
Unlike the multiple mammogram images typically taken for women, men usually receive a single mammogram image of each breast to allow for comparison. This is often supplemented by a breast ultrasound and evaluation of the lymph nodes under the armpit.
Incidental diagnoses
Interestingly, some men are diagnosed with breast cancer incidentally. “The imaging of a lump may also be accidental,” said Theron.
“For example, when we do any form of CT imaging on the chest in a male, even when creating images of the lungs, we always look at the soft tissue in the breast area.
“If we see an asymmetric nodule with an irregular shape — almost like a star — we alert the patient’s healthcare provider, even though that wasn’t the reason for the CT scan.”
Gynecomastia v Breast cancer
Many men may experience tenderness or lumps in their breasts during puberty — usually behind the nipples. This condition, known as gynecomastia, is common and generally harmless.
“About 50% of males develop small lumps in each of their breasts during puberty, usually behind the nipples, which can be tender. This is called gynecomastia — colloquially a ‘stony’ — and it’s perfectly normal. It usually goes away as they finish puberty,” Langehoven mentioned.
On the other hand, breast cancer presents very differently. "Breast cancer usually presents as a firm nodule in one breast that is not tender," according to Theron.
While rare, some men may also develop a more aggressive form known as inflammatory breast cancer, which causes redness, swelling, and tenderness in the breast.
“This type of breast cancer is rare but can be very aggressive, as cancer cells block lymph vessels in the skin,” she added.
How breast cancer in men is treated
Men diagnosed with breast cancer receive the same treatments as women, tailored to the specific type and stage of the cancer.
Treatment options include chemotherapy, hormone withdrawal therapy, targeted therapies, immunotherapy, surgery, and radiotherapy.
“Men with breast cancer are treated exactly as their female counterparts,” said Theron.
Once diagnosed, men and women generally undergo similar treatment options, which can include surgery, chemotherapy, radiation, and hormone therapy. However, because men are often diagnosed at a later stage, their treatment may be more intensive from the outset.
Radiology plays a crucial role in breast cancer care, not just in diagnosis but throughout the treatment process.
"Radiology is integral to breast cancer management beyond diagnosis, providing critical information that guides clinical decisions at every stage of care," explained Theron.
"This includes staging the disease, precise treatment planning, guiding surgical procedures, monitoring treatment responses, and detecting any early signs of cancer recurrence. Each of these steps is vital for improving patient outcomes."
While male breast cancer is rare — affecting approximately one in every 100 diagnosed cases — early detection remains crucial.
"Even though only one in a hundred diagnosed cases of breast cancer in men, we still urge men, and of course, women, to check themselves regularly and to see a doctor if they feel or see any changes in their breasts," Theron advised.
Men need to be aware of the risks and take action if they notice any unusual changes. Early detection can make all the difference, regardless of gender.