Q. This question came in from a male patient – I have a breast lump, what should I do?
A. You should get a mammogram. More specifically, you should go to a full service regional breast diagnostic center to get an evaluation, which should begin with a mammogram.
Take comfort that male breast cancer is extremely rare, so most breast lumps in a man do not turn out to be cancer – but that does not put you out of the woods. Men do have milk ducts that never develop at puberty, so microscopically, some of these (rarely) can develop a breast cancer – simply just from bad luck.
Personally, in my 17-year breast radiology career, I have diagnosed about 10 or 12 male breast cancers, so it is possible that any one lump in any one man could be cancerous. Therefore, don’t procrastinate, hoping it will go away.
The good thing about a mammogram in a male is that it is extremely accurate in determining if the lump is benign. Most of the time the cause is either weight gain or gynecomastia, neither of which is cancerous.
If the mammogram alone is not able to make a clear-cut determination, your full service regional breast diagnostic center can do an ultrasound guided biopsy (hopefully right there on the spot), for a definitive diagnosis, but this does not need to be done very often. The mammogram is usually thorough enough to make an assessment.
If it is gynecomastia, though, your doctor will need to do some further testing to find out why this is developing. The list of things that can cause male gynecomastia is long, so I won’t get into it here – common things are side effects from various medicines, alcohol, street drugs (steroids, amphetamines), cannabis and health problems such as with the liver, kidneys, thyroid, or adrenal glands, so get it checked out, but first get that mammogram.
Q. Why don’t men in general need mammograms?
A. Although some people have proposed it is a cultural stigma, I don’t think this is true. I think it boils down to cost effectiveness for the population of men out there. The incidence of male breast cancer, and the death rate from it, compared to women, is so low that it would not be cost effective to screen all men for breast cancer, like we do women. The lifetime accumulated incidence of a man living to the age of 90 getting breast cancer is about one in 1,000, compared to a woman, which is about one in eight. And only about 400 men will die of breast cancer each year, so we would do better distributing our resources among other male conditions such as heart disease, strokes, and adult onset diabetes, to name just a few.
Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. You can reach him at Mike@breastdiagnostic.com.
