Dear Dr G,

I understand the month of October is generally dedicated to breast cancer awareness and as such I am curious as to whether or not the public is aware that breast cancer can also affect men.

I am 47 years old and generally healthy; however I noticed a lump in my breast about six months ago.

I was not really bothered at first, but when the lump started hurting, I started googling and was horrified to find out men can also get breast cancer.

I saw the doctors, who immediately started investigations. Ultimately I underwent some uncomfortable tests and a biopsy, and I am fortunate the result excluded breast cancer.

I am now aware of all the uncomfortable tests women must endure for breast cancer screening and hope that my scare can be a platform for me to put Dr G on the spot focusing on male breast cancer.

Can you tell me how common breast cancer is in men?

What are the risk factors?

Is it true men tend to present late and have more late-stage cancers?

Thank you and Happy Pink October to you and your readers.

Yours truly,

Pinky Pete

The month of October is widely regarded as Breast Cancer Awareness month and the pink ribbon has been traditionally used as the symbol of pink October.

The movement started with Charlotte Haley, whose sister, daughter and granddaughter were all diagnosed with breast cancer. Haley initially decided to distribute peach-coloured ribbons to raise funds for breast cancer research.

From this, the Susan Komen Foundation started handing out pink ribbons to participants in the New York City charity race for breast cancer survivors in 1991.

The practice has since become a movement and annual international health campaign gathering many breast cancer charities to raise awareness and funding for research into diagnosis, treatment and cures.

Male breast cancer is rare and estimated to be about 1% of all breast cancers. It is recorded to affect 2,140 men in the United States and result in 450 deaths annually.

The incidence of breast cancer is increasing over many decades, typically affecting men in their 60s and 70s. Worldwide statistics record 20,000 deaths from male breast cancer annually.

Because it has a far lower incidence, large-scale breast cancer studies have routinely excluded men. Our current knowledge of male breast cancer is far less than that of female breast cancer and often rests on small, retrospective, single-centre studies.

The most well-known risk factor for male breast cancer is a genetic mutation of the BRCA gene. Other causes may include alcohol abuse, ionising radiation and exposure to female hormones. High oestrogen exposure can occur in medications, obesity and liver diseases.

Another genetic condition such as Klinefelter Syndrome could be a contributing factor. This is when a man has inherited an extra X chromosome, resulting in breast enlargement and testicular failure.

The sufferers have a 20- to 50-fold increased risk of developing male breast cancer. It is thought that this is primarily due to their high oestrogen levels relative to androgen levels, resulting in the cancerous changes.

The survival rate of male breast cancer was thought to be generally higher than among women.

Lack of awareness was also thought to be resulting in late presentation of the disease, with higher risks of metastasis, as the distance for cancer to infiltrate skin and muscles is shorter among men.

However, a large study by the National Institute of Health reported the percentage of cases presenting with purely local disease was 63.1% in males and 45.4% in females; with spread to local lymph nodes, 29.1% in males and 43.6% in females; and with distant metastases, 5.7% in males and 8.1% in females.

Although male breast cancer is rare and generally overlooked, an advocacy group started the Brandon Greening Foundation for breast cancer in men in 2009.

The charity advocates both men and women to wear pink together, celebrating lives of survivors and remembering the departed. In addition, the campaign also provides support for the millions of lives affected by breast cancer and more importantly, pushes for cutting-edge research in search of a cure.

In this month of Pink October, Dr G hopes to be put on the spot bringing solidarity and pink attitude to create awareness and fight breast cancer, both in women and men.

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