Jahnavi Sarma
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After skin cancer, breast cancer is the most common cancer in women. It is also the second leading cause of cancer in women, says the American Cancer Society. But, doctors also diagnose thousands of men every year with this disease. And the prognosis for male breast cancer is similar to that in women.
In fact, the American Cancer Society says that men have a 96 per cent chance of surviving 5 years or more after diagnosis when cancer affects only the breast tissue at diagnosis. It comes down to 83 per cent when it affects nearby areas as well as the breast and 23 per cent when it has spread to other parts of the body. With this document, the FDA finally acknowledges the often-ignored patients with breast cancer, men. Breast cancer diagnosis is made in almost 2,000 men in the US alone every year.
In light of this, the FDA has made a new draft guidance saying that sponsors of clinical trials in breast cancer should include more male patients. According to them, a trial protocol should include a scientific rationale when proposing to exclude men from breast cancer trials. The expected low accrual of male patients is not 'a sufficient scientific rationale for excluding them from a clinical trial,' says the guidance document.
According to the director of the FDA's Oncology Center of Excellence, Richard Pazdur, "Once finalised, the recommendations in the draft guidance will provide clarity regarding how additional data to support efficacy and safety for male patients with breast cancer can be generated through a variety of trial designs using different data sources, including studies using real-world data. He went on to say that hopefully the recommendations will encourage drug development for the treatment of male breast cancer and ultimately, provide additional FDA-approved treatment options for patients.
Some FDA-approved treatments for breast cancer are gender-neutral. But many of these therapies are only for women. Most of the time, when a man receives a breast cancer diagnoses, he is often given drugs that were initially tested in women alone. Further data may be necessary to support labelling indications for men.
Male breast cancer is, no doubt, rare. Less than 1 per cent of all newly diagnosed breast cancers occur in men. It tends to affect older men and the disease is usually in an advanced stage when diagnosis is made. Hence, data on male breast cancer is significantly low. Men have also been almost entirely excluded from clinical trials of breast cancer drugs and this has resulted in limited FDA-approved treatment options for males with breast cancer.
The American Cancer Society says that a man's lifetime risk of developing breast cancer is about 1 in 833. The prognosis is good if diagnosis is early. But, unfortunately, due to lack of awareness, male breast cancer is detected quite late. In 40 per cent of men, detection usually happens in third or fourth stages, when a cure may be next to impossible. Hence, survival rates of men are lower than women.
There are three types of breast cancer that a man may suffer from. He may get either ductal carcinoma, a cancer that begins in the milk ducts, or lobular carcinoma, cancer that begins in the milk-producing glands. Most male breast cancer is ductal carcinoma. Lobular carcinoma is rare in men because they have few lobules in their breast tissue. Or, he may be diagnosed with other rarer types of breast cancer. These are Paget's disease of the nipple and inflammatory breast cancer.
Symptoms of male breast cancer may be a painless lump in one breast, nipple retraction, ulceration and discharge, puckering or dimpling of skin on the breast and also redness or scaling of skin on the breast or nipple. If the cancer spreads, you may exhibit a swelling in the lymph glands in or near the underarm area. You may also experience pain in breasts and bone.
Because men have less breast tissue than women, it is generally easier to detect small lumps. This can lead to early detection. But less breast tissue also means that the cancer can spread faster to nearby tissues. Moreover, because most men have no clue that they can get breast cancer, they don't look out for symptoms of this disease as women do.
If you notice any changes in your breast, contact your doctor immediately. He may recommend a mammogram, ultrasound, nipple discharge test or a biopsy to confirm the disease.
Because of lack of data and research, most men get the same or similar treatment that a doctor may administer to a woman. If your doctor confirms the presence of cancer, he may recommend a mastectomy, where he will surgically remove the whole breast and some of the surrounding tissues as well. Or he may go for a breast-conserving surgery, where he will remove only part of the breast. Another option may be lymphectomy, where your doctor will remove the affected lymph nodes.
If the disease has already progressed to a later stage, radiation therapy and chemotherapy may be recommended. Some patients may also need either of these therapies after surgery to remove any remaining traces of cancer. But these have side-effects. Hair loss, mouth sores, nausea, changes in appetite, an increased risk of infection and fatigue are common side-effects.
In the initial stage, hormone therapy can help by blocking the effects of oestrogen. This will slow the growth of cancer. But this therapy can have adverse effects like hot flashes, sexual problems, fatigue, mood swings and an increased risk of blood clots. It can also make bones fragile and cause pain in the muscles and joints.
Early detection is essential. It can increase your chances of surviving this disease. For this, be alert to any changes in your breast area. Your risk factor will go up if you have a family history of this disease. Liver cirrhosis also increases your risk. Exposing your chest to radiation, taking oestrogen supplements and testicular injury may lead to this disease. Enlargement of breasts due to drug or hormone treatments may also cause male breast cancer.
Have a frank discussion with your doctor and get yourself checked. Don't think that just because this disease is usually associated with women, you are immune to it.
A healthy, nutritious diet and regular exercise may help prevent male breast cancer. Stay away from alcohol and addictive substances and maintain a healthy weight.