Dr Ly­ronne Olivi­er

Con­sul­tant Breast Sur­geon

Med­ical As­so­ciates

Aware­ness of ‘Male Breast Can­cer’ (MBC), is the pil­lar and the down­fall of this rare di­ag­no­sis. It im­pacts the dis­cov­ery and the nec­es­sary clin­i­cal man­age­ment of this sub­set of breast can­cer pa­tients. Sev­er­al stunned ex­pres­sions are al­ways ob­served on the faces of the au­di­ence when the men­tion of men with breast can­cer aris­es. Knowl­edge of MBC is lack­ing with­in the gen­er­al pop­u­la­tion. This ar­ti­cle at­tempts to bridge the gap of un­aware­ness amongst men and women, as well as high­light many key fea­tures of Male breast can­cer.

While the di­ag­no­sis of breast can­cer is syn­ony­mous with women and is the lead­ing cause for fe­male can­cer re­lat­ed deaths, Male Breast Can­cer is rare and ac­counts for few­er than 1 per­cent of all breast can­cers. The av­er­age man’s risk for breast can­cer in his life­time is ap­prox­i­mate­ly one in 1000 ver­sus one in eight for women. The di­ag­no­sis of MBC is gen­er­al­ly as­so­ci­at­ed with a poor­er prog­no­sis and over­all sur­vival when com­pared to Fe­male Breast Can­cer (FBC).

There are many myths and ob­scured nar­ra­tives around Male Breast Can­cer, so let’s tack­le one by one.

1. “Men don’t have breast!”

The male anato­my in­ter­est­ing­ly has breast tis­sue but it is sig­nif­i­cant­ly re­duced in com­par­i­son to fe­males. There­fore, men al­so pos­sess the po­ten­tial for ab­nor­mal pro­lif­er­a­tion of breast cells and sub­se­quent­ly MBC. The male breast tis­sue is most­ly con­cen­trat­ed be­hind the nip­ple lead­ing to an in­creased preva­lence of cen­tral­ly lo­cat­ed tu­mors. An in­creased propen­si­ty for skin in­volve­ment is al­so rec­og­nized be­cause of the sparse amount of breast tis­sue in men. This di­rect­ly re­sults in a poor­er prog­no­sis when one com­pares MBC to FBC.

2. “Isn’t that a Women’s dis­ease?”

The lack of pub­lic aware­ness and the rar­i­ty of this dis­ease has di­rect con­se­quences on the pa­tient’s out­comes. The ear­ly pres­ence of a breast lump maybe dis­re­gard­ed as an in­ci­dent and ‘tem­po­rary ‘ find­ing. An in­sight of MBC may lend to ur­gent eval­u­a­tion by a breast sur­geon.

Re­searchers have demon­strat­ed that low aware­ness amongst men is com­mon and the main cause for a de­lay in di­ag­no­sis.

The pre­sen­ta­tion of MBC is quite sim­i­lar to that of FBC with signs and symp­toms such as skin teth­er­ing, dim­pling, a firm breast lump, breast red­ness, nip­ple turn­ing in­ward and re­trac­tion, nip­ple dis­charge and a lump with­in the armpit.

MBC di­ag­no­sis is al­so as­so­ci­at­ed with the stigma­ti­za­tion that may af­fect one’s ‘Mas­culin­i­ty ‘. Be­ing di­ag­nosed with a dis­ease known to fe­males maybe per­ceived as re­duced mas­culin­i­ty and the pres­ence of fem­i­nin­i­ty. The psy­choso­cial im­pact of this per­cep­tion can al­so have neg­a­tive con­se­quences on health seek­ing and clin­i­cal ap­praisal.

3. “Can male breast can­cer even be di­ag­nosed in T&T?”

Yes, we have di­ag­nosed MBC here in T&T and one of our pa­tients will­ing­ly shared his sto­ry. It’s im­por­tant to note, the di­ag­no­sis of MBC is de­ter­mined by the same prin­ci­ples of FBC: ‘Triple as­sess­ment’. This in­cludes a thor­ough clin­i­cal his­to­ry and ex­am­i­na­tion, ra­di­o­log­i­cal in­ves­ti­ga­tions and a biop­sy of breast tis­sue. Sim­i­lar ra­di­o­log­i­cal in­ves­ti­ga­tions such as breast ul­tra­sonog­ra­phy and mam­mog­ra­phy would be re­quest­ed as in FBC.

Can we treat men with breast can­cer?

YES!

The men un­der­go sim­i­lar treat­ment and man­age­ment pro­to­cols as per fe­male coun­ter­parts. Mas­tec­to­my is the most com­mon op­er­a­tion per­formed sur­gi­cal­ly. This pro­ce­dure en­tails re­moval of the over­ly­ing breast skin, tis­sue and nip­ple with preser­va­tion of the un­der­ly­ing chest mus­cu­la­ture. In gen­er­al the body im­age im­pact is less when com­pared to women un­der­go­ing the sim­i­lar pro­ce­dure.

The treat­ment fol­low­ing sur­gi­cal man­age­ment is trans­posed from fe­male pa­tients since there is a pauci­ty of re­search for MBC.

In­creased aware­ness of male breast can­cer by our fa­thers, broth­ers and male rel­a­tives is the pil­lar for MBC man­age­ment. To im­prove the clin­i­cal care, it is im­per­a­tive to in­crease aware­ness and an adap­ta­tion of sup­port ser­vices, pa­tient ed­u­ca­tion­al out­reach and treat­ment strate­gies to meet the de­mands of Men.

Dr LY­RONNE OLIVI­ER

Breast Sur­gi­cal On­col­o­gist

Con­sul­tant On­coplas­tic and Re­con­struc­tive Breast Sur­geon

As­so­ciate Lec­tur­er UWI

Dr Olivi­er’s ca­reer and per­son­al goals have been aligned with im­prov­ing Breast dis­ease and Breast can­cer care in Trinidad and To­ba­go. From 2007, he has been in the field of surgery; and com­plet­ed the Doc­tor of Med­i­cine in Surgery to be­come Con­sul­tant Sur­geon in 2016. Dr Olivi­er was award­ed the Prakash Schol­ar­ship by the Uni­ver­si­ty of Toron­to, Cana­da in 2020 to pur­sue his Fel­low­ship in Breast / Breast Sur­gi­cal On­col­o­gy. He is a fel­low of the Caribbean Fel­low­ship of Sur­geons, Amer­i­can Col­lege of Sur­geons, as well as a mem­ber of the Amer­i­can So­ci­ety of Breast Sur­geons.

He cur­rent­ly works as Con­sul­tant Breast Sur­geon/Gen­er­al Sur­geon in the pub­lic and pri­vate sec­tor as well as As­so­ciate Lec­tur­er in the De­part­ment of Clin­i­cal Sur­gi­cal Sci­ences, UWI. Train­ing of Gen­er­al Surgery res­i­dents in Breast Sur­gi­cal On­col­o­gy is an­oth­er pas­sion of Dr Olivi­er.