What’s Good for the Goose, is Good for the Gander: A Case of Male Breast Cancer.
Judith Oriental-Pierre, MD; Henria Fain, MD; Mahin B Bahadorani, MD; Kishankumar Patel, MD; David Sukhai, MD MBA; Eva Gupta, MD; Salvador Villanueva, MD, FACEP
We present a case of a 57-year-old Caucasian male with a medical history of gastritis and COPD with a 30 pack-year smoking history who presented the emergency room with complaints of non-exertional intermittent chest pain for 1.5 years. He had multiple ER visits for this complaint and was diagnosed with costochondritis each visit. A previous cardiac workup was negative. Upon physical exam during this visit a tender asymmetrical left breast mass measuring 4 cm x 4 cm was evident. CT of the chest revealed moderate bilateral gynecomastia. Ultrasound guided biopsy was performed and pathology revealed invasive ductal carcinoma of histological grade 2 of 3.
Breast cancer is usually a diagnosis far more common in females, with the incidence being 1 in 8 in female and 1 in 1,000 in male. Invasive ductal carcinoma is seen more in men with breast cancer (90%) when compared to females with breast cancer (70-80%). It is very important to know that risks factors for male breast cancer seems to be similar risk factors as for female breast cancer such as older age, high estrogen levels, radiation exposure, genetics and family history. Liver disease can cause a reduction in male hormones leading to an increased female hormone therefore increasing men risk factor to develop breast cancer. Testicular disease or surgery such as orchitis or orchiectomy can increase males risk for breast cancer. One unique condition that increases a male risks for breast cancer is Klinefelter syndrome which is an inherited condition. BRCA 1 and BRCA 2 are inherited mutations that increases the risk of breast cancer in men. BRCA 2 appears to increase the risk the of breast cancer in men more than BRCA 1. Males with BRCA 2 mutation have an estimated 6% lifetime absolute risk of breast cancer
A social stigmata exists that males cannot present with diseases of the breast, since it is assumed that men do not have breasts. However, it is important to note that hormonal changes in men leading to alteration in estrogen and androgen ratio can stimulate breast cell growth.
Male breast cancer is such a rare disease that physician do not consider it as a differential diagnosis in patient coming in with chest pain, we strongly urge that male patients presenting with atypical chest pain, should have a physical exam for breast mass as there may have an underlying breast pathology.
