What are the symptoms of male breast cancer?

Male Breast Cancer Symptoms

The most concerning symptoms of male breast cancer include a painless palpable lump (typically subareolar or eccentric to the nipple), nipple discharge, nipple retraction, skin changes (redness, flakiness, or ulceration), and axillary lymphadenopathy. 1, 2

Key Symptoms to Watch For

Male breast cancer is rare, accounting for less than 1% of all breast cancer cases, but its incidence has been increasing at a rate of approximately 1.1% annually 2. The following symptoms should raise suspicion for male breast cancer:

• Palpable mass or lump:

  • Usually hard and fixed
  • Typically located beneath the areola or eccentric to the nipple
  • Often painless
  • May be peripheral to the nipple in some cases 3

• Nipple discharge:

  • Particularly concerning when spontaneous and unilateral
  • Present in up to 23-57% of male breast cancer cases 1
  • May be the only presenting symptom in some cases 4

• Skin changes:

  • Redness or flaky skin
  • Irritation
  • Thickening
  • Ulceration (in advanced cases) 2, 3

• Nipple abnormalities:

  • Retraction
  • Inversion
  • Fixation to deeper tissues 3

• Lymphadenopathy:

  • Particularly axillary lymph node enlargement 3

Distinguishing from Benign Conditions

It's important to differentiate male breast cancer from gynecomastia, which is the most common male breast condition:

• Gynecomastia presents as:
  • A disc-like area of breast tissue under the nipple
  • Bilateral in approximately 50% of cases
  • Often tender, particularly when present for less than 6 months
  • Typically soft, rubbery, or firm and mobile 5

In contrast, male breast cancer typically presents as:

• A unilateral, hard, fixed mass
• Often eccentric to the nipple or in a peripheral position
• May be associated with secondary signs like skin changes and nipple abnormalities 3

Risk Factors

Understanding risk factors can help identify men at higher risk:

• Increasing age (median age 63)
• Family genetic history
• Specific gene mutations (particularly BRCA1 and BRCA2)
• Hormonal imbalances
• High levels of estrogen or androgen receptors 5, 2, 6

When to Seek Medical Attention

Diagnostic evaluation is warranted when a palpable mass has any of these characteristics:

• Unilateral
• Hard
• Fixed
• Peripheral to the nipple
• Associated with nipple discharge, skin changes, or lymphadenopathy 3

Diagnostic Approach

For men presenting with suspicious breast symptoms, the American College of Radiology recommends mammography as the initial imaging study, with ultrasound added to assist in diagnosis and guidance for biopsy 1. This approach differs from that for women under 40, where ultrasound may be the initial imaging modality.

Clinical Significance

Due to the paucity of breast parenchyma in men compared to women, male breast cancer can rapidly progress to advanced stages 3. This underscores the importance of early recognition of symptoms and prompt medical evaluation. The mortality rate has decreased from 11% to 3.8% over the past decade, highlighting the importance of early detection 2.