Male Breast Cancer Symptoms
The most common symptoms of male breast cancer include a painless palpable retroareolar lump, nipple discharge, nipple retraction, skin changes (including ulceration or thickening), and axillary lymphadenopathy. 1, 2
Primary Symptoms
Male breast cancer accounts for less than 1% of all breast cancer cases but requires prompt evaluation due to its rapid progression to advanced stages. Key symptoms include:
- Palpable mass: Most commonly presents as a hard, fixed, unilateral lump that is typically subareolar or eccentric to the nipple 3, 2
- Nipple discharge: Though rare in men, nipple discharge is highly suspicious for underlying malignancy 4
- Skin changes: Due to smaller breast size in men, secondary signs appear earlier 5:
- Nipple retraction
- Skin ulceration or thickening
- Increased breast trabeculation
- Skin changes around the areola
Secondary Signs and Advanced Disease
As male breast cancer progresses, additional symptoms may develop:
- Axillary lymphadenopathy: Enlarged lymph nodes in the armpit area 1, 5
- Fixation to deeper tissues: The mass becomes attached to underlying structures 3
- Cutaneous manifestations: Skin involvement may appear as 6:
- Vegetative lesions
- Infiltrating changes with nipple retraction
- Nodules with skin changes
Distinguishing from Benign Conditions
It's important to differentiate male breast cancer from benign conditions:
- Gynecomastia: The most common male breast mass, typically presents as bilateral, soft, rubbery tissue directly beneath the nipple 7, 3
- Other benign conditions: Lipomas, epidermal inclusion cysts, pseudoangiomatous stromal hyperplasia, and intraductal papillomas may mimic breast cancer 5
When to Suspect Malignancy
Diagnostic evaluation is warranted when a breast mass presents with any of these concerning features:
- Unilateral, hard, fixed mass
- Peripheral location from the nipple
- Associated with nipple discharge
- Skin changes
- Lymphadenopathy 3
Diagnostic Approach
According to the American College of Radiology, mammography should be the initial imaging study for male patients with suspicious breast symptoms 1. Ultrasound is often added to assist in diagnosis and guidance for biopsy.
Risk Factors and Surveillance
Men with a history of breast cancer should be counseled about symptoms of recurrence including new lumps, bone pain, chest pain, dyspnea, abdominal pain, or persistent headaches 1. Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy 1.
Important Caveat
Male breast cancer is often diagnosed at later stages due to lack of awareness and delay in seeking medical attention. The average period before consultation can be as long as 25 months 6, highlighting the importance of early recognition of symptoms.