Breast Cancer Awareness Month is an opportunity to highlight an often-overlooked fact: men can develop breast cancer too. Although uncommon, male breast cancer is a potentially serious disease, and recognising symptoms early is important for timely diagnosis and treatment.

Mr Georgios Exarchos, Consultant Oncoplastic Breast Surgeon at New Victoria Hospital, explains the symptoms men should be aware of, the factors that may increase their risk, and how modern diagnostic and surgical approaches can help achieve effective treatment, while considering cosmetic and functional outcomes.

Breast cancer in men: how common is it?

Breast cancer is predominantly diagnosed in women, but men also have breast tissue, particularly behind the nipple and areola, from which cancer can develop.

According to Cancer Research UK, approximately 420 men are diagnosed with breast cancer in the UK each year, accounting for less than 1% of all breast cancer diagnoses. Despite its rarity, male breast cancer deserves greater public awareness.

Male breast cancer is most frequently diagnosed in men over 60, although younger men can also be affected. The most common histological subtype is invasive breast carcinoma of no special type (NST), previously known as invasive ductal carcinoma.

Limited recognition of symptoms, embarrassment and the misconception that breast cancer affects only women may contribute to delays in seeking the medical help men need. As with breast cancer in women, prognosis depends on several factors, including the stage at diagnosis, tumour biology, and response to treatment. Identifying cancer at an earlier stage can increase the range of treatment options available.

What are the symptoms of breast cancer in men?

The most common presenting symptom is a painless lump, usually situated behind or close to the nipple. However, breast cancer can also cause changes in the nipple, surrounding skin or lymph nodes in the armpit.

Men should seek medical advice if they notice:

• A new lump or persistent thickening in the breast or chest area.
• A lump or swelling in the armpit.
• Nipple inversion (the nipple turning inwards), particularly if it is a new change.
• Spontaneous nipple discharge, especially if blood-stained.
• Skin dimpling, puckering or a change in the contour of the breast.
• Persistent nipple eczema-like changes, scaling, crusting or ulceration.
• Unexplained changes in the size or shape of one breast.
• Persistent, localised breast or nipple pain.

Importantly, not all breast lumps in men are cancerous.

A considerably more common cause of male breast enlargement is gynaecomastia, a benign proliferation of glandular breast tissue. This may affect one or both breasts and can cause swelling or tenderness beneath the nipple.

Gynaecomastia may be associated with hormonal changes, obesity, certain medications or underlying medical conditions. Although it is usually benign, a new or unexplained breast lump should not automatically be attributed to gynaecomastia without appropriate clinical assessment.

Some men with advanced breast cancer may also experience symptoms such as unexplained weight loss, persistent fatigue or bone pain. However, these symptoms are non-specific and are more commonly caused by other conditions.

The most important message is that a new breast lump or persistent nipple change should always be assessed rather than ignored.

How should men check their chest?

Breast awareness means becoming familiar with the normal appearance and feel of your chest so that new changes can be recognised promptly.

Unlike routine breast screening in women, there is no population-based NHS breast screening programme for men. However, men can benefit from being aware of changes to their breast tissue.

There is no established evidence that following a rigid monthly self-examination schedule reduces breast cancer mortality in men. Nevertheless, regularly checking the your chest, perhaps once a month, can be a practical way of developing body awareness.

1. Look for visible changes

Stand in front of a mirror with your arms relaxed at your sides and then raised above your head.

Look for any new asymmetry, swelling, skin dimpling, nipple inversion, redness or persistent rash.

2. Feel the chest tissue

Using the flat pads of your fingers, gently examine the tissue around and behind each nipple, extending across the chest.

Use small circular movements and a combination of gentle and slightly firmer pressure.

3. Check the armpits

Feel beneath each arm for any new lump or swelling.

4. Pay attention to the nipples

Look for new changes in nipple position, skin appearance or spontaneous discharge. Routine squeezing of the nipples is unnecessary and may itself cause discharge.

If you notice a new or persistent change, arrange a clinical assessment rather than repeatedly examining the area.

What increases the risk of breast cancer in men?

There is rarely one identifiable cause of breast cancer. Most cases arise through a combination of age-related, genetic, hormonal and environmental influences.

Several risk factors have been identified through epidemiological and clinical research:

Age

Increasing age is one of the strongest established risk factors. Most cases occur in men over 60, although breast cancer can develop at any adult age.

Family history and inherited genetic mutations

A family history of breast, ovarian, pancreatic or certain prostate cancers may indicate an inherited cancer predisposition.

The strongest established genetic association is with pathogenic variants in the BRCA2 gene. Other genes, including BRCA1, PALB2 and CHEK2, may also contribute to inherited susceptibility.

Men carrying a pathogenic BRCA2 variant have a substantially higher lifetime risk of breast cancer than men in the general population. Identifying an inherited genetic variant may influence future surveillance, treatment decisions and risk assessment for family members.

Importantly, the absence of a family history does not exclude a hereditary predisposition.

International guidance from the American Society of Clinical Oncology (ASCO) recommends that all men diagnosed with breast cancer should be offered genetic counselling and germline genetic testing. This recommendation is also consistent with NHS England's genomic testing eligibility criteria.

Hormonal factors and medical conditions

Most male breast cancers express oestrogen receptors, suggesting that hormonal pathways play an important role in the development and progression of the disease.

Conditions associated with altered oestrogen or testosterone levels may increase risk. These include:

• Klinefelter syndrome, a chromosomal condition commonly associated with reduced testosterone levels.
• Liver cirrhosis, which can alter the metabolism of sex hormones.
• Certain testicular conditions, including previous testicular damage or removal.
• Exposure to certain hormonal treatments, particularly those that increase oestrogen activity.

Thyroid dysfunction may also influence hormone balance, although the relationship between thyroid disorders and male breast cancer is less well-established than for some other risk factors.

Obesity and lifestyle

Obesity is a recognised modifiable risk factor for male breast cancer. Adipose tissue contains aromatase, an enzyme that converts androgens into oestrogens. Increased adiposity may therefore influence circulating hormone levels and breast tissue exposure to oestrogen.

Maintaining a healthy weight, undertaking regular physical activity and following a balanced diet are important for overall health and may help reduce the risk of several cancers.

Evidence linking specific individual foods or alcohol consumption directly to male breast cancer is less consistent than the evidence available for breast cancer in women. It would therefore not be appropriate to attribute male breast cancer to particular foods or dietary patterns.

However, established public health recommendations regarding healthy weight, exercise, alcohol moderation and smoking cessation remain relevant.

Previous chest irradiation

Previous therapeutic radiotherapy involving the chest is another recognised risk factor, particularly when exposure occurred at a younger age.

What about environmental chemicals and hormone disruption?

There is growing scientific interest in the possible health effects of endocrine-disrupting chemicals (EDCs).

These substances can interfere with normal hormonal signalling and are found in various environmental and consumer products, including some plastics, pesticides and industrial compounds.

Experimental and observational research has explored possible associations between certain endocrine-disrupting chemicals, hormonal changes and breast tissue development.

However, current evidence is insufficient to establish that everyday exposure to these chemicals directly causes male breast cancer.

Much of the research is experimental or observational, and findings involving gynaecomastia or breast cancer in women cannot automatically be extrapolated to male breast cancer.

Although this remains an important area of research, established risk factors such as age, inherited susceptibility, obesity and previous radiation exposure currently provide a stronger evidence base for clinical risk assessment.

How is breast cancer diagnosed in men?

A new breast lump or suspicious nipple change should be assessed by a healthcare professional. The first step is usually a consultation with a GP, who may refer the patient to a specialist breast clinic.

In the UK, NICE guidance on suspected cancer referral recommends a suspected cancer pathway referral for people aged 30 and over with an unexplained breast lump, with or without pain. It also provides criteria for concerning nipple changes and unexplained axillary lumps.

At New Victoria Hospital's Breast Clinic, patients can undergo specialist assessment using a triple-assessment approach, where clinically appropriate.

Triple assessment combines three complementary methods:

1. Clinical examination

The breast specialist will take a detailed medical history and examine the breasts, nipples and lymph nodes in the armpits. The examination helps differentiate common benign conditions, such as gynaecomastia, from findings requiring further investigation.

2. Breast imaging

Depending on the patient's age, clinical findings and symptoms, imaging may include mammography, ultrasound or both.

For men aged 25 or older with an indeterminate breast lump, mammography is generally the recommended initial imaging investigation. Targeted ultrasound may be used to further characterise abnormalities or guide a biopsy. For younger men, ultrasound may be the initial investigation.

Men with clinical findings typical of uncomplicated gynaecomastia do not always require breast imaging. These principles are supported by the American College of Radiology's Appropriateness Criteria for the symptomatic male breast.

3. Tissue biopsy

If clinical examination or imaging identifies a suspicious abnormality, an image-guided core needle biopsy may be recommended. The biopsy provides tissue for histopathological examination, allowing a definitive diagnosis. If cancer is confirmed, the tissue is also assessed for biological markers, including oestrogen receptors, progesterone receptors and HER2 status, which help guide treatment decisions.

At New Victoria Hospital, the One-Stop Breast Clinic aims to coordinate clinical examination and imaging during the same appointment, with biopsy performed where indicated. This approach can reduce unnecessary delays, improve diagnostic efficiency and provide patients with a clearer understanding of the next steps.

What are the treatment options for male breast cancer?

Treatment depends on the stage of the cancer, tumour biology, the patient's general health and individual preferences. As male breast cancer is uncommon, many treatment recommendations are informed by studies involving women, supported by male-specific observational evidence and international clinical guidelines. Treatment decisions should be made through a multidisciplinary team involving breast surgeons, radiologists, pathologists and oncologists.

Surgery

Surgery is a central component of treatment for most men with localised breast cancer.

Mastectomy

A mastectomy, involving removal of the breast tissue, remains a commonly performed operation for male breast cancer. This is partly because men usually have a relatively small volume of breast tissue, and tumours are frequently located close to the nipple. Depending on the clinical circumstances, surgery may also include sentinel lymph node biopsy to assess whether cancer has spread to the lymph nodes.

Breast-conserving surgery

Although mastectomy is common, it is not always necessary. Clinical guidelines support offering breast-conserving treatment to men who meet appropriate selection criteria.

For some men, breast-conserving surgery (lumpectomy), usually followed by radiotherapy, is an effective treatment option. The choice depends on tumour size, location, the relationship to the nipple, the extent of disease and the ability to achieve complete excision with an acceptable cosmetic result.

The role of oncoplastic breast surgery

Oncoplastic breast surgery combines the principles of cancer surgery with techniques intended to preserve or improve the appearance of the chest. For male patients, aesthetic considerations may include the position and appearance of the nipple, chest contour, symmetry and the visibility of surgical scars. In selected cases, tissue rearrangement or reconstructive techniques may help optimise the final appearance.

At New Victoria Hospital, Oncoplastic Breast Surgeons can discuss surgical options tailored to the individual's disease and preferences. The primary objective of surgery remains complete cancer removal, while also considering functional and cosmetic outcomes.

Hormonal (endocrine) therapy

The majority of male breast cancers are hormone receptor-positive. For men with hormone receptor-positive breast cancer, endocrine therapy is an important component of treatment and can substantially reduce the risk of recurrence.

Tamoxifen is the recommended first-line endocrine treatment for most men with hormone receptor-positive early breast cancer who require adjuvant endocrine therapy. ASCO recommends an initial treatment duration of five years, with consideration of extending treatment to ten years in selected patients at higher risk of recurrence who have tolerated treatment well. Aromatase inhibitors should not generally be used alone in men: when indicated, they are usually combined with treatment that suppresses testicular hormone production.

Radiotherapy, chemotherapy and targeted treatments

Recent advances in molecular diagnostics and personalised oncology mean that treatment increasingly reflects the biological characteristics of the tumour rather than relying solely on its size and stage.

• Radiotherapy is commonly recommended following breast-conserving surgery and may also be indicated following mastectomy, depending on tumour characteristics and recurrence risk.
• Chemotherapy may be recommended for patients with higher-risk disease, depending on factors such as tumour size, lymph node involvement and tumour biology.
• Targeted therapies may be appropriate for particular molecular subtypes or stages of breast cancer.

When should men seek specialist advice?

"Breast cancer is uncommon in men, but it is important that men recognise they can develop the disease and do not ignore changes in their chest or nipples.

Most breast lumps in men are benign, and a specialist assessment can often provide reassurance. However, when breast cancer is diagnosed, early detection gives us the best opportunity to offer effective, personalised treatment.

Modern breast surgery is not only about removing the cancer. It is also about considering the patient's quality of life, chest appearance and long-term wellbeing. My aim is to ensure every patient understands their diagnosis and treatment options and feels confident in the decisions we make together." 
Mr Georgios Exarchos, MB BS, MRCS, FRCS, FEBS, CEBS, MSc, Consultant Oncoplastic Breast Surgeon at New Victoria Hospital

Breast awareness should be part of men's health throughout the year, not only during Breast Cancer Awareness Month. Most changes in male breast tissue are benign, but distinguishing harmless conditions from breast cancer may require specialist assessment.

Men should seek medical advice if they develop a new lump, persistent nipple changes, spontaneous nipple discharge or other unexplained changes in the breast or armpit. Early diagnosis can make treatment simpler and may increase the likelihood of successful management.

It is equally important that men do not feel embarrassed or reluctant to seek medical advice because breast cancer is traditionally perceived as a women's disease.

Book an appointment with our Breast Specialists

If you have noticed a new breast lump, nipple change or any other unexplained change in your breast or chest, specialist assessment can help establish the cause and determine whether further investigations are needed.

The Breast Clinic at New Victoria Hospital offers clinical assessment and appropriate diagnostic investigations for both men and women.

To arrange an appointment with one of our Breast Specialists, including Mr Georgios Exarchos, call 020 8949 9020 or complete our online appointment enquiry form.