Breast Cancer in Men: The Chest Changes Worth Showing Your GP

You are drying off after a shower when your fingers catch on something small and firm beside one nipple. It does not hurt, and it is not dramatic. Most men in that position do the obvious thing: press it a second time, decide it is a muscle or a cyst or something from the gym, and carry on with the day. The trouble is that this reasoning rests on an assumption nobody examines, which is that men do not get breast cancer. They do. Cancer Research UK puts the figure at around 420 men diagnosed every year in the UK, and with Breast Cancer Awareness Month running from 1 to 31 October, now is a sensible time to learn what to look for.

Rare is the right word, but it is a poor excuse

Fewer than 1 in 100 breast cancers in the UK are diagnosed in men, according to Cancer Research UK, which sets the roughly 420 male cases a year against around 59,000 in women. Other charities quote slightly lower totals, between 370 and 400 a year, because they count different years of data, so treat any single figure as an approximation. The Institute of Cancer Research has put male deaths from the disease at around 80 a year. What the headline numbers hide is timing: Breast Cancer UK reports that most men are diagnosed between 60 and 75, roughly five to ten years later than the average for women, and that men are often diagnosed later because they do not know the risks or the signs. Researchers at Oxford's Health Experiences Research Group, who interviewed men with the disease, found that most had not known men could get breast cancer before their own diagnosis, and they link that partly to awareness campaigns with such a pink, female focus. Then there is the practical gap, because the NHS breast screening programme is aimed at women, which leaves a man's own attention as the only early-detection system he has.

What to look for, and where

Most of the signs are painless, and that is exactly why they get ignored.

Cancer Research UK describes the typical lump as nearly always painless, and since men have breast tissue in the area around the nipple, that is where your fingers should spend their time. The NHS list of symptoms is short enough to remember:

• A lump or swelling in your chest or armpit
• Liquid leaking from a nipple, which may have blood in it
• A change in the size or shape of either side of your chest
• Sores or ulcers on the chest
• A nipple that has started to turn inwards, or a rash on it that can look like eczema

The NHS adds a broader instruction that matters more than the list itself: any change in your chest or nipples that is not normal for you deserves a GP appointment. Knowing what is normal for you means looking, so attach the check to a routine you already have. The shower works, as does the first of the month or whichever Sunday you change the bed. Use the flat of your fingers on both sides, work out towards the armpit because a lump or swelling there counts too, and glance in the mirror for dimpling that looks like orange peel, redness, or one side that has changed shape. It takes a minute or so. Do it the same way every time, so that a difference stands out.

Most lumps are not cancer, and that cuts both ways

Gynaecomastia, the enlargement of male breast tissue, is common and often harmless, according to the NHS. It can affect one or both breasts, the area may feel swollen or sore, and the usual causes include hormone shifts in men over 50 (or during puberty), being overweight, certain medicines, anabolic steroid use, and conditions such as an overactive thyroid, kidney disease or cirrhosis. That sounds reassuring until you meet the catch, which is that you cannot reliably tell the two apart from the outside. A Northern Cancer Alliance briefing for GPs says to think cancer when there is a hard lump on one side, a nipple change or a bloody discharge, but a man with a firm lump and a bit of tenderness can fit either picture. So do not diagnose yourself in either direction. A swollen, tender chest is not a reason to relax, and a hard lump is not a reason to panic; both are reasons to book an appointment, and the NHS gynaecomastia advice says the same for any lump, skin dimpling, or bleeding from a nipple.

Who is at higher risk

Age comes first: the NHS lists being over 60 at the top of its causes. Family history is next, and it is the one men most often get wrong, because it can come down the father's side as easily as the mother's. A faulty BRCA gene can be inherited from either parent, and NHS Lothian's genetics service says a child of a carrier, son or daughter, has a 1 in 2 chance of inheriting it. The numbers are worth seeing. Macmillan says about 1 in 1,000 men in the general population will develop breast cancer before the age of 80, against between 2 and 8 in 100 men with a BRCA2 variant, and the Institute of Cancer Research estimates that around 10 per cent of male cases are caused by BRCA2 mutations. The same gene raises prostate cancer risk as well: Macmillan gives 21 to 35 in 100 for BRCA2 carriers by 80, against 16 or 17 in 100 for men generally, so a family history of breast or ovarian cancer is worth mentioning even if your only worry is your prostate.

If breast or ovarian cancer runs in your family, tell your GP now rather than waiting for a symptom. The NHS says you may be eligible for a genetic test, and the GP can refer you to a breast clinic or a genetics clinic for assessment. Separately, NHS BRCA testing is open to anyone aged 18 or over who has at least one Jewish grandparent.

Beyond genes, the other risks cluster around higher oestrogen and past damage. On the oestrogen side the NHS names obesity or being overweight, cirrhosis and Klinefelter syndrome, a rare condition in which a boy is born with an extra X chromosome, and Cancer Research UK adds thyroid problems. On the damage side it lists radiotherapy to the chest, conditions that harmed the testicles (undescended testicles, or mumps in adulthood), removal of a testicle, and working in a hot environment such as a steelworks. Smoking is linked too, and the NHS advice for lowering your risk is the dull trio you have probably heard before: keep alcohol under 14 units a week, lose weight if you are carrying extra, and stop smoking. None of this means a man with a risk factor will develop the disease, and most never do. Trans women and non-binary people assigned male at birth can also get breast cancer, and the NHS says feminising hormones taken for more than two years may raise the risk, with breast screening available between the ages of 50 and 71.

What happens when you go

Here is what the NHS says to expect. The GP will ask about your symptoms and about breast cancer in the family, and if you have a lump or a change they will examine your chest, which means undressing from the waist up behind a screen. You can ask for a friend, a family member or another member of staff to be in the room. If the GP thinks the symptoms could be cancer you may be referred urgently to a breast clinic, which the NHS is careful to say does not mean you definitely have it. At the clinic you can expect an examination of your chest, possibly a mammogram, an ultrasound, and a biopsy in which a small sample of cells is usually taken with a needle. You may not need all of them, and the NHS says the tests you need are usually done in one visit, although biopsy results can take several weeks.

If the result is cancer, a clinical nurse specialist becomes your main point of contact, and further tests such as a chest X-ray, CT or MRI scans, a bone scan and blood tests show the stage and type. Treatment depends on the size and stage, the grade of the cells, and whether they respond to particular hormones. More than 95 per cent of breast cancers in men are oestrogen receptor positive, against up to 80 per cent in women, according to the Institute of Cancer Research, which is why hormone therapy, with tamoxifen the best-known example, sits among the options alongside surgery, radiotherapy, chemotherapy and targeted drugs. Those treatments were all first developed for women, and researchers have been asking for studies built around men for that reason.

The outcome gap

Outcomes are the part to be honest about. In a 2019 study in JAMA Oncology using the US National Cancer Database, five-year overall survival after a breast cancer diagnosis was 77.6 per cent for men and 86.4 per cent for women, and more men arrived with advanced disease: 5.8 per cent were at stage IV when diagnosed, against 3.8 per cent of women. Differences in tumour type and stage, age and treatment accounted for about 63 per cent of the gap, and the researchers pointed to later diagnosis and undertreatment among men. That is American data covering 2004 to 2014, so read it as a direction rather than a UK forecast. The direction fits the NHS's own line that finding cancer early may make it easier to treat.

What to do this week

Check your chest tonight and note what you find, including which side and roughly where. If there is a lump, nipple discharge, an inverted nipple, a sore or a rash, ring the surgery tomorrow and say plainly what you have found; do not wait to see whether it hurts first. If you have been diagnosed, or someone close to you has, the free Macmillan Support Line is on 0808 808 00 00, open 8am to 8pm every day, and Breast Cancer UK points men to the Men's Virtual Meet-Up, a space to talk with other men who have had the disease. The appointment itself takes minutes. What it replaces, weeks of pressing the same spot and hoping, takes far longer.