Breast cancer in men is diagnosed based on signs and symptoms. The breast cancer diagnosis in men relies on the type of tumor, such as benign or malignant. There are different types of tests for diagnosing breast cancer in men. Imaging examinations are done in cases of metastasis of breast cancer in men. Physical examination of the breast and surrounding lymph nodes, imaging tests for the breast, and a biopsy of the breast and skin are also required to confirm breast cancer diagnosis in men. A core needle biopsy determines if a physical examination or imaging test finding is cancerous. Chest inspection is also done for diagnosing breast cancer development in men. Diagnostic mammography is recommended if a lump or worrisome region is found. Other diagnosis method includes ultrasound, nipple discharge, and imaging techniques such as magnetic resonance imaging (MRI). Biopsy performed surgically is one of the effective ways to remove vast tissue during the procedure. Testing for ER and PR can assist estimate the risk of recurrence and the type of treatment that is most likely to reduce it. The HER2 status is used to assess if medications targeting the HER2 receptor can help with cancer treatment. Grade biopsy is also used to determine the tumor grade. Molecular testing involves PD-L1, NTRK, and PI3KCA. Blood tests and serum biochemistry (genomic tests, Oncotype DxTM, Mammaprint) are also the diagnostic approaches used to diagnose breast cancer in men. X-ray, bone scan and PET scan are also used.
Diagnosis of Breast Cancer in Men
Medical practitioners use numerous procedures to detect or cure breast cancer. They also perform tests for the diagnosis to see if breast cancer in men has migrated to other parts of the body from where it started. It is known as metastasis when this happens in imaging examinations. For example, one can reveal whether cancer has spread. Images of the body, from the inside, are produced via imaging tests. General practitioners may also conduct tests that determine which treatment or medication for breast cancer is suitable and will be the most effective while we near the outcomes 1.
A biopsy is the only guaranteed route for a general practitioner to know if a part of the body has cancer in most types of tumors. Let us first understand what a biopsy is. It is a procedure in which the doctor removes a tiny portion of tissue that will undergo testing in a laboratory. If this part of the procedure isn’t possible, the doctor may have to recommend further tests to aid the process of breast cancer diagnosis in men.
A biopsy is a method in which a small portion of the tissue is removed and examined under a microscope. Only a biopsy can lay out a definite breast cancer diagnosis in men where several other tests may indicate the occurrence of cancer. A pathologist will next evaluate the sample. A pathologist is a clinician and specializes in diagnosing the disease by interpreting laboratory tests and assessing cells, tissues and organs. In this technique, the size of the needle used to obtain a piece of tissue is used to classify different types of biopsies. Biopsy with a fine needle aspirator. A very tiny needle is used to remove a small sample of cells in this sort of biopsy.
A core needle biopsy is a type of biopsy used by a giant needle. As to retrieve a larger sample of the tissue 2. This is the most common type of biopsy used to determine if a physical examination or imaging test finding is cancerous. Chest inspection in a healthcare setting. The medical practitioner will feel bumps in the nipple and under the arm during the operation.
Mammography for breast cancer diagnosis
Diagnostic mammography will be recommended if a lump or worrisome region is found 3.
Ultrasound is a process that creates an image of the breast tissue by using high-frequency sound waves. An ultrasound can tell the dissimilarity between a solid tumour that could be cancerous and a fluid material filled Cyst that isn’t generally malignant.
The nipple discharge is performed under a microscope, where the fluid from the nipple can be checked for cancerous cells.
This kind of biopsy is used when a lump or a bulge isn’t felt, but an anomaly may be shown on an imaging test, such as mammography. An imaging scan, such as Ultrasound, mammography, or magnetic resonance imaging, is used to guide a needle to the desired region during the magnetic resonance imaging treatment.
The mammography is used to guide the needle during the stereotactic biopsy. If the biopsy sample is malignant and extra surgery may be required, a small metal clip may be implanted in the breasts to mark the location of the biopsy sample. This clip may be embedded in the breast to mark the location of the biopsy sample. This clip is usually titanium; as a result, it won’t cause any interference with the future process of imaging exams, but it is a must to verify it with your doctor before scheduling any more of the tests.
During the process, majorly depending on the amount of tissue that is to be taken, an image-guided biopsy can be performed with a needle, core, or vacuum aided biopsy.
Biopsy performed surgically is one of the effective ways to remove vast tissue during the procedure. This kind of biopsy might be incisional, that is, removing the portion of the mass or exclusionary, which means the removal of the whole lump. Biopsy performed surgically usually is not advised to identify breast cancer because the surgery is best done after the breast cancer diagnosis in men. Breast cancer is typically diagnosed via non-surgical core needle biopsies. This means that after a diagnosis, only one surgical treatment is usually required to remove the tumour and collect the lymph node samples.
The medical practitioner can learn about specific features of cancer by analyzing the samples removed during the biopsy. The process then will help the medical practitioner to determine the treatment options. The tumor’s characteristics under a microscope are examined to see if it is invasive or in situ, ductal or lobular, and has migrated to the lymph nodes. The tumor’s migraine or edges are also evaluated, and the distance between them and the tumor is measured.
ER and PR are two different types of emergency room visits. Testing for ER and PR can assist estimate the risk of recurrence and the type of treatment that is most likely to reduce it. Patients’ ER and PR are frequently evaluated. In general, hormone therapy is an option for ER-positive and PR-positive tumors.
The HER2 status is used to assess if medications targeting the HER2 receptor can help with cancer treatment. About half of HER2 positive cancer also have hormone receptors, making hormone and HER-2 targeted therapy. In the breast cancer diagnosis in men segment of the guide to breast cancer, learn about breast cancer and HER2 recommendations.
Grade biopsy is also used to determine the tumor grade. When viewed under a microscope, status refers to how similar cancer cells appear to healthy cells. The malignant tissue is compared to healthy tissue by the medical practitioner. Many distinct types of cells are frequently clustered together in healthy tissue. The malignancy is labelled well-differentiated or a low-grade tumour if it resembles healthy tissue and has various groupings. A poorly differentiated or high-grade tumor is a malignant tissue that looks considerably different from healthy tissue.
Molecular testing of the tumor
The medical practitioner may recommend running several other laboratory tests on a tumor sample to identify specific proteins, genes, and other factors unique to the tumor. Molecular testing can also be utilized to identify mutations targeted by new drugs being looked into via clinical trials 4. If one has locally advanced or metastatic breast cancer, you recommend testing the following molecular features.
PD-L1 is a protein found on the surface of the cancer cells and some of the body’s immune cells. It stops the body’s immune cells from tearing down cancer.
NTRK gene fusion is a specific genetic change found in the range of cancers, including breast cancer.
PI3KCA gene mutation is a specific genetic change commonly found in breast cancer. Tumor testing at the molecular level, other lab tests on tumor samples may be recommended by your medical practitioner to identify specific genes, proteins, and other factors specific to the tumor. Molecular testing can also be used to find mutations that could be targeted by novel medications now being tested in clinical trials.
Due to the mutation deficit, microsatellite instability-high or MSI-H is a type of microsatellite instability (dMMR). Microsatellite instability-high or dMMR- positive tumors have a hard time mending DNA damage. This means they go through a lot of alterations and modifications. These mutations cause aberrant proteins to form on tumor cells, making it easier for immune cells to locate and fight the tumour.
Blood tests for breast cancer diagnosis
To understand much more about malignancy, the practitioner may need to perform many types of blood tests. A complete blood count is required. The total blood count is a test that counts the number of different types of cells in a blood sample, such as red blood cells and white blood cells. It is performed to ensure that your bone marrow is in good working order.
Biochemistry of the serum
The serum chemistry tests are commonly used to check for minerals in the blood, such as potassium and salt, as well as help to assess kidney function. Serum chemistry may also contain tests to assess the liver’s health.
Genomic tests to predict the risk of recurrence tests that take an even closer look at the biology of the tumor are commonly used to understand more about the person’s breast cancer, particularly for cancer that has not spread to other organs. These tests can help estimate the risk of cancer recurrence in the years after breast cancer diagnosis in men 5. They can also predict whether a treatment will be helpful to reduce the risk of cancer recurrence; this helps some patients avoid the possible side effects of a treatment that is not likely to work well.
The tests described below are typically done on tissue removed during surgery. Most of the patients will not need any extra biopsy or more surgery. For more information about the genomic tests, what they mean and how the results might affect your treatment plan, so it is always better to consult and talk with your general practitioner.
Diagnostics that investigate the DNA of the tumour in great detail are routinely performed to learn more about a persons breast cancer, significantly if cancer has not progressed to other organs. These tests can aid in determining the likelihood of cancer recurrence in the years following the diagnosis. They can also determine whether a treatment will effectively reduce the risk of recurrence of cancer. This can assist some patients with the negative consequences of a treatment that isn’t likely to work.
The tests outlined below are usually performed on tissue that has been removed following surgery. The majority of individuals will not require a second biopsy or further surgery. Get an appi\ointment and chat with your medical practitioner for more details on genetic tests, what they mean and how results may influence the strategy.
Oncotype DxTM is a trademark of Oncotype Inc. This test is for individuals who have ER-positive and or PR-positive breast cancer that hasn’t progressed to the lymphatic system and HER-2 negative. Patients and their medical practitioners can use this treatment or test to determine whether chemotherapy should be added to the ongoing hormonal therapy. This test looks at 16 cancer-related genes and five reference genes to determine a frequency score that quantifies the risk of cancer coming back within ten years after breast cancer diagnosis in men. The recurrence score is used to guide chemotherapeutic recommendations depending on the age. It looks to provide knowledge that is equally useful for men and women. In the diagnosis part of the guide to breast cancer, have a glance at Oncotype Dx recommendations 6.
Mammaprint is a test for individuals who have ER-Positive or PR-Positive, Her2 melanoma that hasn’t spread to the lymph nodes or has spread to one of the three nodes. This test estimates the likelihood of recurrence for the early stage of breast cancer using the information from 70 genes 7. This test can eventually aid cancer patients and doctors in deciding if chemo needs to be added to their schedule, including hormonal therapy and if cancer has a high chance of recurrence.
For individuals with HER-2 positive or triple-negative prostate cancer, the tests indicated down below have not been found beneficial in predicting if cancer can recur. As a result, none of these tests are presently being advised for HER2 positive or triple-negative breast cancer. The medical practitioner will consider other methods when the medication is recommended.
Further diagnostics may be available for individuals with ER-positive or PR-Positive, HER2-negative breast cancer that has not progressed to the lymph nodes. PAM50, EndoPredict, and uPA/PAI are some of the tests that can be used to predict if the tumor will spread to other parts of the body.
It’s possible that additional imaging tests won’t be performed until after surgery. These tests are usually indicated for those who have an advanced stage of cancer.
X-ray – an x-ray uses a radiation beam to visualize the anatomical structures. The chest X-ray could be used to check for malignancy that has progressed to the lungs.
A bone scan can be performed to check for cancer spread to the bones. A radioactive dye or tracer is injected into a patient’s vein, followed by a scam utilizing a specific camera several hours later. The tracer accumulates in sections of the bone that are mending due to the cancer cells damage. Compared to a healthy bone, which appears lighter, the places where the tracer gathers appear in the image.
Some malignancies do not respond to treatment in the same way and will not show up on a bone scan. Advanced arthritis or the healing process after fracture will also be visible.
Scanning with a positron emission tomography machine, the tumors in organs other than the breast, such as the bone, liver, lungs and lymph nodes, may be detected with a CT Scan. A CT scan uses x rays captured from various angles to create images of the inside of the body.
These images are combined by a detailed, three-dimensional image that shows anomalies, including most cancers. A CT scan can determine the size of the tumor and if it is shrinking due to treatment.
PET scan or a positron emission tomography is performed to see if cancer has progressed to other organs other than the breast. Typically a PET scan is paired with a CT scan. These scans are used to get images of the organs and tissues inside the body. A small amount of radioactive sugar is injected into the patient’s veins. This sugar molecule is taken by the actively dividing cells and needs the most extraordinary energy. Cancer cells absorb more of the radioactive material because they consume energy actively. This material is then detected by the scanner, which produces images. Shiny bright spots indicate the most active locations, and the intensity of brightness can be evaluated to characterize these areas better.
- 1.Zehr K. Diagnosis and Treatment of Breast Cancer in Men. Radiol Technol. 2019;91(1):51M-61M. https://www.ncbi.nlm.nih.gov/pubmed/31471487
- 2.Westenend PJ. Core needle biopsy in male breast lesions. Journal of Clinical Pathology. Published online November 1, 2003:863-865. doi:10.1136/jcp.56.11.863
- 3.MD ST, MD HO. Mammography in men with breast cancer: Review of the mammographic findings in five cases. Australas Radiol. Published online November 1996:387-390. doi:10.1111/j.1440-1673.1996.tb00432.x
- 4.Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. Published online December 22, 2016:575-586. doi:10.1007/s10549-016-4085-4
- 5.Rayson D, Erlichman C, Suman VJ, et al. Molecular markers in male breast carcinoma. Cancer. Published online November 1, 1998:1947-1955. doi:6.Williams AD, McGreevy CM, Tchou JC, De La Cruz LM. Utility of Oncotype DX in Male Breast Cancer Patients and Impact on Chemotherapy Administration: A Comparative Study with Female Patients. Ann Surg Oncol. Published online May 29, 2020:3605-3611. doi:10.1245/s10434-020-08473-y7.Wittner BS, Sgroi DC, Ryan PD, et al. Analysis of the MammaPrint Breast Cancer Assay in a Predominantly Postmenopausal Cohort. Clin Cancer Res. Published online May 15, 2008:2988-2993. doi:10.1158/1078-0432.ccr-07-4723