Carcinoma and Other Neoplasms of the Male Breast

Cancer of the male breast is rare and the end-results are disappointing. Among the factors that contribute to the poor prognosis is the fact that to many physicians mammary carcinoma in the male is something of a myth—an oddity in medicine—and for that reason inconsequential. Unfortunately, both the medical profession and the layman underestimate any mammary lesion in the male, and diagnosis is made too late for adequate intervention to effect a cure. The infrequency of tumors of the male breast may be explained on both anatomical and physiological grounds. Most textbooks of anatomy present an erroneous impression of the male mammary gland. Cunningham and Gray pass over the subject superficially, describing the male breast as a vestigial and rudimentary organ, and one is left with the impression that it contains only scraps of glandular tissue. A good anatomical description is to be found in the paper by Andrews, whose observations are based on sections of normal breasts taken from subjects of all ages. It was found that in every male breast there is a complex series of ducts and alveoli. These are lined by a single layer of columnar epithelium, are patent, and are embedded in a dense connective tissue. Each patent duct has an opening through the nipple. Surrounding the ducts is a sharply differentiated tissue which consists of less deeply staining fibers containing a greater number of nuclei. Andrews claims that this periductal tissue resembles growing tissue and is often mistaken for proliferating fibrous tissue. The adult male mammary gland is in essentially the same state as in preadolescent girls. While the female gland continues to undergo great functional activity (as in menstruation, lactation, and pregnancy), the male gland remains in the so-called rudimentary stage. The rare occurrence of carcinoma of the male breast is in accord with the general rule that cancer seldom arises in vestigial organs. Geschickter emphasizes the relation of the rarity of cancer in the male breast to the absence of intense endocrine stimulation by ovarian hormones, and Cheatle and Cutler furnish experimental evidence to substantiate this thesis. Reducing the amount of ovarian hormone and the duration of its action on the female breast lowers the percentage of spontaneous carcinoma in mice, and vice versa. History Despite the relative infrequency of carcinoma of the male breast, as compared to the same disease in the female, a sufficient number of cases appear in the literature to indicate the importance of the disease not only to the patient and general practitioner, but especially to the surgeon and radiation therapist. The earliest reference to cancer in the male breast was made by Franciscus Arcaeus (1493–1573). Up to 1890 Schuchardt had collected 472 cases. The first reference in the English literature to carcinoma in the male breast was in 1889 by Williams, who reported on 100 cases.