How Much Do You Know about Male Breast Cancer? Let’s Find Out!

WORDS LIM TECK CHOON

DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre
BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple
HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.
MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.


Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

DR WINNIE NG NYEK PING
Consultant Clinical Oncologist
Subang Jaya Medical Centre
NO FAMILY HISTORY OF BREAST CANCER = NO PROBLEM? WELL, THINK AGAIN!

“Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” says Dr Winnie Ng, a consultant clinical oncologist.

“Aside from genetics, there are numerous underlying possible causes of breast cancer,” says Dr Ng
  • Alcohol intake
  • Smoking
  • Prolonged exposure to female reproductive hormones such as oestrogen, such as in women that reach menstruation at early age, women that have never been pregnant, women on oral contraceptive pills, women that experience menopause late, and woman that have their first full-term pregnancy at a later age
  • Postmenopausal women on hormone replacement therapy
  • Obesity

Theerfore, even if you have no family history of breast cancer, Dr Ng recommends that still going for breast cancer screening.

“The easiest method of screening is by self-examination of the breast,” she adds.

How to perform a breast self-examination. Click on this image to view a larger version.
AS WE STILL DON’T HAVE A CURE FOR BREAST CANCER, SCREENING REMAINS THE MOST PRACTICAL SOLUTION TO DETECT BREAST CANCER EARLY

Dr Ng recommends that

  • Women below 40 should undergo a breast ultrasound
  • Women above 40 are advised to go for a mammogram

You should consult your doctor about your risk factors and how often you should go for breast cancer screening.

 “A breast cancer diagnosis is not a death sentence. Self-tests and regular screenings can save lives,” says Dr Winnie Ng.

Will Consuming Bak Kut Teh Soup Damage Your Liver?

WORDS DR CHIENG JIN YU

DR CHIENG JIN YU
Consultant Physician, Gastroenterologist & Hepatologist
Pantai Hospital Ampang

Back in June, the journal Forensic Science, Medicine and Pathology published a paper titled ‘Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?’.

WHAT DOES THE PAPER SAY?

You can read the paper here (link opens in a new tab), but here are the key points:

  1. One of the investigators had a patient that suffered liver damage after eating bak kut teh soup.
  2. These researchers added 4 different formulations of bak kut teh soup to cultures of liver cancer cells.
  3. All 4 formulations were seen to cause ‘significant’ toxicity to these cells.
THAT SOUNDS ALARMING!

Indeed, this paper generated some discussion in the media recently. After all, bak kut teh is a popular delicacy especially among the Chinese population in Malaysia and Singapore!

Let me point to the statement made by Professor Roger Byard, the lead author of the study, in an interview with ABC Radio Adelaide: he said that he didn’t feel that people should panic over the results of the study.

“Obviously, a lot of people have this soup and don’t have a problem,” Prof Bayard told the interviewer, adding that he personally loves bak kut teh and has enjoyed the dish for years.

WHY PANIC MAY BE PREMATURE

We still don’t know the direct cause the patient’s liver damage. Perhaps she had a previous liver disease that led to the observed liver damage, or perhaps her liver was damage after she took her lipid-lowering medication.

We haven’t identified the exact component(s) in bak kut teh soup that may lead to liver damage. Furthermore, to date, we are not informed of the concentrations of various ingredients in these soup bases, so we can’t make a definite conclusion about the toxicity of these ingredients to our liver cells.

The investigators conducted an in-vitro laboratory study. What this means is that it was done in a controlled environment such as a test tube or petri dish.

Hence, we don’t know yet whether a similar result will be seen if the test were performed on actual people. Our digestive system is far more complex than what is in a test tube or petri dish, so this study does not accurately replicate what will happen to our body after we’ve consumed bak kut teh.

They did not study drug-food interactions. Everything we ingest, whether it’s medicine, foods, and drinks, may have a favourable response or therapeutic effect. It may also have therapeutic side effects.

THE TAKE HOME MESSAGE FROM ALL OF THIS

This is why the title of the paper is framed as a question: ‘Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?’

It is meant to be a starting point for more research into the matter.

Until we have more information, there’s no harm in enjoying bak kut teh so long as it’s in moderation and in line with our healthy eating principles!


Reference: Britza, S. M., Farrington, R., Musgrave, I. F., Aboltins, C., & Byard, R. W. (2022). Could herbal soup be a potentially unrecognized cause of hepatotoxicity at autopsy?. Forensic science, medicine, and pathology, 1–4. Advance online publication. https://doi.org/10.1007/s12024-022-00490-5