A few days ago the manager of Free, Vittorio Feltri, published a letter directed to Fedez, in which he revealed that he had been operated on for breast cancer on March 1st. “They found a lump in my breast. Although I’m a boy I have a tumor typical of women, crazy stuff, I have absolutely nothing feminine. Although I don’t have boobs, I got breast cancer,” he said later. Felts in an interview with Corriere della Sera. That of “not having boobs” is a belief as common among men as it is wrong, as evidenced by the fact that breast cancer can also affect the male population. It is true, however, that it is a rare tumor in males, and of which little is said. Are there any differences with the female one? Are there any particular risk factors? Is it possible to do prevention? And how? There are many questions about male breast cancer that research has tried to answer over the past 15 years. He tells us about it Laura Ottiniresearch oncologist and Full Professor of General Pathology at Sapienza University of Rome, interviewed for the newsletter of Breast Health.
Professor Ottini, let’s start by debunking the false myth.
“Breast cancer is culturally a malignancy of women and it is understandable that there is this false belief. Out of 100 cases that occur, 99 are female and only one is male. More than 600 men have to be followed throughout their lives to find them. one that develops breast cancer; in the female population, on the other hand, as we read everywhere, one in 8 women gets sick. There is therefore a great disproportion in epidemiology, which makes male breast cancer a very rare disease. But men must be aware that ‘rare’ does not mean ‘impossible’: they too retain some mammary gland, and cancer can develop there. There are many risk factors. About 15% of cases are related. to genetic mutations, while for the other forms it is assumed that there is a hormonal imbalance at the base: an increase in estrogen to the detriment of androgens “.
What has changed in the last 15 years?
“Surely there is much more curiosity and there has also been an evolution in customs. Before, I only received requests for information on male breast cancer from women: usually the wives or companions of those who had been diagnosed. Today, instead, I am contacted by those directly involved: they ask who they can contact, if they should go to the breast specialist. Many have discovered that they have a genetic risk and need to know if it is possible to prevent the disease. Others complain that there is no mention of it. Certainly there is a strong unsatisfied demand for information and interlocutors are not easily found. Unfortunately there is a bit of confusion even among some doctors: not in the large oncology centers, of course, but there are some situations in which men are told that they are not at risk or that they cannot transmit genetic mutations to their children: two wrong and dangerous statements “.
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And from a research point of view?
“Research on male breast cancer in Italy was born with the discovery of the BRCA 1 and 2 genes (the so-called” Jolie genes “, ed). We started from this consideration: since these genes increase the risk and that men also have breast tissue, does genetics act in the same way in the two genders? We have started a pioneering project thanks to funding from the Italian Association for Cancer Research, Airc. Over time the study has expanded and has come to involve as many as 20 Italian hospital research centers, which has allowed us to work on hundreds of cases. The goal is to identify the genetic characteristics that predispose to male breast cancer in the Italian population. But we also participate in international consortia. At the important breast cancer congress in San Antonio, Texas, more and more space is given to the disease in men, and associations of male patients with breast cancer such as the Male Breast Cancer Coalition (MBCC) have emerged. In short, the pink bow is also coloring with a little blue “.
How is male breast cancer treated?
“Still like the female one, although today we know that there are differences. Historically, however, clinical studies were conducted only on women, both for the need to have a homogeneous sample and because there was no current knowledge. the result is that the therapies for breast cancer have all been developed on female patients. There are still no clinical studies conducted on men only, due to the rarity of the disease which would require a great deal of effort, but at least male patients do not they are no longer excluded “.
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How is breast cancer different in boys and girls?
“It is observed that, generally, the responses to hormonal therapies are lower in the former than in the latter, while the side effects are more pronounced. This leads to a greater rate of abandonment of treatments and, consequently, to a worsening of the prognosis. he hypothesizes that these differences are due to different hormonal structures in the two sexes. In men, moreover, breast cancer diagnoses are made at an older age: the age group most at risk is between 60 and 80 years. , while in women the greatest risk is between the ages of 50 and 70, although it must be said that for both genders an anticipation of age is being observed. Precisely because men do not expect to have breast cancer, finally , often do not recognize or underestimate the symptoms, and the disease is frequently discovered at an advanced stage. “
Can an early diagnosis be made?
“For men, given the low frequency of cancer, it would not make sense to have a mammography screening as it does for women aged 45-50 (depending on the region, ed.). Even less does it make sense to do a CT scan. Total Body in the absence of symptoms and a precise indication. What all men can do is self-examination: that habitual gesture of women that costs nothing, but helps to know each other and to recognize a suspicious lump on the chest or in the armpit. , or any changes in the nipple and skin. It is also important that they know that the risk increases with age and that having close family members, such as a mother or a sister, one or more cases of breast cancer increases the risk . Awareness is the first step. A different speech must be made for those with a genetic predisposition, given by mutations in particular genes, such as BRCA1, BRCA2 and PALB2 “.
What is the risk associated with these mutations?
“Also in this case we observed differences between men and women. In men it is above all the mutations in the BRCA2 gene that increase the risk of breast cancer: they increase it up to 40 times, while the mutations of BRCA1 and PALB2 increase it by about In women, on the other hand, the variants of BRCA1 have a greater weight. Genetics, in short, do not act in the same way in both sexes. It must also be remembered that in men the BRCA2 mutation also increases the risk of prostate cancer. Furthermore, mutations in BRCA1 and BRCA2 are now also associated with pancreatic and stomach cancer. For people with genetic predisposition, surveillance and early diagnosis programs have been set up at large cancer centers. For those who have already developed cancer. knowing you have one of these mutations can change your therapy. “
What do you need now?
“There is still a lot to understand about male breast cancer. One goal is to develop ad hoc screening programs for men with BRCA mutations, which take into account gender differences from the beginning. In addition, we are currently studying other gene variants that modulate an individual’s risk of getting sick, and then providing a highly personalized risk profile. In the jargon it is called polygenic susceptibility. It is true that this information does not yet have a practical impact, but in the near future it could change the path of diagnosis and treatment. Finally, we are working to identify specific biomarkers for male breast cancer that allow us to follow the evolution of the disease, as we are doing for female “.