The rising incidence of male breast cancer.

TLDR: Male breast cancer incidence is increasing in the UK, paralleling US data which shows a concordant increase over a similar time period and its rising trend, which seems likely to continue, suggests coordinated multi-centre approaches are necessary to accumulate data.

Abstract: Although breast cancer rates are declining in Western societies, quoted figures are restricted to female breast cancer. Recently in this journal, Stang and Thomssen reversed this trend by analysing male breast cancer data from the SEER Program of the National Cancer Institute, which showed an increased incidence in male breast cancer of 1.0 per 100,000 in the late 1970s to around 1.2 per 100,000 at the start of this decade [1]. In the UK around 350 cases of male breast cancer are diagnosed annually [2]. To determine if this figure is changing, we reviewed data obtained from members of the United Kingdom Association of Cancer Registries (UKACR). In most cases data was provided directly from UKACR members both as absolute numbers (1981–2004) and European Age Standardised Rates (EASR; 1991– 2004). As shown in Fig. 1, male breast cancer incidence is increasing in the UK, paralleling US data which shows a concordant increase over a similar time period [1, 3]. This begs the question of why male rates are rising. Age is the single biggest risk factor for male breast cancer. We are an ageing population and increased male breast cancer may well parallel increased longevity. However this increase is also reflected in ASR rates, which accounts for this. Nowadays, men are more health conscious and with increased public awareness of breast cancer in general e.g. through pink ribbon campaigns, they may be much more likely to seek medical attention for breast symptoms than ever before, which could contribute to increased diagnosis. Men who have been repeatedly exposed to radiation from a young age and over a long time period are at greater risk of developing breast cancer [4]. One might expect that males living within the fallout zone from the 1986 Chernobyl nuclear disaster (which included the UK) may be at greater risk. Although reports are sketchy, an article published in Croatian suggests that post-Chernobyl, the ratio of male breast cancer increased from 1:139 to 1:79 [5]. Rising levels of obesity resulting from physical inactivity and poor diet is a serious public health issue in both the US and UK and may be contributory to increasing male breast cancer. High estrogen levels are linked to breast cancer and local estrogen biosynthesis by breast tissue adipocytes may be an important factor in obese individuals. Increased use of pesticides, many of which are weakly estrogenic, by the agricultural industry and their subsequent introduction into the food chain could also add to rising trends. Increased alcohol intake has been associated with male breast cancer [6] and this is probably indirectly linked to alcohol-induced liver damage and subsequent hyperestrogenism. Liver cirrhosis is associated with increased estrogen levels which could increase breast cancer risk. There are suggestions that this risk is higher when cirrhotic patients live longer [7]. The so-called ‘binge drinking’ culture that has developed in recent years, particularly in the UK could also be a casual factor. Although male breast cancer is rare, for the patient a diagnosis is often unexpected but it should be regarded as no less important than other ‘male’ illnesses. Its rarity precludes randomised clinical trials but its rising trend, which seems likely to continue, suggests coordinated multi-centre approaches are necessary to accumulate V. Speirs (&) Leeds Institute of Molecular Medicine, Wellcome Trust Brenner Building, St James’s University Hospital, Leeds LS9 7TF, UK e-mail: v.speirs@leeds.ac.uk

Figures

Fig. 1 Breast cancer incidence in males in the UK according to data from UKACR. (a) Total numbers from 1981 to 2004. Data not available from: * three, ** two and *** one region. (b) European age-standardised incidence rates per 100,000 person-years at risk from 1991 to 2004 from nine UKACRs and data not available from one region (+)

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The rising incidence of male breast cancer
Valerie Speirs, Abeer M. Shaaban
To cite this version:
Valerie Speirs, Abeer M. Shaaban. The rising incidence of male breast cancer. Breast Cancer Re-
search and Treatment, Springer Verlag, 2008, 115 (2), pp.429-430. �10.1007/s10549-008-0053-y�. �hal-
00486588�

LETTER TO THE EDITOR
The rising incidence of male breast cancer
Valerie Speirs Æ Abeer M. Shaaban
Published online: 14 May 2008
Ó Springer Science+Business Media, LLC. 2008
Although breast cancer rates are declining in Western
societies, quoted figures are restricted to female breast
cancer. Recently in this journal, Stang and Thomssen
reversed this trend by analysing male breast cancer data
from the SEER Program of the National Cancer Institute,
which showed an increased incidence in male breast cancer
of 1.0 per 100,000 in the late 1970s to around 1.2 per
100,000 at the start of this decade [1].
In the UK around 350 cases of male breast cancer are
diagnosed annually [2]. To determine if this figure is
changing, we reviewed data obtained from members of the
United Kingdom Association of Cancer Registries
(UKACR). In most cases data was provided directly from
UKACR members both as absolute numbers (1981–2004)
and European Age Standardised Rates (EASR; 1991–
2004). As shown in Fig. 1, male breast cancer incidence is
increasing in the UK, paralleling US data which shows a
concordant increase over a similar time period [1, 3]. This
begs the question of why male rates are rising.
Age is the single biggest risk factor for male breast
cancer. We are an ageing population and increased male
breast cancer may well parallel increased longevity.
However this increase is also reflected in ASR rates, which
accounts for this. Nowadays, men are more health con-
scious and with increased public awareness of breast
cancer in general e.g. through pink ribbon campaigns, they
may be much more likely to seek medical attention for
breast symptoms than ever before, which could contribute
to increased diagnosis.
Men who have been repeatedly exposed to radiation
from a young age and over a long time period are at greater
risk of developing breast cancer [4]. One might expect that
males living within the fallout zone from the 1986 Cher-
nobyl nuclear disaster (which included the UK) may be at
greater risk. Although reports are sketchy, an article pub-
lished in Croatian suggests that post-Chernobyl, the ratio of
male breast cancer increased from 1:139 to 1:79 [5].
Rising levels of obesity resulting from physical inac-
tivity and poor diet is a serious public health issue in both
the US and UK and may be contributory to increasing male
breast cancer. High estrogen levels are linked to breast
cancer and local estrogen biosynthesis by breast tissue
adipocytes may be an important factor in obese individuals.
Increased use of pesticides, many of which are weakly
estrogenic, by the agricultural industry and their sub-
sequent introduction into the food chain could also add to
rising trends.
Increased alcohol intake has been associated with male
breast cancer [6] and this is probably indirectly linked to
alcohol-induced liver damage and subsequent hyperestr-
ogenism. Liver cirrhosis is associated with increased
estrogen levels which could increase breast cancer risk.
There are suggestions that this risk is higher when cirrhotic
patients live longer [7]. The so-called ‘binge drinking’
culture that has developed in recent years, particularly in
the UK could also be a casual factor.
Although male breast cancer is rare, for the patient a
diagnosis is often unexpected but it should be regarded as
no less important than other ‘male’ illnesses. Its rarity
precludes randomised clinical trials but its rising trend,
which seems likely to continue, suggests coordinated
multi-centre approaches are necessary to accumulate
V. Speirs (&)
Leeds Institute of Molecular Medicine, Wellcome Trust Brenner
Building, St James’s University Hospital, Leeds LS9 7TF, UK
e-mail: v.speirs@leeds.ac.uk
A. M. Shaaban
St James’s Institute of Oncology, St James’s University Hospital,
Leeds LS9 7TF, UK
123
Breast Cancer Res Treat (2009) 115:429–430
DOI 10.1007/s10549-008-0053-y

sufficient numbers for meaningful study into the biology of
male breast cancer. Ultimately this may help clinicians
better understand the disease and thus improve outcome for
men with breast cancer.
Acknowledgements Thanks to the following for providing statis-
tics: Northern and Yorkshire Cancer Registration and Information
Service, Scottish Cancer Registry, North West Cancer Intelligence
Service, Eastern Cancer Registration and Information Centre, Thames
Cancer Registry, Trent Cancer Registry, West Midlands Cancer
Intelligence Unit, Oxford Cancer Intelligence Unit Welsh Cancer
Intelligence and Surveillance Unit, Northern Ireland Cancer Registry.
Our male breast cancer programme is supported by the Breast Cancer
Campaign (UK).
References
1. Stang A, Thomssen C (2008) Decline in breast cancer incidence in
the United States: what about male breast cancer? Breast Cancer
Res Treat. doi:10.1007/s10549-007-9882-3
2. http://www.breastcancercampaign.org/breastcancer/breast_
cancer_facts//
3. Fentiman IS, Fourquet A, Hortobagyi GN (2006) Male breast
cancer. Lancet 367:595–604
4. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN
(2004) Breast carcinoma in men: a population-based study. Cancer
101:51–57
5. Belicza M, Lenicek T, Glasnovic
´
M, Elez M, Gladic
´
V, Marton I
(2002) Change in the occurrence of breast cancer in hospital
registries (1980–2000). Lijec Vjesn 124:347–353 (Croatian)
6. Memon MA, Donohue JH (1997) Male breast cancer. Br J Surg
84:433–435
7. Misra SP, Misra V, Dwivedi M (1996) Cancer of the breast in a
male cirrhotic: is there an association between the two? Am J
Gastroenterol 91:380–382
91-95
96-00
01-04
0.0
0.2
0.4
0.6
0.8
1.0
Years
EASR
81-85
86-90
91-95
96-00
01-04
0
200
400
600
800
1000
1200
Years
Number of cases
a
b
*
**
***
+
Fig. 1 Breast cancer incidence in males in the UK according to data
from UKACR. (a) Total numbers from 1981 to 2004. Data not
available from: * three, ** two and *** one region. (b) European
age-standardised incidence rates per 100,000 person-years at risk
from 1991 to 2004 from nine UKACRs and data not available from
one region (+)
430 Breast Cancer Res Treat (2009) 115:429–430
123

Frequently asked questions

Q1. What are the contributions in "The rising incidence of male breast cancer" ?

HAL this paper is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. 

Q2. What is the common reason for breast cancer in the UK?

men are more health conscious and with increased public awareness of breast cancer in general e.g. through pink ribbon campaigns, they may be much more likely to seek medical attention forbreast symptoms than ever before, which could contribute to increased diagnosis. 

Q3. What is the link between obesity and breast cancer?

Rising levels of obesity resulting from physical inactivity and poor diet is a serious public health issue in both the US and UK and may be contributory to increasing male breast cancer. 

Q4. What is the name of the registry?

Thanks to the following for providing statistics: Northern and Yorkshire Cancer Registration and Information Service, Scottish Cancer Registry, North West Cancer Intelligence Service, Eastern Cancer Registration and Information Centre, Thames Cancer Registry, Trent Cancer Registry, West Midlands Cancer Intelligence Unit, Oxford Cancer Intelligence Unit Welsh Cancer Intelligence and Surveillance Unit, Northern Ireland Cancer Registry. 

Q5. What is the link between breast cancer and obesity?

High estrogen levels are linked to breast cancer and local estrogen biosynthesis by breast tissue adipocytes may be an important factor in obese individuals. 

Q6. What is the link between increased alcohol intake and breast cancer?

Increased alcohol intake has been associated with male breast cancer [6] and this is probably indirectly linked to alcohol-induced liver damage and subsequent hyperestrogenism. 

Q7. What is the risk of breast cancer in the UK?

One might expect that males living within the fallout zone from the 1986 Chernobyl nuclear disaster (which included the UK) may be at greater risk.