Breast cancer affects men too: in Tunisia, the Salah Azaiez Institute records more than 3,000 new cases of breast cancer every year, fewer than 1% of them in men — a proportion in line with global data. Rare but real, this male cancer is often diagnosed late and carries a bleaker prognosis than in women. Symptoms to recognise, risk factors specific to the region, the path to diagnosis and treatment: here is what you need to know about a reality that remains taboo.
A little-known disease with troubling figures
In Tunisia, where the Salah Azaiez Institute records more than 3,000 new cases of breast cancer each year, fewer than 1% concern men. This proportion, on a par with global data, nonetheless conceals a stark reality: breast cancer in men often carries a bleaker prognosis than in women.
Contrary to popular belief, men also have breast tissue and nipples — less developed than in women, admittedly, but still liable to develop cancer. This lack of awareness explains why most diagnoses come late, at already advanced stages.
Breast cancer in men: understanding this biological particularity
Men mainly develop infiltrating ductal carcinomas, which account for nearly all cases. These cancers arise in the milk ducts — structures that, although rudimentary in men, retain their cancer-causing potential.
A notable feature of male breast cancer: it is generally hormone-sensitive. This means the cancer cells carry receptors for oestrogen and progesterone. This particularity considerably influences the treatment options, often steering care towards approaches similar to those used in postmenopausal women.
Risk factors specific to the Maghreb context
Several factors significantly increase the risk of developing breast cancer in men:
Genetic and hereditary factors
Klinefelter syndrome holds a special place. This chromosomal abnormality (47,XXY) multiplies the risk of male breast cancer by 20 to 60. Affected men have low testosterone levels and normal oestrogen levels, creating a hormonal imbalance that favours tumour development.
Genetic mutations in BRCA1 and BRCA2 also play a crucial role. Nearly 14% of men with breast cancer carry a BRCA2 mutation. This genetic predisposition explains why family history is a major risk factor.
Regional environmental factors
Occupational exposure is particularly significant in our region. Men working in high-temperature environments (steelworks, metallurgical industries) face an increased risk. Heat affects the testicles and disrupts hormonal balance.
Liver disorders, common in the region and often linked to hepatitis B or alcohol consumption, alter hormone metabolism and raise oestrogen levels.
Age and hormonal factors
Unlike in women, the peak incidence occurs later in men, generally after the age of 60. This difference is explained by the absence of continuous exposure to female hormones.
| Risk factor | Observed effect |
|---|---|
| Klinefelter syndrome (47,XXY) | Multiplies the risk by 20 to 60 |
| BRCA2 mutation | Present in nearly 14% of men with breast cancer |
| Occupational exposure to heat (steelworks, metallurgical industries) | Increased risk, disruption of hormonal balance |
| Liver disorders (hepatitis B, alcohol) | Increased oestrogen levels |
| Advanced age | Peak incidence after age 60 |
Symptoms of breast cancer in men: the signals to recognise
Lack of awareness of this disease dangerously delays diagnosis. Several symptoms should raise the alarm:
The main symptom: a hard, painless lump, usually located beneath or around the nipple. This preferred location distinguishes male breast cancer from its female form.
Skin changes: thickening, puckering of the breast skin or scaling should be cause for concern.
Nipple discharge: any fluid leaking from the nipple, especially if bloody, calls for urgent medical attention.
Nipple retraction: a change in the shape or position of the nipple.
Signs of spread: swelling, redness of the breast or a lump in the armpit often signal already advanced disease.
Diagnosing breast cancer in men: a specialised pathway
In Tunisia, diagnosis relies on a multidisciplinary approach involving several complementary examinations.
Imaging examinations
The mammogram is the reference examination, supplemented by a breast ultrasound to clarify the tissue characteristics.
A breast MRI is often required to assess local spread and look for any lesions on the opposite side.
Histological confirmation
The biopsy remains essential to establish a definitive diagnosis. It also helps determine the molecular characteristics of the tumour, key to guiding treatment.
Staging work-up
Given that diagnosis is often late, a full staging work-up is systematically required, including a thoraco-abdominal CT scan and a bone scan.
Groundbreaking treatments for breast cancer in men
Treatment follows the same principles as in women, with a few specific adaptations.
Surgery: the reference treatment
A mastectomy is often necessary owing to the small volume of male breast tissue. This procedure involves removing all of the breast tissue, including the areola and the nipple.
The sentinel lymph node technique allows doctors to assess the spread to the lymph nodes while limiting after-effects.
Male breast reconstruction
Contrary to popular belief, breast reconstruction remains possible in men. A tissue graft fills the scar while a tattoo redraws the areola, restoring the natural appearance of the chest.
Suitable complementary treatments
Radiotherapy: it systematically follows surgery to destroy any residual cancer cells.
Hormone therapy: since the majority of male cancers carry hormone receptors, this approach proves particularly effective.
Chemotherapy: reserved for advanced stages, it uses the same protocols as in postmenopausal women.
Targeted therapies: the new personalised treatments offer encouraging prospects, particularly for HER2-positive forms.
Specific hormonal treatment
In certain cases of metastatic cancer, removal of the testicles may be considered to drastically reduce the production of male hormones that can stimulate tumour growth.
Prognosis and monitoring of breast cancer in men
The prognosis depends essentially on the stage at diagnosis. Unfortunately, lack of awareness of this disease often leads to a delayed diagnosis, which explains why men statistically have a higher mortality rate.
Nevertheless, when diagnosed early, male breast cancer can carry a favourable prognosis, comparable to that of women.
Specific challenges in the region
Limited healthcare infrastructure
With a single specialised institute in Tunisia (the Salah Azaiez Institute), three cancer-care centres in Algeria and six oncology centres in Morocco, access to care remains problematic.
Sociocultural taboo
Lack of awareness and cultural taboos delay medical consultation. Talking about breast cancer in men remains difficult in our traditional societies.
Medical training
The rarity of this condition calls for specialised training of healthcare professionals so they can recognise the early signs.
Leading regional organisations
Tunisia
- Salah Azaiez Institute: national reference centre for oncology
- Tunisian Society of Medical Oncology (STOM): training and research
- LGC Genetics: specialised genetic screening
Algeria
- Pierre and Marie Curie Centre (Algiers, Oran, Blida)
- Algerian Society of Medical Oncology
- Cancer surveillance laboratory (Oran)
Morocco
- Mohammed VI Centre for Cancer Treatment (Casablanca)
- International Oncology Centre of Casablanca
- Pasteur Institute of Morocco: cancer research
Prevention and screening: a shared responsibility
Unlike in women, there is no systematic screening for men, even for those carrying genetic mutations. This reflects how rare the disease is.
However, certain preventive measures remain effective:
- Maintaining an optimal weight
- Limiting alcohol consumption
- Quitting smoking
- Regular physical activity
Particular vigilance for men at risk
Men with a family history, Klinefelter syndrome or other risk factors should be especially vigilant and seek medical advice promptly if symptoms appear.
A message of hope and action
Breast cancer in men, though rare, remains a serious medical reality. That it remains little known must not be treated as inevitable. In our region, where cancer-care resources remain limited, awareness and education are our most powerful weapons.
Gentlemen, your breasts deserve the same attention as women's. Faced with any suspicious symptom, seeking help early can save lives. This disease is neither a shame nor a taboo, but a medical challenge we must take on together, with dignity and determination.
