BMJ  2008;336:709-713 (29 March), doi:10.1136/bmj.39511.493391.BE

Clinical Review

Gynaecomastia and breast cancer in men

¹ Metabolism Section, VA Medical Center 111G, One Veterans Drive, Minneapolis, MN 55417, USA, ² Hematology/Oncology Section, VA Medical Center 111E, Minneapolis, USA

The first 150 words of the full text of this article appear below.

Summary points Most breast enlargement in males is due to the benign enlargement of breast tissue (gynaecomastia) Physiological gynaecomastia occurs in neonates, at puberty, and with obesity and ageing Gynaecomastia is due to an increased oestrogen to testosterone ratio; possible causes are many Treatments for painful or embarrassing gynaecomastia include an anti-oestrogen, such as tamoxifen, or surgery (liposuction or mammoplasty) One per cent of breast cancers occur in men, with higher rates in men with a family history of breast cancer or previous chest radiation Irregular, eccentric, hard or fixed breast tissue, ulceration, nipple abnormalities, or associated adenopathy suggest breast cancer Men typically have more advanced breast cancer at diagnosis than women; management is similar

Breast disorders in males can be distressing for both patients and examining doctors. Patients often feel embarrassed and anxious. Although cancers are diagnosed in only about 1% of cases of male breast enlargement, practitioners may feel uncertain . . . [Full text of this article]

Sources and selection criteria

What is gynaecomastia?

How do hormones affect the breast?

What are the hormone sources in men?

When is gynaecomastia physiological?

What disorders or drugs enlarge the breast?

Diseases associated with gynaecomastia
Low androgen levels
High androgen and high oestrogen levels
High oestrogen levels
High sex hormone binding globulin levels leading to low free testosterone levels
Other or multifactorial
Drugs associated with gynaecomastia
Low androgen levels: inhibition of testosterone synthesis
Low androgen levels: inhibition of testosterone action
High androgen levels resulting in high oestrogen levels
High oestrogen levels or oestrogen action
Other or multifactorial
Drugs, creams, cosmetics, and lotions
Starvation and refeeding
Illness
Tumours
Genetic causes

Who is at higher risk for breast cancer?

How should male breast tissue be evaluated?

Examination
Initial laboratory evaluation
Imaging
Biopsy

Metastatic and non-malignant breast masses

When and how should gynaecomastia be treated?

Non-surgical treatment
Surgical treatment

How is male breast cancer treated?

Patient vignette
Additional educational resources
Information resources for patients
Tips for non-specialists
Questions for future research

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