Compounding for Breast Cancer in Men: Examining How Treatment Differs than in Women
Last year, actors Samuel L. Jackson and Mark Ruffalo famously joined the Free the Nipple campaign, not for gender equality for but an issue far less well known: male breast cancer. The campaign was started by One for the Boys, a charity that gives men the facts and tools they need regarding male cancer awareness, treatment options, and avenues for support. One fact this campaign stresses is that while many men are embarrassed to think they can get a disease ‘that just doesn’t sound manly,’ early detection is a part of why the 5-year survival rate of this cancer is 99%. Another fact—compounding for breast cancer is a part of effective treatment and patients need to be aware of the right treatment options for them.
What Else Do Patients Need to Know About Breast Cancer in Men?
Breast cancer in men follows a process similar to what happens in women, but because men have less breast tissue, they also have fewer cancer cells.1 In fact, male breast cancer is rare, making up about 1% of all cancers in the U.S. However, for that 1%, knowledge and treatment are key to saving their lives.
Male breast cancer comes in different types2:
- Ductal carcinoma in situ, a preinvasive cancer where cells lining the ducts look like cancer cells but haven’t spread.
- Infiltrating ductal carcinoma, an invasive cancer that breaks through duct, usually close to the nipple, and grows into the fatty tissue of the breast. This is the most common type of breast cancer in men.
- Infiltrating lobular carcinoma, a rare invasive cancer that starts in the lobules and grows into the fatty tissue of the breast
- Paget disease, another cancer that starts in the ducts but spreads to the nipple and/or areola (the dark circle around the nipple). This is a common cancer in men and can cause redness, itchiness, oozing and crusting around the nipple, possibly with an underlying lump in the breast.
- Inflammatory breast cancer, a rare but aggressive cancer that causes swelling and redness in the breast and is often mistaken for infection.
There are some things patients can do to lower their risk for the disease, such as stop smoking, exercising regularly, and eating a healthy diet, and every man should self-examine their breasts regularly.
Is Treatment and Compounding for Breast Cancer Different for Men Versus Women?
Yes—and no.3 The main treatment strategy for men is to remove the tumor, usually by mastectomy rather than lumpectomy because men have such little breast tissue. Some men will need radiation therapy if their cancer is more advanced. Most male breast cancers are hormone-receptor positive, meaning they can be treated with hormone therapy. Tamoxifen is the preferred treatment and works by attaching to the hormone receptor in the cancer cell, blocking estrogen attachment and thereby stopping the cancer cells from growing. Fulvestrant is another estrogen-based therapy that can be used in patients who don’t respond to tamoxifen.
There are also hormone therapies that work specifically in men. Anti-androgens, such as flutamide and bicalutamide, or luteinizing-releasing hormone analogs, such as leuprolide and goserelin, turn off production of male hormones and can be used by themselves or with other drugs.
There are some drugs that have worked well in women but which have not been studied well in men. These include aromatase inhibitors, which work by blocking the enzyme aromatase from converting male hormones in fat tissue to estrogen, and megestrol, a progesterone-like drug used in older men who stop responding to tamoxifen. All hormone therapies can cause loss of sexual desire or problems maintaining an erection, weight gain, mood swings, and hot flashes; compounding for breast cancer using this class of compounds may be best if combined with supplements to mitigate these side effects.
Compounding for breast cancer in men with hormone receptor-negative tumors usually involves chemotherapy, most likely with trastuzumab and with another taxane. Sometimes tamoxifen will be given after chemotherapy, depending on the stage and type of cancer.
What Can Pharmacists Do to Help Fight the Disease and Stigma of Male Breast Cancer?
Awareness campaigns like the male breast cancer dialogue One for the Boys started are useful precisely because they get men to talk about their health. Pharmacists are great front-line providers of information, but in this case, the real challenges lie in getting the patient to absorb information they don’t think pertains to them, and getting over the embarrassment that seems to accompany this disease. Giving out brochures that discuss genetic testing, a topic that’s become popular in recent years, can help.4 A creative group of pharmacy students have made some laugh-out-loud YouTube awareness videos that are sure spread the word among your patients, but in a fun way.5
As Jackson, who is Chairman of the advocacy organization One for the Boys, says, “Cancer awareness isn’t all pink ribbons. It’s a man’s problem too. We need to all start doing more to look after our bodies and keep those motors running.” Pharmacists can and should be a large part of that effort.
Cancer can strike any person, regardless of gender, age, or ethnicity. At Pharmaceutica North America, we understand all too well how devastating cancer can be. We are committed to compounding for breast cancer using safe and high-quality compounding materials. Learn more about our Bulk APIs by contacting us today.
- “Breast Cancer in Men,” January 26, 2016, http://www.cancer.org/cancer/breastcancerinmen/detailedguide/breast-cancer-in-men-what-is-breast-cancer-in-men ↩
- “Male Breast Cancer Treatment,” August 12, 2015, http://www.cancer.gov/types/breast/patient/male-breast-treatment-pdq ↩
- “Treatment for Breast Cancer in Men,” November 11, 2015, http://ww5.komen.org/BreastCancer/MaleBreastCancer.html ↩
- “Yes, Men Can Get Breast Cancer Too!, http://www.hisbreastcancer.org/male-breast-cancer.pdf ↩
- “Pharmacy Students – Bowel Cancer and Male Breast Cancer,” September 15, 2014, https://www.youtube.com/playlist?list=PLBD1FAF21DED7422F ↩