Treatment for breast cancer in men

1. Types of treatment 
2. Surgery
3. Hormone (endocrine) therapy
4. Radiotherapy
5. Chemotherapy
6. Targeted (biological) therapy
7. Blood clots
8. When treatment finishes 

1. Types of treatment

There are a number of different treatments for breast cancer in men, which can be given alone or in combination. 

Your doctors will consider the best treatment for you once they have the information they need from tests. 

The treatment you’re offered will depend on a number of things including:

• The type of breast cancer you have: the most common type is called invasive ductal breast cancer
• The cancer stage: the size of the cancer and how far it has spread
• The cancer grade: how different the cancer cells are to normal cells and how quickly they are growing
• Whether the cancer is oestrogen receptor positive or negative 
• Whether the cancer is HER2 positive or negative 

If the cancer hasn’t spread beyond the breast tissue or the lymph nodes under the arm (primary breast cancer), treatment aims to remove the cancer and reduce the risk of it coming back or spreading to other parts of the body. 

If the cancer has spread to another part of the body (secondary breast cancer), treatment can be given to control and slow the spread of the cancer, relieve symptoms and give you the best quality of life for as long as possible. 

You can discuss treatment with other men with breast cacner on our online discussion Forum.  It's a confidential area where you can share tips and information, and talk about what's on your mind with other men who really get it.

2. Surgery

Surgery to remove the cancer is the first treatment for most men. 

The amount of breast tissue removed depends on the area affected and the size of the cancer.

Sometimes chemotherapy or hormone therapy may be given before surgery to reduce the size of the tumour.

There are two main types of operation.

Mastectomy

This is the most common treatment for men. 

A mastectomy involves removing all the breast tissue including the nipple area. 

You will usually have some or all of the lymph nodes under the arm removed with the breast tissue.

Wide local excision (lumpectomy)

This is where the cancer is removed with a margin (border) of normal breast tissue around it. This is less common than a mastectomy and your treatment team will tell you if it’s an option.

Lymph node removal

If you have invasive breast cancer, your treatment team will want to check if any of the lymph nodes under the arm contain cancer cells. This, along with other information about your cancer, helps them decide whether you’ll benefit from any additional treatment after surgery.

Usually an ultrasound scan of the underarm is done before surgery to assess the lymph nodes.

If the ultrasound appears normal your surgeon is likely to recommend an operation to remove some of the lymph nodes (called a sentinel lymph node biopsy). 

If it appears abnormal, you’ll have a fine needle aspiration (FNA) or a core biopsy to see if the cancer has spread to the lymph nodes. 

If these tests show cancer has spread to the lymph nodes, you’ll usually be recommended to have all or most of your lymph nodes removed. This will be done at the same time as your breast surgery and is known as an axillary clearance.

You can find out more about surgery to the lymph nodes on our surgery page. 

Effects of surgery

You can read more about the effects of surgery on our after surgery page. 

Changes to your body 

Having surgery can mean the shape of your chest changes and your nipple may be removed.

The first time you look at your body after the operation may be difficult. Your chest area is likely to be bruised and swollen, but this will gradually improve. 

You might feel self-conscious about your chest area, for example if you’re in a communal changing room, particularly at first.

For some men, the changes to their body affect their confidence and self-esteem.

If you continue to feel uncomfortable about looking at your body, you may find it helpful to speak to a counsellor. Your GP or breast care nurse should be able to arrange this for you.

It’s sometimes possible to improve the symmetry of the chest area with reconstructive surgery. This may be done at the same time as surgery to remove the cancer, or at a later date.

Lymphoedema

Lymphoedema is swelling of the arm, hand or chest area caused by a build-up of fluid in the body’s tissues. 

Some people develop lymphoedema after treatment for breast cancer.

It can occur as a result of damage to the lymphatic system, for example because of surgery or radiotherapy to the lymph nodes under the arm and surrounding area. 

Find out more lymphoedema.

3. Hormone (endocrine) therapy

The hormone oestrogen can stimulate some breast cancers to grow. All men have a small amount of oestrogen. 

Hormone therapies work in different ways to block the effect of oestrogen on cancer cells.

Hormone therapy will only be prescribed if your breast cancer has receptors within the cell that bind to the hormone oestrogen, known as oestrogen receptor positive or ER+ breast cancer.

Tamoxifen

The most common hormone therapy drug used in men is tamoxifen. 

Tamoxifen is taken as a tablet. It’s best to take it at the same time every day. If you miss a dose you don’t need to take an extra one the next day. 

Your treatment team will tell you how long you need to take tamoxifen for.

Side effects of tamoxifen

Hot flushes

Hot flushes can range from a mild warming of the face to waves of heat throughout the body. 

How often they occur can vary, from a couple a day to a few every hour. 

It’s worth speaking to your treatment team or GP as there may be treatments that can help.

Other tips for dealing with hot flushes include:

• Keeping a diary of when you have hot flushes to identify any patterns or if anything triggers them (some people find spicy foods, caffeine or alcohol are triggers)
• Losing weight if you’re overweight
• Doing regular exercise and stopping or cutting down on smoking 

Many people try complementary therapies, such as hypnosis, acupuncture or meditation. Although the evidence about their effectiveness is varied, some people find them helpful.

Problems getting an erection

Some men have difficulty getting an erection, and orgasms may feel different or less intense. 

This usually improves over time and should resolve when you stop taking tamoxifen. 

There are treatments which might help, including drugs taken as tablets or given as an injection or a small pellet placed in the urethra (the tube that drains urine from the bladder out of the body).

Some men use vacuum pumps that draw blood into the penis, causing an erection.

Sex or couples therapy can be a useful addition to medical treatments. Organisations such as Relate provide this kind of counselling.

You can find more information on treating erection problems on the NHS website. 

Prostate Cancer UK also has lots of information on erection problems and other changes to your sex life caused by hormone therapy.

Other common side effects

Other common side effects include:

• Indigestion
• Headaches
• Loss of sex drive (libido) 
• Change in mood

Less common side effects

There’s a very slight risk of changes in your vision. If you notice any changes in your vision tell your GP or someone from your treatment team.

There is also an increased risk of blood clots in people taking tamoxifen. 

If you experience any new symptoms it is important to discuss them with your GP, specialist or breast care nurse.

4. Radiotherapy

Radiotherapy uses high-energy x-rays to destroy cancer cells. It’s given to reduce the risk of the cancer coming back.

Radiotherapy may be given to the chest wall after a mastectomy if the cancer was large or near the chest wall.

If you have a wide local excision (lumpectomy), you will usually be offered radiotherapy to the chest area. 

You may be offered radiotherapy to the lymph nodes under your arm.

Side effects of radiotherapy

Side effects of radiotherapy include:

• Skin reactions
• Swelling 
• Hair loss in the area treated
• Tiredness and fatigue

Find out more about side effects of radiotherapy.

5. Chemotherapy

Chemotherapy destroys cancer cells using anti-cancer drugs. 

Different types of chemotherapy drugs are used to treat breast cancer. They can be given in different ways and in different combinations.

Chemotherapy is commonly given in addition to surgery or radiotherapy to treat primary breast cancer.

Chemotherapy can be given:

• After surgery to reduce the risk of cancer coming back (known as adjuvant chemotherapy)
• Before surgery to slow the growth of rapidly growing breast cancer, or to shrink a larger breast cancer (primary or neo-adjuvant chemotherapy)

The benefit of chemotherapy might be clear for some people but less clear in other cases. Your treatment team may suggest a test to help decide whether you would benefit from chemotherapy. There is more information about these tests on our chemotherapy page.

Side effects of chemotherapy

Side effects of chemotherapy include:

• Increased risk of infections
• Hair loss
• Nausea and vomiting
• Fatigue 

Find out more information about side effects of chemotherapy.

Effects on fertility 

Chemotherapy can affect sperm production, which can lead to temporary or permanent infertility in men. If you’re concerned about infertility, talk to your specialist before beginning treatment.

Sperm banking is a way of storing some of your sperm so that it can be used to artificially inseminate your partner at a later date. Artificial insemination involves putting the sperm directly into your partner’s womb. 

You can find more information about sperm banking on the Cancer Research UK or HFEA websites.

6. Targeted (biological) therapies 

This is a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that cause cancer to grow. 

The most widely used targeted therapies are for people with HER2 positive breast cancer. HER2 is a protein that makes cancer cells grow. 

Breast cancer in men is less likely to be HER2 positive. However, if your cancer is found to be HER2 positive you may be offered drugs such as trastuzumab and pertuzumab.

All the large-scale studies on these drugs have so far been on women, so the specific benefits for men are not fully known.

7. Blood clots

People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer.

If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.

Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.

If you experience any of the following symptoms contact your local A&E department, GP or specialist team straight away:

• Pain, redness/discolouration, heat and swelling of the calf, leg or thigh
• Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
• Shortness of breath
• Tightness in the chest
• Unexplained cough (you may cough up blood)

Find out more about blood clots.

8. When treatment finishes 

You will continue to be monitored after your hospital-based treatments finish. This is known as follow-up. 

How you are followed up will depend on your individual needs and the arrangements at the hospital you’ve been treated in. 

Find out more about follow-up after treatment.

Worries about the cancer coming back

Most people worry about breast cancer coming back. These worries are normal, and the fear and anxiety usually lessens with time.

While most people have no further problems, sometimes breast cancer can return after treatment.

Knowing the symptoms you should report can help manage your feelings of uncertainty. 

Moving forward

Finishing treatment at your hospital can sometimes mean leaving behind the routine and support you’ve become used to. It may have left you feeling alone.

Coping with the shock of a diagnosis, treatment and side effects, and worries about recurrence can make it difficult to readjust to the everyday. 

That’s why Moving Forward is here. Through supportive, open conversations in a safe, confidential space, you’ll connect with people who understand. And you’ll find the tools you need to feel more empowered, confident and in control. Ready to move forward with your life.

Our Moving Forward booklet and course look at issues that you may face at this time, from the physical side effects of treatment like fatigue (extreme tiredness) to how you feel about your relationships and the future.