Gynecomastia vs Breast Cancer

People often confuse disorders of the breast tissue especially because they seem to be non-existent in males. However, the truth is that gynecomastia is a disorder that exists solely in males!

Gynecomastia is a condition where there is harmless growth of male breast tissue. It is fairly common in guys during puberty and in new-borns of both sexes. The condition usually resolves within first few days in neonates and in 2 years for most adolescent males. Breast cancer, on the other hand, is a serious disease that involves malignant transformation of the breast tissue, in both males and females. The incidence of breast cancer in men is extremely low but definitely exists.

Other pathological causes for gynecomastia are Klinefelter’s syndrome, a genetic mutation causing breast growth along with other disordered secondary sexual characteristics or metabolic disorders like pituitary hormone deficiency, liver failure/cirrhosis and hyperthyroidism. The basic disorder is an imbalance between the androgen testosterone and estrogen ratio in the body. If estrogen rises or testosterone levels fall, breast development takes place in men. A good 25% cases of gynecomastia are the result of medications like spironolactone, cardiac medication like nifedipine, verapimil, antacids like omeprazole, prostate medications like finasteride/dutasteride and risperidone. Breast cancer, in contrast, is known to have a strong family history and incidences are higher in first-degree relatives. It is 100 times more common in women than men. The risk factors for breast cancer are female gender, lack of children, lack of breastfeeding, obesity, smoking, high alcohol intake and high fat diet.
Symptoms of gynecomastia are swollen breasts in men, on one or both sides, with or without tenderness. It is commonly associated with increase in the overall chest tissue. Pain and discharge are uncommon unless associated with more severe medical problems. Breast cancer presents in multiple manners. There might be pain in one or both the breasts, discharge from nipple, nipple retraction, shrivelling or dimpling of the breast/nipple skin, lump in the breast tissue or a change in the colour of the skin over the breast/nipple.

Diagnosis is usually made by a physical examination by a qualified doctor or a gynaecologist. A mammogram is routinely ordered to confirm or rule out the diagnosis of breast cancer. If the mammogram is not conclusive, then a fine needle aspiration might be done where a small sample of the breast tissue is taken using a needle and analyzed under a microscope for cancerous pattern.

Treatment for gynecomastia depends on the cause. If it’s due to certain medications, then they are withdrawn or the dose is reduced. Drugs are available to treat gynecomastia but surgery might be needed in long-standing cases. Breast cancer compulsorily needs chemotherapy/radiotherapy/surgical removal based on the kind of cancer and its stage. Close monitoring is needed post treatment for recurrence in case of breast cancer.

Prognosis for gynecomastia is very good. Breast cancer prognosis depends on stage and type of cancer. In general, if detected early, the prognosis is better.

Take home pointers:

Gynecomastia is a harmless swelling of breast tissue in males that commonly occurs in newborns and during puberty as well.
Breast cancer can occur in both men and women although rarely in men. It is a malignant transformation of breast tissue and may be fatal if left untreated.
Gynecomastia can occur due to medications and returns to normal on withdrawal of the offending medication. Medical treatment is available for gynecomastia.
Breast cancer must be detected early and treated immediately for better outcomes. A lump, discharge, pain, skin changes should prompt immediate attention by a qualified specialist.
Chemotherapy/radiation/surgery is available for breast cancer with good outcomes if detected in time.

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