Hyderabad: All you want to know about breast cancer in men

Hyderabad: A new study from Hyderabad has revealed that male breast cancer, a condition that receives little attention in clinical and public discourse, continues to reach doctors at advanced stages, raising concerns about awareness gaps and delays in care.

Researchers at Hyderabad’s ESIC Medical College and Hospital analysed 15 male patients treated between 2019 and 2025, publishing their findings in the Journal of the Association of Physicians of India(https://japi.org/article/japi-74-3-56).

The study offers a rare window into how this condition unfolds in a South Indian setting, where stigma, limited awareness, and uneven access to care shape how men experience this disease.

Diagnosis arrives too late

Of the 15 patients studied, 60% came to the hospital with stage III cancer, while another 26.7% had already reached stage IV by the time doctors confirmed the diagnosis. In total, nearly 87% of the men carried locally advanced or metastatic disease when they first sought care.

The gap between noticing symptoms and receiving a diagnosis stood at six months. Every patient presented with a lump in the breast, often accompanied by nipple retraction or skin changes.

"All patients presented with a retroareolar mass, frequently accompanied by nipple retraction or skin thickening," the authors wrote, adding that two patients arrived with ulcerated fungating tumours, a sign of disease that had progressed without intervention for some time.

Researchers noted that men tend to ignore or misread these signs, and that providers themselves sometimes fail to investigate further. The study described this as diagnostic inertia, a tendency within the medical system to underestimate the possibility of breast cancer in a male patient.

"Late recognition, shaped by stigma, low awareness, and diagnostic inertia, contributes to advanced presentation, particularly in resource-limited settings," the authors observed.

None of the 15 patients had a documented history of familial cancer, oestrogen exposure, radiation, or occupational carcinogen exposure, suggesting that awareness rather than risk profile drove the delays.

What the tumours looked like

The study found hormone receptor-positive cancers in 80% of patients, a profile that responds to endocrine therapy and generally carries a more manageable trajectory. However, 40% tested positive for HER2, a subtype that behaves more aggressively and demands targeted treatment. A quarter of patients carried what researchers described as a triple-positive profile, combining oestrogen, progesterone, and HER2 positivity.

Patients with HER2-positive or triple-positive tumours showed up with more advanced disease and greater lymph node involvement than others, pointing to a pattern where this subtype drives faster progression before detection.

"HER2-positive and triple-positive tumours correlated with more advanced presentation," the authors noted. "Among seven patients with T4 disease, four were HER2-positive. All 13 patients with lymph node involvement were HER2-positive or triple-positive."

At the last follow-up, nine patients, representing 60%, remained alive with the disease under control. Five had completed curative treatment, two continued on adjuvant endocrine therapy, and two stage IV patients had stable disease. Two patients with metastatic disease died due to progression.

However, access to targeted therapies remained inconsistent. Cost and infrastructure gaps meant that not every patient who needed advanced treatment could receive it. Radiotherapy and neoadjuvant chemotherapy were used less than evidence supports, pointing to holes in comprehensive care delivery.

"Radiotherapy was underutilised, despite evidence that it reduces local recurrence and improves survival in high-risk male breast cancer," the authors stated.

Where the system falls short

Four patients, representing 26.7%, dropped out of follow-up entirely. Researchers attributed this to financial pressures, distance from the hospital, and the absence of sustained support systems.

"These losses reflect systemic barriers such as travel constraints, treatment fatigue, lack of community support, and financial burden, issues widely reported in oncology settings across low- and middle-income countries," the authors wrote.

The study also pointed to limitations in diagnostic infrastructure. HER2 status was confirmed through immunohistochemistry, with dual in situ hybridisation used for uncertain cases because fluorescence in situ hybridisation was unavailable. The authors acknowledged that this gap could affect treatment decisions in borderline cases.

What researchers want changed

The authors called for awareness campaigns that speak directly to men, noting that male breast cancer sits outside the frame of most public health messaging in India. They pushed for male-specific protocols to enter national cancer guidelines, including those issued by ICMR, and argued for dedicated registries to track patterns in this population.

"We advocate for national policies that mandate inclusion of male-specific protocols in breast cancer guidelines," the authors stated. "Establishing male breast cancer registries and enabling gender-inclusive clinical trials are essential next steps."

They also called for equitable access to HER2-directed and endocrine therapies, arguing that durable outcomes achieved in this study demonstrate what treatment can deliver when it reaches patients.

"Biomarker-guided multimodality therapy achieved durable disease control in many patients," the authors concluded. "These findings underscore the need for earlier detection and awareness, as well as equitable access to targeted therapies across resource-limited settings."

Male breast cancer accounts for under 1% of all breast malignancies globally. That rarity, researchers argued, cannot justify the delays this cohort experienced, particularly when treatment, once delivered, produced results that held. The Hyderabad study stands as a call for the medical system to look beyond assumptions and extend the reach of early detection to everyone who needs it.