The Male Breast

Gynecomastia is the enlargement of one or both breasts in a man. It often occurs at puberty, occurs with aging, or is drug-related. Figure 16-21 shows a 90-year-old man who was treated with diethylstilbestrol for carcinoma of the prostate and developed gynecomastia.

Carcinoma of the breast affects approximately 1000 men per year in the United States. More than 300 men per year die of metastatic breast cancer. The average age at the time of diagnosis is 59 years. The most common clinical manifestation, occurring in 75% of cases, is a painless, firm, subareolar mass or a mass in the upper outer quadrant of the breast.

The incidence of breast carcinoma in men, as well as in women, is highest in North America and in the British Isles;it is lowest in Japan and Finland. As in women, breast carcinoma in men most commonly metastasizes to the bone, lung, liver, pleura, lymph nodes, skin, and other visceral sites.

*The importance of breast self-examination has been recognized for more than 60 years. However, to date, the efficacy of this examination is not definitive. A large, randomized, controlled trial was conducted in 1997 by Thomas and associates in Shanghai and included more than 267,040 women, half of whom were given intensive training in breast self-examination; the other half were asked to attend training sessions on the prevention of low back pain. All women were observed for 5 years for the development of breast diseases. The study showed neither a significant difference in mortality rate in the two groups nor an earlier identification of breast disease in the group trained in breast self-examination. The authors' conclusion was that ''there was insufficient evidence to recommend for or against the teaching of breast self-examination.''

Back Pain Relief

Back Pain Relief

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