Radiology

Mammography: Male Mammography

by: Ashley Yeaer, MD and Daniel Bradley, MD

Although more common in women, breast cancer is an important health concern that men should also be aware of. Mammography remains the gold standard for diagnosing male breast cancer and the importance of a comprehensive physical exam and thorough medical history should not be overlooked. Any palpable lumps, nipple discharge, or skin changes warrant prompt evaluation for underlying breast pathology. Understanding the presenting symptoms and risk factors for male breast cancer can help patients and providers know when mammography is appropriate for further workup of breast findings in the male patient.

When Is Male Mammography Recommended?

  • Men with symptoms: Lumps, nipple discharge, skin changes, or breast pain should be investigated.

Challenges of Mammography in Men

  • Small breast size: Smaller amounts of breast tissue in men can make mammographic images more challenging to interpret.
  • Dense gynecomastia: Overlapping dense breast tissue can obscure a potential cancer and ultrasound may be considered as an additional imaging tool if mammographic findings are indeterminate.

Gynecomastia vs. Breast Cancer

Gynecomastia is the enlargement of breast tissue and is a common mammographic finding in older men. Important imaging differences that help distinguish benign gynecomastia from cancer include:

  • Location: Gynecomastia is typically found behind the nipple (i.e. subareolar region).
  • Shape: Gynecomastia is usually a smooth, “fan-shaped” density while cancer is often irregular in shape.

Typical Findings in Male Breast Cancer:

  • Spiculated or Circumscribed Mass: Male breast cancer can present as an irregular mass with radiating spiculations on mammography. Male breast cancer may also present a well-defined mass with circumscribed borders.
  • Skin Changes: Skin thickening, dimpling, or nipple retraction, can be indications of underlying breast pathology.
  • Enlarged Lymph Nodes: Large lymph nodes in the armpit (i.e. axilla) warrant additional evaluation to exclude the possibility that disease has spread to local lymph nodes.
  • Calcifications: Although less common in male breast cancer, calcifications (tiny calcium deposits that can be seen on mammography) can sometimes be seen and indicate the presence of cancer. 

Conclusion

Recognizing the mammographic findings of breast cancer is essential to the accurate diagnosis and management of male breast cancer patients. Understanding the limitations of mammography and the importance of a comprehensive physical evaluation allows for a well-rounded approach to male breast health.

References

  1. Chantra PK, So GJ, Wollman JS, Bassett LW. "Mammography of the Male Breast." AJR Am J Roentgenol. 1995 Apr;164(4):853-8.doi: 10.2214/ajr.164.4.7726037. PMID: 7726037.
  2. Underferth, Danielle. “Mammograms for Men: What to Expect.” MD Anderson Cancer Center, www.mdanderson.org/cancerwise/mammograms-for-men--what-to-expect.h00-159387468.html.
  3. Evaluation of the Symptomatic Male Breast, acsearch.acr.org/docs/3091547/Narrative/.