How Does Breast Cancer Affect Black Men?

Breast cancer doesn’t just hit Black women hardest, it’s a problem for Black men too. Only 2% of breast cancer cases in the United States are in men, but Black men are disproportionately impacted by the disease compared to White men.¹

A recent study found that even when receiving similar treatment, Black men ages 18 to 64 were 76% more likely to die from breast cancer than White men, underscoring the differences in the impact of insurance and income on outcomes between White and Black men.² The reasons for these disparities remain a mystery.

While much research has been done to figure out why Black women have worse survival rates than White women, similar research has not been done in Black men. 

Symptoms of Breast Cancer in Black Men

The main sign of breast cancer in Black men is a lump in the breast, although the nipple and adjacent breast tissue may be affected.

Most lumps and swellings are not a sign of cancer, but you should never categorically ignore them. They’re usually caused by something fairly harmless, such as enlarged male breast tissue (gynecomastia), a fatty lump (lipoma), or a fluid-filled bump (cyst).

Even though rates of breast cancer in Black men are relatively low, all lumps should be checked by a healthcare provider. 

Other signs of breast cancer to look for include:

• Swelling of the breast
• Swollen glands, especially under the armpit
• Bloody or red nipple discharge
• Red or hardened breast tissue

Of note, men with a lump in their breast usually have one or more of these specific characteristics:

• Occurs in one breast
• Grows under or around the nipple
• Painless 
• Non-mobile
• Feels hard or rubbery
• Feels bumpy rather than smooth
• Gradually grows in size over time

Causes and Risk Factors

The cause of breast cancer in Black men is largely unknown. Genetic damage to DNA is always found in breast cancer, but why or how this happens is a mystery. 

Still, there are known risk factors that can help unpack this story. They include:³

• Inherited genetic mutations (most notably BRCA1 and BRCA2 mutations)
• Acquired gene mutations: Exposure to radiation can damage DNA in cells. Mutations to tumor suppressor genes and oncogenes due to cancer-causing chemicals in our environment or diet may also play a role, but none have been identified as outright causes of male breast cancer.
• A family history of breast cancer: About one out of five men with breast cancer has a close relative, male or female, with the disease.⁴
• A personal history of cancer
• Prior exposure to radiation: Young men who have had radiation therapy for another condition, like Hodgkin’s lymphoma, are especially at high risk. 
• Hormone imbalance: Certain medical conditions can create a hormone imbalance in the body, increasing your risk of breast cancer.
• Smoking
• Heavy alcohol use
• Obesity
• Sedentary lifestyle: Approximately 3% of all cancer can be attributed to a lack of physical activity. There is strong evidence that 30 minutes of moderate-intensity exercise decreases the risk of breast cancer.⁴
• Older age: The average age for a man with breast cancer is 72 years old. Black men are often diagnosed at an even younger age. 

Some factors like smoking, obesity, and alcohol use are preventable factors, while others like older age, reproductive history, and your genetics are out of your control. More research is being done to highlight the many ways you can limit your cancer risk.

Effect on Black Men

Male breast cancer is a rare disease—it accounts for less than 1% of all breast cancers and less than 1% of cancer in general in men—but it’s becoming more common, especially in Black men.⁵

The burden of breast cancer in Black communities exists at each phase in the complex breast cancer care trajectory, from screening and follow-up of abnormal findings to treatment initiation and completion. These disparities are fueled and compounded by the racial wealth gap, which leads to frustrating delays in receipt of diagnosis and treatment.

Gaps in the U.S. healthcare system, like lack of health insurance and bias in health care, mean that timely access to health care is an elusive proposition for most Black men. 

Diagnosis

Black men typically detect breast cancer accidentally when they notice a lump or incidentally on a physical exam before symptoms have developed. A healthcare provider will conduct a detailed health history and clinical breast exam, and order additional tests—like a mammogram, ultrasound, or MRI—to help diagnose the breast lump.

Your provider may ask you to describe the size, location, and how your lump feels. Hard, painless lumps are more concerning.

The following questions may assist your provider in making a diagnosis:

• When did you first notice the lump?
• Is the lump in one breast or both breasts?
• Can you feel the lump if you change positions (such as going from lying down to standing, or sitting to standing)?
• What does the lump feel like (hard, tender, firm)?
• Have you noticed any areas of swelling near the breast or armpit?
• Is the lump fixed in one place or does it move?
• Have you experienced associated symptoms like breast pain, fever, or unexplained weight loss?
• Do you have a personal or family history of cancer (especially anyone in the family who has been found to have either a BRCA1 or BRCA2 mutation)?

Fortunately, most lumps that are identified turn out to be non-cancerous. If cancer is suspected, a biopsy must be taken. The two most common types are a fine-needle or larger core-needle biopsy, although some conditions may call for a surgical biopsy.

Selection of the type of biopsy is based on multiple factors, including the size and location of the mass, your preference, and access to resources.

Treatment

Finding optimal treatments for breast cancer in Black men is challenging because of how little is known about the race-specific differences that exist in tumor biology. What’s more, finding optimal management strategies has been difficult to determine because of the rarity of this disease, which makes randomized trials impractical.

Adjuvant chemotherapy and radiation therapy seem to decrease the likelihood of local recurrence, but five-year overall survival rates in Black men with breast cancer remain worse than for White men.⁶

Researchers believe that a personalized medical approach yields the best overall outcomes. The treatment option that is best for you depends on your age, the stage of cancer, and your overall health, therefore your treatment regimen may require a combination of chemotherapy, radiation, and surgery. 

Depending on the type of breast cancer and how advanced it is, you may need additional treatments that kill cancer throughout the body. These systemic treatments include:⁷

• Chemotherapy
• Hormone therapy
• Targeted drug therapy
• Immunotherapy

These medications can reach cancer cells by being ingested via the mouth or put directly in the bloodstream.

A team of healthcare professionals are needed to manage your treatment. An oncologist, a doctor who specializes in cancer treatment, will lead the care team. They will manage your care and share pertinent information with your primary care doctor. 

Discuss all of your treatment options—including your goals, medication side effects, and length of treatment—with your doctors to help make the decision that best fits your needs.

Access to Care

Black men are at higher risk for getting and dying from breast cancer than White men, and early detection is not happening sufficiently to stop this from happening due to lack of access to care.

Societal obstacles like lack of insurance and lower socioeconomic status are significant contributors to both the individual and systemic barriers that create delays in breast cancer treatment for many Black men, but the specific factors that contribute to racial disparities are rarely highlighted.

Additional barriers to care like medical mistrust, chronic stress, and biased medical recommendations further impact a Black man’s ability to obtain or comply with breast cancer treatments, even when money is not a factor.

Regardless of insurance or income status, Black men should seek the health care that they need. More and more local providers and larger hospital systems are providing cost-effective treatment services.

Open up a dialogue with your physicians about the difficulties of receiving treatment or getting to and from appointments. Oftentimes, the medical staff can assist you with securing free transportation to and from your medical appointment, like hospital shuttle services, or contact your health insurance company on your behalf to get lower-priced prescription medications.

Prognosis

Black men have the highest incidence rates of breast cancer—2.7 out of every 100,000 men, compared to 1.9 out of every 100,000 White men—and the lowest chance of recovery.³ 

Mortality rates in Black men are worse for late-stage breast cancers and breast cancer subtypes, like triple-negative that are resistant to treatment.

Like breast cancer in women, breast cancer in men can be hormone-receptor-positive or hormone-receptor-negative, as well as HER2-positive or HER2-negative, but it is unknown whether Black men experience the same high rates of hormone-receptor-negative, HER2-negative, and triple-negative breast cancer as Black women.

Younger black men with early-stage breast cancer are at the greatest risk. One study showed that there is a 76% greater risk for death in young Black men than younger White men, despite receiving similar treatment.

When insurance and income differences were adjusted, the difference in mortality rates between the two narrowed significantly, suggesting that access to care plays a major role in the racial disparities in male breast cancer mortality.²

Coping

Finding out that you have breast cancer can shake you to your core. Feelings of anger, confusion, resentment, numbness, and guilt are natural. Talking to your friends and relatives can help you to build or strengthen your support network.

Making a list of questions to ask your doctor can help you to form a plan that will help beat cancer, and knowing what to expect helps you to take charge of the situation. 

No two cancer journeys are the same. What’s right for you may not be right for someone else, but connecting with a support group may help. Knowledge and awareness of breast cancer disparities have risen in recent years, and there are many breast cancer support networks that serve Black men.

These local networks will not only help you to deal with your emotions and the challenges ahead, but also help prepare you for many of the practical things you and your family might need as you manage your treatment, such as finding childcare and securing financial support, like insurance or disability benefits and sick pay. 

A Word From Verywell

Breast cancer in Black men is rare, so it’s not surprising that less time and resources are dedicated to studying this disease. Because many Black men don’t consider the possibility that they may develop breast cancer, they may wait weeks, months, or even a year to talk to their doctor after noticing a breast symptom. This can result in a later-stage diagnosis and worsen health outcomes.

Early detection and treatment save lives, so if you feel or notice a lump, make your best effort to have a healthcare professional examine it as soon as possible. 

The emotional burden of breast cancer in Black men should not be overlooked. The lack of attention placed on this condition can make you feel like there is no support out there for you. These feelings of frustration are natural, but don’t let that stop you from getting the help you need. Having concerns about pain, receiving bad news, or cost is understandable, but treating breast cancer early saves money and may add years to your life.

If you are nervous, going to your appointments with a friend may ease your fears and concerns. Studies have shown that including loved ones in your care plan, and even formulating a plan that includes the thoughts of your family and trusted healthcare professionals, lead to better health outcomes. Was this page helpful?Article SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2019;4(1):pkz091. doi:10.1093/jncics/pkz091
2. Sineshaw HM, Freedman RA, Ward EM, Flanders WD, Jemal A. Black/White disparities in receipt of treatment and survival among men with early-stage breast cancer. J Clin Oncol. 2015;33(21):2337-2344. doi:10.1200/JCO.2014.60.5584
3. American Cancer Society. Cancer facts and figures for African Americans.
4. Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31-54. doi:10.3322/caac.21440
5. Ellington TD, Henley SJ, Wilson RJ, Miller JW. Breast cancer survival among males by race, ethnicity, age, geographic region, and stage—United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2020;69:1481–1484. doi:10.15585/mmwr.mm6941a2
6. Shin JY, Kachnic LA, Hirsch AE. The impact of race in male breast cancer treatment and outcome in the United States: a population-based analysis of 4,279 patients. Int J Breast Cancer. 2014;2014:685842. doi:10.1155/2014/685842
7. American Cancer Society. Treating breast cancer.

By Shamard Charles, MD, MPH

Medically reviewed by Doru Paul, MD

Source: VeryWell Health