Question:

A male, 45-year old friend has confided in me that he has a small lump in his left breast. It is about 2 inches above his left nipple and hurts to the touch. The surrounding area is swollen. He's had this problem for about three weeks now, but he won't go and see his doctor. I know he is very worried about breast cancer. Could these symptoms be caused by other conditions? He is quite overweight and both drinks and smokes.

Answer:

The most likely cause of your male friend's tender lump is a non-cancerous lump related to a condition called gynecomastia. However, you must continue to encourage him to see his doctor. Any new breast lump in a male - or female - must be evaluated by a health professional.

Although breast cancer is uncommon in men, it surely does occur. An estimated 2,700 men will be diagnosed with breast cancer this year. Breast cancer in men has a higher mortality rate than breast cancer in women. About 500 men die each year of the disease.

Getting back to the condition that he likely has-gynecomastia. This is benign breast enlargement in a male. Most often both breasts are involved. When it is only one area of one breast, as you describe, that's when it's especially important to be sure that it is not breast cancer.

Some men have prominent breasts simply because they are overweight. But true gynecomastia is caused by an enlargement of the breast's glandular tissues, not by an excess of fat. The glandular tissue is concentrated under the nipple, but fat is spread around the whole breast area.

Gynecomastia is very common in teenage boys. About one-third of them will show some breast enlargement at the time of puberty. It is much less common in adulthood, occurring in less than 1% of men. Two-thirds of the cases involve both breasts. The breast enlargement is usually mild and painless. But about a third of men complain of tenderness.

When a reason for the gynecomastia can be identified, it is usually caused by a medication or liver disease. There is a long list of other much less common causes.

Of the many medications that sometimes cause gynecomastia, these are at the top of the list:

• Digoxin (Lanoxin) - used for heart disease

• Aldactone (Spironolactone) - a type of water pill

• Cimetidine (Tagamet) - a stomach acid blocker

• Ketoconazole (Nizoral)-used for fungal infections

• Finasteride (Proscar) and dutasteride (Avodart)-used for an enlarged prostate.

Street drugs (marijuana, amphetamines, and heroin) and liver disease caused by over-use of alcohol can cause gynecomastia.

A couple of other possibilities: He may have a fatty lump called a lipoma. This is a non-cancerous, localized growth of fat cells. But usually these are not tender to the touch.

The other consideration is an entity called "jogger's" or "marathoner's" nipple. Pain and tenderness of one or both nipples are quite common in people who do a lot of running due to the mechanical irritation of the runner's shirt rubbing up and down against the nipples. But usually this won't cause a lump.