Cases of male breast cancer (MBC) are likely to rise over the next quarter century in certain regions – including southern sub-Saharan Africa – say researchers who, after a large analysis, suggested that the global burden of MBC had significantly increased from 1990 to 2021 – but with notable geographic disparities.
They said efforts aimed at prevention and control strategies should take into account the inequities in the global distribution of MBC.
This year, about 2 800 men will be diagnosed with breast cancer and approximately 510 will die from the disease, while in comparison, about 316 950 women will be diagnosed in 2025 and 42 170 will die.
Yet, while male breast cancer accounts for less than 1% of all breast cancer cases, this still means that one in 726 men will develop breast cancer in their lifetime.
The American Cancer Society says although that statistic may not sound as daunting as the equivalent for women – one in eight will be diagnosed in their lifetime – the fact that male breast cancer is so rare makes it uniquely challenging.
And, write Chinese researchers in The Lancet who undertook a systemic analysis of the global, regional, and national burden of MBC in 204 countries and territories, evidence indicates it poses a significant global public health challenge, yet with notable geographic disparities in its burden.
“Although global incidence and mortality rates have increased from 1990 to 2021, they are expected to decrease by 2050: however, certain regions, like sub-Saharan Africa, for instance, may see rising rates due to demographic changes and shifting risk factors by 2025,” they noted.
The study, led by a team from Chongqing Medical University, China, is the first to provide a comprehensive, global analysis of MBC using data from the Global Burden of Disease Study 2021, identifying geographic disparities and exploring the influence of risk factors like diet, alcohol use, and tobacco consumption on MBC-related deaths and disability-adjusted life-years (DALYs).
The authors said it offered new insights into the epidemiology of MBC. Moreover, it provides lifetime risk estimates and projections of MBC incidence, prevalence, mortality and DALYs to 2050, filling a critical gap in the literature and guiding healthcare strategies for prevention and control.
Variations
Their findings suggest that the epidemiological features of the MBC burden showed significant regional variations in age-standardised rates of incidence, prevalence, mortality, and DALYs across countries and territories.
Alcohol use, dietary risks, and tobacco were important modifiable contributors, making them crucial targets for decreasing the global burden of male breast cancer in the future, they said.
In 2021, a greater MBC burden regarding incidence, prevalence, mortality and DALYs was found in Eastern sub-Saharan Africa, which encompassed 14 of the top 20 countries with the highest age-standardised rates of incidence (ranging from 1.80 to 4.54 per 10 000 people) among the 204 countries and territories, namely Uganda, Zambia, Mozambique, Kenya, Malawi, South Sudan, Djibouti, Rwanda, Somalia, Eritrea, Ethiopia, Comoros, and Burundi.
The researchers said race may contribute to the high incidence in this region – mainly inhabited by black populations – as black men have been reported to have a higher MBC incidence risk than other races, which may be linked to genetic factors, lifestyle choices, and socio-economic determinants of health.
To address this, healthcare policies in this region could focus on reducing disparities by providing equitable access to healthcare services, including screenings, and ensuring that these services are culturally and linguistically appropriate for minority populations.
Conversely, Zimbabwe had a relatively low MBC burden, which may be attributed to under-reporting or delayed diagnosis, potentially caused by severe political, economic, and social crises, as well as a significant unawareness of breast cancer in the country.
In addition, East Asia and high-income North America also had a relatively higher MBC burden in terms of age-standardised rates of incidence and prevalence, but the mortality and DALYs rates in these areas are comparatively low.
This may be attributed to advanced healthcare infrastructure that enable early detection and effective treatments, leading to improved survival and reduced disability, said the researchers. Healthier lifestyle habits, such as improved diet and lower alcohol consumption, could also contribute.
Going up…
From 1990 to 2021, the global MBC burden was significantly increased, with East Asia, Tropical Latin America, Caribbean, and Central Asia being the top four regions showing significant increases in age-standardised rates of MBC incidence.
The countries included in these four regions are mainly in middle or high-middle SDI quintiles. Several factors may contribute to this increase. First, these regions have undergone demographic transitions, including increasing life expectancy and ageing populations, which may contribute to the higher incidence of male breast cancer.
Additionally, improvements in healthcare infrastructure, diagnostic capabilities, and social awareness have enhanced detection and reporting, uncovering previously under-diagnosed cases rather than a true rise in incidence.
The increase in cases may also be partly driven by changes in certain risk factors, particularly those influencing oestrogen levels either directly or indirectly.
These factors include increased alcohol consumption, potential radiation exposure, the growing prevalence of obesity, physical inactivity, poor dietary habits, and hormone therapy use among transgender women.
However, unlike female breast cancer, which has declined in middle high and high-SDI regions due to successful prevention and screening efforts, male breast cancer incidence in middle or high-middle SDI regions continues to rise, said the researchers. This reflects the complex interaction of demographic, socioeconomic, social cognition, and lifestyle factors.
Moreover, the age-standardised mortality rates were significantly increased in 10 of the 21 regions from 1990 to 2021, whereas Eastern Europe, high-income Asia Pacific, Australasia, and Western sub-Saharan Africa experienced significantly decreased mortality rates.
The decline in mortality and DALYs in these regions may be attributed to advancements in targeted therapies and surgical interventions, which have improved survival rates and reduced disability associated with MBC.
Over the next three decades, the authors’ projections suggest that the global age-standardised rates of incidence, mortality, and DALYs for MBC, will decrease, with Southern sub-Saharan Africa, Western Europe, and Southern Latin America expected to experience the largest reductions in these respective metrics.
The decline in MBC incidence in Western Europe over the next 30 years may be attributed to several interrelated factors. First, the advancement of precision medicine enabling high-risk individuals to undergo earlier genetic screening and tailored risk interventions, particularly those with BRCA1/2 mutations or a strong family history.
Additionally, strict regulatory measures on industrial pollutants and endocrine-disrupting chemicals may educe environmental exposures linked to MBC.
Previous studies have suggested that rural areas, where industrial pollutants and endocrine-disrupting chemicals may be more prevalent, could experience higher incidences of MBC.
Africa
In sub-Saharan Africa, the increase in healthcare funding and the gradual expansion of oncology services are beginning to address historical disparities in cancer care, which probably contribute to the observed reductions in mortality rates in the region.
The study authors said various risk factors may contribute to the development of male breast cancer, including modifiable risk factors like obesity and physical inactivity, and non-modifiable risk factors, like age and family history.
The analysis showed that dietary risk was also an important risk factor for MBC deaths (11.69%) and DALYs (11.74%) worldwide, while a diet high in red meat was the major dietary risk leading to male cancer deaths and DALYs.
Unhealthy dietary patterns, particularly the excessive consumption of red meat and processed foods, are linked to metabolic changes and increased inflammation, which may contribute to worse MBC outcomes.
The researchers said their study goes beyond cross-sectional analysis by projecting MBC trends up to 2050, aiding future healthcare planning and resource allocation, particularly in regions with rising incidence.
It also addresses a critical gap by including lifetime risk estimates and evaluating the impact of modifiable risk factors – dietary risks, alcohol use, and tobacco – on subsequent deaths and DALYs, offering valuable guidance for public health strategies and prevention efforts.
Nevertheless, several limitations need to be clarified. First, the limited diagnostic capabilities and absence of population-based cancer registries in some developing countries may lead to the under-diagnosis or under-reporting of MBC in these regions.
Additionally, their estimates and projections do not account for the potential impact of the Covid-19 pandemic on MBC burden between 2022 and 2023, as these data were not available at the time of this analysis.
Therefore, their forecasting results should be interpreted independently of the pandemic’s influence.
They added that the risk factor analysis for developing male breast cancer was unavailable in the Global Burden of Disease 2021 study and only limited behavioural risk factors, like alcohol use, dietary risks, and tobacco, were available for the analysis of MBC-related deaths and DALYs.
Other potentially important factors, including oestrogen, environmental exposures, and genetic risk factors – on which most MBC-specific prevention strategies rely – are not included in the Global Burden of Disease study, which could be valuable for further research on MBC.
Finally, comorbidities are critical factors contributing to MBC-related deaths, but the Global Burden of Disease study of 2021 does not provide data on this aspect.
They said future research should address the broader disease burden in MBC patients, including mortality related to comorbidities, to provide a more comprehensive understanding of the impact of male breast cancer on overall health.
Study details
Global, regional, and national burden of male breast cancer in 204 countries and territories: a systematic analysis from the global burden of disease study, 1990–2021
Yunhai Li, Ying Huang, Hongbo Huang, Tingting Wei et al.
Published in The Lancet in February 2025
Summary
Background
Male breast cancer (MBC) is a rare malignancy that has been under-investigated, with limited global epidemiological research dedicated to it. A comprehensive estimate of the global, regional, and national burden of MBC is valuable for policy planning. This study aims to evaluate the burden of MBC across 204 countries and territories.
Methods
MBC data were collected from the 2021 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates spanning from 1990 to 2021. The global incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) attributed to MBC, as well as corresponding age-standardised rates, were calculated. Temporal trends, projections of incidence and mortality to 2050, lifetime risk, and risk factors of MBC were also estimated according to regions and countries.
Findings
In 2021, there were 38,827 (95% uncertainty interval [UI], 24,650–47,846) new cases, 320,459 (95% UI, 220,533–384,317) prevalent cases, 13,274 (95% UI, 9074–16,240) deaths, and 380,917 (95% UI, 252,922–476,417) DALYs attributed to MBC worldwide, with the highest disease burden observed in the Eastern Sub-Saharan Africa region. From 1990 to 2021, the age-standardised incidence and mortality rates of MBC significantly increased, but they are projected to decrease over the next 30 years. High-middle socio-demographic Index (SDI) quintile had the highest lifetime risk of developing MBC, while the low SDI quintile had the highest lifetime risk of dying from MBC. Dietary risk and alcohol use were identified as important risk factors for MBC deaths and DALYs globally.
Interpretation
The global burden of MBC significantly increased from 1990 to 2021, with notable geographic disparities. Efforts aimed at MBC prevention and control strategies should take into account the inequities in its global distribution.
Global Burden of Disease 2021: Findings from the GBD 2021 Study (Open access)
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