A clinic visit men don't expect to make
Most people associate breast cancer with women. They aren't wrong — male breast cancer is rare, accounting for less than 1 in 100 cases.
But men do get breast lumps. When they appear, both the man and his doctor are usually unsure what to do next.
A new audit of one UK breast clinic shows what tends to happen — and where the system can do better.
Male breast referrals are common in symptomatic breast clinics, even though most don't turn out to be cancer. The most common cause is gynecomastia, a benign enlargement of breast tissue. Other causes include benign cysts, fatty tissue changes, and side effects of certain medications.
The challenge is that doctors, understandably cautious, often order imaging "just to be sure." That can mean unnecessary mammograms or ultrasounds, exposure to radiation, anxiety while waiting for results, and added pressure on already-busy clinics.
To address this, the UK Association of Breast Surgery has issued guidelines designed to reduce unnecessary imaging in men. Whether clinics actually follow those guidelines is a different question.
The old way versus the new way
Before standardized guidelines, the approach to male breast referrals varied widely. Some clinics imaged nearly every patient. Others relied mostly on physical exam.
The newer guidance is more selective. It uses age, clinical findings, and risk factors to decide who actually needs imaging and what type. Younger men with classic gynecomastia features, for example, often don't need a mammogram. Older men with concerning lumps usually do.
This study tested how closely one busy UK clinic actually stuck to the guidelines.
Imagine being asked to tell apart two similar-looking objects, one harmless and one rare but dangerous. The natural impulse is to use every tool available, just to be safe.
That's roughly the dilemma in male breast clinics. The vast majority of lumps are benign, but the small fraction that turn out to be cancer can be devastating if missed.
The newer approach tries to rebalance the equation. A skilled exam, a clear history, and a knowledge of which medications can cause breast tissue changes can rule out cancer in many cases without imaging. When imaging is needed, ultrasound is usually preferred over mammography for younger men because it doesn't involve radiation and works well in dense or small amounts of breast tissue.
The study snapshot
The team reviewed every male patient referred to the symptomatic breast clinic at King George Hospital in the UK during 2022 — 148 patients in total. They recorded clinical presentations, breast exam scores, imaging used, biopsy results, and current medications. They then compared the imaging pathway followed for each patient against the 2021 Association of Breast Surgery guidelines.
The vast majority of referrals turned out to be benign. Gynecomastia and related benign conditions dominated the diagnoses. Cancer was identified in only a small minority of cases.
Despite the low cancer rate, imaging was often performed even when guidelines did not require it. Younger men in particular received imaging that the guidelines suggested could safely be avoided.
The audit also identified patterns in medication use — several drugs known to cause gynecomastia appeared frequently in the patient histories, often unrecognized as the likely cause of the lump until the clinic visit.
This doesn't mean the doctors involved were doing anything wrong. It reflects a system-wide caution that the guidelines are trying to recalibrate.
Where this fits in the bigger picture
Reducing unnecessary imaging is a recurring goal across modern medicine. Less imaging means less radiation exposure, less anxiety for patients, lower costs, and faster appointments for the people who genuinely need them.
But changing established habits is hard. Doctors who fear missing a rare cancer often find it safer to image than not. That instinct is understandable and sometimes correct, but applied broadly it leads to overuse.
This audit fits a pattern across many healthcare systems — small, careful studies that document where guidelines and practice are out of sync, then push for incremental change.
If you're a man with a new breast lump or persistent breast tissue change, don't ignore it. Most causes are benign, but a doctor's evaluation is the right first step.
What you can ask: is imaging actually recommended for someone in my situation, or is it being ordered out of caution? And: are any of my current medications known to cause this?
For most younger men with classic gynecomastia, a careful clinical exam and a review of medications may be enough. For older men with new, firm, or unilateral lumps, imaging is usually indicated.
This was a single-center audit covering one year. Practice patterns differ between hospitals and countries. The cancer detection rate may also differ depending on the population being referred. The audit also could not assess long-term outcomes — whether men whose imaging was skipped came back later with missed disease.
The findings are likely to inform ongoing efforts within UK breast clinics to improve guideline adherence. Wider audits across multiple centers would clarify how representative this picture is, and educational efforts targeting referring GPs could help reduce inappropriate imaging at the source.