Richard Roundtree's Story: Yes, Men Can Get Breast Cancer

A diagnosis in 1993, and thirty more years

Richard Roundtree played detective John Shaft and became one of the defining screen presences of the 1970s. BBC News reports that he was diagnosed with breast cancer in 1993 and underwent a double mastectomy.

He died at home in Los Angeles on a Tuesday afternoon in October 2023, aged 81, with his family beside him. His manager Patrick McMinn told The Hollywood Reporter that his death followed a short illness with pancreatic cancer. Those were two separate diseases, three decades apart.

The part of his story that keeps mattering is the first diagnosis, because most men do not know it is possible.

How rare, exactly

For 2026 the American Cancer Society puts breast cancer in men in the United States at about 2,670 new cases and 530 deaths. Readers usually meet a number like this in the National Cancer Institute's PDQ summary, which still carries the Society's 2025 figures of 2,800 and 510, but the Society is the source either way. Set the 2026 count beside the 321,910 cases projected in women for the same year and the ratio is clear.

Rare is not the same as nonexistent. Rarity is also why male breast cancer gets found late. Neither the patient nor the clinician is expecting it.

Where it comes from

NCI lists the predisposing risk factors. Radiation exposure to the breast or chest is one. Estrogen exposure is another. So are conditions that raise estrogen levels, such as cirrhosis of the liver or Klinefelter syndrome.

Family history carries real weight. NCI notes clustering in families with BRCA pathogenic variants. Risk is higher with inherited BRCA2 variants than with BRCA1. The figures are specific. By age 70, men have an estimated cumulative breast cancer risk of 1.2 percent with a BRCA1 variant and 6.8 percent with a BRCA2 variant.

NCI adds other genes to the list: PTEN, TP53 in Li-Fraumeni syndrome, PALB2, and the mismatch repair genes associated with Lynch syndrome.

That has a practical consequence. A man diagnosed with breast cancer is a reason for genetic counseling in his family, including for his daughters and sisters.

When to get checked

• A firm lump under or near the nipple, the usual first sign
• A lump in the armpit
• A nipple that has turned inward or changed shape
• Nipple discharge, especially with blood
• Chest skin that is dimpled, puckered, scaly, or red
• A sore on the nipple that will not heal
• Swelling on one side of the chest only

Painless is the norm, and painless is what gets ignored. A lump behind a man's nipple lasting more than two or three weeks needs an examination. Waiting to see is the wrong move.

How it is worked up

NCI is precise about the sequence. For men aged 25 or older, or for anyone with a highly concerning physical examination, mammography is recommended as the initial test. Ultrasound is useful when the mammogram is inconclusive or suspicious.

Suspicious findings are then confirmed with a core biopsy. That takes a cylinder of tissue rather than just cells. If cancer is confirmed, NCI states that estrogen receptor, progesterone receptor, and HER2 status should be evaluated.

Note that mammography is used here for a man with a symptom. That is a diagnostic test, not screening. NCI does not recommend routine screening mammography for men.

The biology is different from the average

This is where male breast cancer stops being simply a rarer version of the same disease.

Ductal cancer is the most common type in men, and invasive lobular carcinoma is very rare. More striking, NCI states that "breast cancer in men is almost always hormone receptor positive." In one series it cites, 99 percent of tumors were estrogen receptor positive, 82 percent were progesterone receptor positive, 9 percent were HER2 positive, and 0.3 percent were triple negative.

Compare that with breast cancer in women, where triple-negative disease is a substantial subgroup. Practically, it means hormone-blocking therapy is central to treatment in nearly every man diagnosed.

Treatment, and one specific caution

NCI states that primary treatment is a mastectomy with evaluation of the lymph nodes in the armpit. The anatomy makes breast-conserving surgery less practical here. There is little breast tissue to conserve.

Hormone therapy follows for the great majority. NCI flags an important difference from practice in women. Aromatase inhibitors, widely used in postmenopausal women, do not perform the same way in men.

NCI cites a retrospective analysis of 257 men with stage I to III breast cancer, 50 treated with an aromatase inhibitor and 207 with tamoxifen. At a median follow-up of 42 months, the aromatase inhibitor group had a higher risk of death, 32 percent versus 18 percent, with a hazard ratio of 1.55. That study was retrospective rather than randomized, so it shows an association rather than proving cause. NCI's guidance is nonetheless explicit. In men who cannot take tamoxifen, "single-agent AI therapy is not recommended." Aromatase inhibitors should be combined with a GnRH analogue.

If you are a man on hormone therapy for breast cancer, that is a reasonable thing to ask your oncologist about by name.

What predicts the outcome

NCI separates the two kinds of factor cleanly. Tumor size, lymph node involvement, and grade are the anatomical prognostic factors. They describe how far along the cancer is. Estrogen receptor, progesterone receptor, and HER2 status are predictive factors, describing which treatments are likely to work.

Stage at diagnosis dominates here as it does elsewhere. That returns the question to how quickly a lump gets examined.

The second cancer, named accurately

Roundtree died of pancreatic cancer, a separate disease with nothing to do with his breast cancer.

NCI gives two blunt reasons pancreatic cancer is usually found late. "There are no noticeable signs or symptoms in the early stages," and "the pancreas is obscured by other organs in the abdomen." Its later symptoms are jaundice, dark urine or pale stools, pain in the upper or middle abdomen and back, unexplained weight loss, and loss of appetite. Any of those warrants a prompt appointment.

What the numbers can and cannot say

These are group figures drawn from registries and trials. Male breast cancer is rare enough that some of its evidence comes from small retrospective series rather than large randomized trials. That is a real limitation. It is also one reason trial participation matters in uncommon cancers.

What is not uncertain is the point his diagnosis makes. Men have breast tissue, breast cancer can start there, and a lump is a lump.

Sources

• https://www.bbc.co.uk/news/entertainment-arts-67191245
• https://www.cancer.gov/types/breast/hp/male-breast-treatment-pdq
• https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
• https://seer.cancer.gov/statfacts/html/breast.html
• https://www.cancer.org/cancer/types/breast-cancer-in-men/about/key-statistics.html
• https://www.cancer.org/research/cancer-facts-statistics.html