Somewhere in the back of his mind, 77 year-old Donald knew that men could get breast cancer. He remembered the sad case of a local man in his early 50s who succumbed to the disease after it spread to vital organs.
On vacation earlier this year, he noticed a hardness in his left breast while showering. His wife, Virginia, thought the nipple appeared inverted and a darker color than unusual. Donald readily admits that without his wife’s observation and insistence that they cut their vacation short, he likely would have procrastinated and delayed seeing a doctor.
How does it feel to be a man with breast cancer?
A few tests and several weeks later, the shocking diagnosis of breast cancer became reality. Cancer is cancer and it’s never a welcome diagnosis. But how does it feel to be a man with breast cancer? Donald says, “Initially, I wanted to tell people I had a ‘chest cancer’ or a ‘breast tumor.’ However, we decided to ‘tell it like it is’ largely out of respect to our deceased young man. I do sort of joke about having a ‘woman’s disease,’ but responses are very supportive.”
Donald hopes that his openness will help other men to realize that they can get breast cancer, too, and he encourages men to promptly check out any suspicions. He suggests that men seek references from others, most likely women, who have had breast cancer and can refer them to specialists and support.
“Don’t be ashamed or embarrassed, it’s too important to you and your loved ones to delay treatment,” he cautions.
As for Donald and Virginia, the word “cancer” still elicits a certain amount of fear, but they are very optimistic about his prognosis. He is still undergoing chemotherapy and has yet to begin radiation treatment. The St. Louis Cancer and Breast Institute doctors and staff, along with community religious groups provide support and encouragement for which he is very grateful. He hasn’t actually felt the need to join a support group, but says that may come later.
Rare, but Not Unimportant
Breast cancer in women is about 100 times more common than in men, says surgical oncologist Dr. Diane Radford, who specializes in breast cancer and breast diseases. “There are just under 2,000 new cases of breast cancer in men in the U.S. per year, and just under 400 deaths. To put in perspective almost 40,000 women die of breast cancer each year.”
Because male breast cancer is not a common occurrence, many people don’t even realize men can get breast cancer. When men do find a lump or something unusual on their chest, they generally don’t think of cancer and put off going to the doctor. That’s a big mistake because, as Dr. Radford explains, “Stage for stage cure rates for male breast cancer are similar to females, however, males are more likely to be diagnosed with more advanced stage and with lymph node involvement.”
As with women, she says, any symptoms or signs need to be evaluated. The vast majority of breast cancers in men are of the ductal type.
Next: Signs & Symptoms / Risk Factors / Treatment / Research / Takeaways
Signs and Symptoms of Breast Cancer in Men
- a breast mass — these are usually firm and painless, most commonly occurring below the nipple
- skin changes (tethering)
- nipple discharge
- scaling of the nipple
Risk Factors for Breast Cancer in Men
- gynecomastia (enlargement of the male breast)
- elevated estrogen levels
- therapeutic radiation exposure
- Klinefelter’s syndrome
- inherited BRCA2 mutation — males who are carriers of a deleterious BRCA2 mutation have a 6-8 percent lifetime risk of breast cancer, whereas female carriers have a risk of 50-80 percent. Dr. Radford makes it a practice to test male breast cancer patients for BRCA1/2 mutations.
Treatment for Breast Cancer in Men
“Mastectomy will be the most common surgical treatment, although breast conservation could be offered,” says Dr. Radford. “Adjuvant treatment (radiation, chemotherapy, endocrine therapy) will be decided based on stage, estrogen receptor status of the tumor, etc.”
Dr. Michael Musci, medical oncologist from Ironwood Cancer & Research Centers, adds: “The treatment protocol is slightly different for men than for women. The surgical treatment for men is modified radical mastectomy. Women often choose lumpectomy because they want to conserve their breasts. Men aren’t usually too concerned about saving breast tissue. Male breast cancer is most commonly treated with radiation, chemotherapy and/or tamoxifen, which is similar to treatment in females with breast cancer.”
Men can get all the same types of breast cancers that women do — progesterone receptor positive and negative, estrogen positive and negative, and HER2 positive and negative — and triple-negative breast cancer, which does not respond to hormone treatments like tamoxifen, says Dr. Musci.
Next: Research / Takeaways
Research into Breast Cancer in Men
The world’s largest study into the genes that cause breast cancer in men shows similarities with female breast cancer, but identifies differences that could potentially lead to treatments specific to males. Results of the study conducted by Breakthrough Breast Cancer and The Institute of Cancer Research (ICR) are published in the journal PLoS Genetics.
The research team studied 433 men with breast cancer and found that among the 12 most common genes that contribute to breast cancer in females, five add risk in men, although at a lesser rate.
“It is exciting that this study is already producing results because we know so little about male breast cancer,” said Professor Anthony Swerdlow from the ICR. “We hope that this work will provide us with a much better understanding of the disease and allow us to find ways to prevent it.”
Another study presented at the 2011 Breast Cancer Symposium revealed that, on average, men are older than their female counterparts when diagnosed with breast cancer and frequently have more lymph node involvement. Study authors suggest this may be due to a “lack of awareness” among physicians and patients.
This study included information on 2,475 men and 393,259 women with breast cancer. While the average age for men at diagnosis was 67, it was 61 for the women. Lymph nodes were involved in 32 percent of the men, versus 22 percent of the women. The study did not include information on risk factors like BRCA or family history.
“While the study itself has some limitations, the authors confirm what has been shown historically. Breast cancer in men occurs later in life, is frequently associated with a delay in diagnosis, and is commonly associated with lymph node involvement,” said Gail S. Lebovic, MD, a member of the 2011 Breast Cancer Symposium News Planning Team and past president of the American Society of Breast Disease. “Although breast cancer is rare in men, these findings demonstrate that it is critically important to continue to raise awareness about the occurrence of breast cancer in men.”
This article was prompted by an email I received from someone who was had spent years trying to get more information regarding male breast cancer. That really got to me. Indeed, information specific to male breast cancer is hard to come by. However, there are a few takeaways:
- 1. Everyone should do what they can to educate themselves about the known causes of cancer, and make healthy lifestyle choices.
- 2. No matter how good those lifestyle choices may be, don’t ever fool yourself into thinking that cancer can’t happen to you.
- 3. If you’re a man, don’t assume that you cannot get breast cancer.
- 4. Whether you’re a man or a woman, be familiar with your own body. A lump in the chest area should be checked out so you know what you’re dealing with. If it is cancer, the earlier you begin treatment, the better your chances of a positive outcome. The good news is that most breast/chest lumps turn out to be benign.
It’s Breast Cancer Awareness Month, so please share information and support wherever you can.
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