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Imagine telling someone you have breast cancer—and being laughed at.
It wouldn’t happen if you were female. But when men announce they’ve got breast cancer, “people sometimes think they’re joking,” says Nitin Rohatgi, M.D., medical director of the Breast Cancer Program at Sutter Cancer Center.
People don’t mean to be cruel or unfeeling. It’s simply a matter of ignorance.
“A lot of people don’t realize that men can get breast cancer,” says Rohatgi.
That’s the way it goes with rare diseases. They’re not written about much, talked about much or researched much. While breast cancer in American women is a raging epidemic, with about one in eight at risk of being diagnosed at some time in their lives, men’s lifetime risk for breast cancer is about one in 1,000, according to the American Cancer Society website, cancer.org.
The upshot? Tons of support for women with breast cancer.
For men, not so much.
WHAT WE KNOW
Researchers don’t mean to “dis” men with breast cancer. There just aren’t enough of them to study, according to Helen Chew, M.D., director of the clinical breast cancer program at UC Davis Cancer Center.
“It’s not that we want to exclude men,” says Chew. But when clinical trials are done, “most of the inclusion criteria will refer to women and not men, because having men won’t add a lot to the conclusion,” she says.
So here’s what we do know. While the most frequently repeated fact is that it doesn’t happen often—all three local doctors interviewed for this story say they see just a few cases a year, if any at all—we know that treatment options are the same for men as they are for women. Yep, men get mastectomies, along with radiation, chemotherapy and hormone therapy in the form of drugs such as tamoxifen. That, of course, leads to another question: Why should men, whose hormonal makeup is so markedly different from that of women, take the same kinds of hormone-suppressing drugs?
The answer, according to the National Cancer Institute, is that some 85 percent of all male breast cancers are estrogen receptor-positive, and 70 percent are progesterone receptor-positive. Obese men may be particularly vulnerable, says Ernie Bodai, M.D., director of the Breast Health Center at Kaiser Permanente Sacramento. “The theory is that fatty cells [produce and] store estrogen, so obesity is probably a factor in male breast cancer,” Bodai says. All three of the patients he treated for the disease so far this year were obese, he notes.
Family history and BRCA mutations have also been cited as risk factors. But Bodai believes it’s mostly a roll of the dice.
“Some men do carry the breast cancer gene, but it’s exceedingly rare,” he says. “I think it’s mostly just really a stroke of bad luck.”
NO SCREENING, DELAYED DIAGNOSIS
Since men don’t dutifully get annual mammograms like most women, early diagnosis is unlikely. “Breast cancer in men tends to be diagnosed later than in women,” says Sutter’s Rohatgi. “The stage of presentation is later because there is no screening.” A lump is typically the signal that sends men in for evaluation, by which time the disease is likely to be more advanced and the risk of death higher, says Rohatgi. The American Cancer Society projects that in 2010, nearly 2,000 men in the United States will be diagnosed with invasive breast cancer, and some 390 will die of the disease.
But the numbers don’t tell all. Bodai believes that there may be many men who have breast cancer and just don’t know it.
“There are probably a lot more males out there with breast cancer than the numbers indicate, because we don’t get screened,” Bodai says. “There are probably a lot who die with breast cancer, but not of breast cancer.” A man who dies of a heart attack or stroke, for example, may also have undetected breast cancer.
FINDING THAT LUMP
Interestingly, and perhaps not surprisingly, Bodai says he’s noticed that many men can’t take the credit for finding a lump themselves.
“My experience is that their partners are typically the ones who catch it,” he says. The shower is a good place for men to detect changes in the breast, he adds. The symptoms are similar as for women, including a lump or thickening of breast tissue, unusual changes to the skin (such as dimpling or redness) and discharge from the nipple.
While regular self-checks are not indicated for most men, those with known family risk factors (such as a BRCA mutation) may want to consider doing a self-exam twice a year and a mammogram once a year, suggests Rohatgi. Men diagnosed with breast cancer should also consider genetic testing, adds UC Davis’ Chew.
AWARENESS IS A GOOD THING
Chew admits the medical community tends to think of breast cancer as a woman’s disease, “and accurately so, because it generally is.” Still, she is empathetic to men with the disease and their frustrations with lack of support.
“This kind of frustration applies to people with any kind of really rare cancer,” says Chew. “You just don’t have the same kind of data or public support as those with more common forms of cancer.”
No one is suggesting it’s time to launch a massive male mammography initiative or spend big money on research. But a bit of raised awareness wouldn’t hurt.
“I wouldn’t start a national screening campaign for male breast cancer; it’s not that prominent a disease,” says Bodai. “But men should be aware they can get breast cancer.”
I HAD BREAST CANCER—HOW RANDOM IS THAT?
The host of “Golf Talk Radio Show” on KHTK Sports 1140 talks about his battle with breast cancer.
By Vince Mastracco
It started one night with an itch in my chest. My left nipple itched. When I scratched it, it felt on fire. Surprisingly, I also felt a bump. I told my wife, Patty, about it and she suggested applying a “calming cream.” The next day there was no irritation. A couple of weeks later, I checked for the lump again—it was still there. The irritation also came back. Sheepishly, I made a doctor’s appointment. No one seemed alarmed, so the appointment was casually scheduled for 3 weeks out. I almost canceled because I was scheduled to cover The Players Championship PGA Tour event in Florida that week. By now, though, I had done some online research and found that men could get breast cancer. An inner voice told me to skip the golf tournament and get checked. The lump appeared suspicious to my doctor, so I had to get a mammogram. It is not easy to do a mammogram on a man’s chest, but they did and immediately told me to get a biopsy. The next day, I had a fine-needle aspiration biopsy performed. A day later, the diagnosis was confirmed.
Here are some excerpts from my diary along with my subsequent thoughts.
TUESDAY, MAY 12, 2009—Last Thursday, I was diagnosed with breast cancer. Today, my wife and I met with the surgeon. My surgeon had previous experience with male breast cancer; that was important to me. Surgery was scheduled for May 26, but my daughter Abbey’s graduation from Long Beach State was May 28. No way was I going to miss that. Plus, I was so freaked out, I wanted the surgery right away. I have a dual career. I’m an agent with Lyon Real Estate and I host “Golf Talk Radio Show.” I decided to wait to inform KHTK, where my show airs, until after my surgery because that’s when we would know the extent of my condition. If I had to be a problem, I would be the one with a solution. I had to confidentially inform Lyon immediately because I had escrows open and would likely need backup support.
SUNDAY, MAY 17, 2009—My surgery was moved up to Tuesday, May 19. First prayer answered.
The surgery, a modified mastectomy, went well, although they did find an affected lymph node. I went home that very same night.
TUESDAY, MAY 26, 2009—Follow-up appointment with the surgeon. He said, “By the way, I have good news for you.” He was referring to my pathology report. My surgical margins were clear and no other lymph nodes were affected. I would, however, have to undergo chemotherapy. I attended my daughter’s commencement but didn’t tell her that I still had the drainage tube in my side. She’s off and running on a sports journalism career. I decided to cover the U.S. Open at Bethpage, N.Y., in June. She got a freelance assignment from the Long Beach Press-Telegram and joined me.
FRIDAY, JUNE 26, 2009—Took chemo Tuesday. Had belching and hiccups but did not throw up. Hate all the pills for nausea. Must eat some prunes today. I can feel it starting: constipation.
The treatment protocol for my tumor type and stage was four cycles of chemo administered intravenously at three-week intervals. I referred to them as my “happy hour” treatments. I was determined to be upbeat. After all, it could have been worse. I really tried to find the upside mentally because I knew that physically I’d be challenged for months. My prognosis was good, so no reason to be down. Throughout the chemotherapy, my throat was raw and my favorite “go to” food became fruit and juice bars. Everything else, and I mean everything, tasted metallic. My wife also made frozen bars out of Muscle Milk. Not particularly tasty, but I needed the nutrition.
TUESDAY, JUNE 30, 2009—I now have a blood disorder. It’s a common reaction. White blood cell count is precipitously low. Need a couple of shots. Patty’s birthday was yesterday. She had to take our son, Ben, to Palo Alto for shoulder surgery. He’s a nutrition sciences major at Chico, and a gym rat. He’ll be OK. Not Patty’s happiest b-day. After I missed several radio shows due to unrelenting fatigue, another side effect of chemotherapy, co-host Brett Taylor suggested I consider a public announcement.
SATURDAY, JULY 4, 2009—Called the radio show; too fatigued to be there in person. A longtime listener called me afterward and broke down and started to cry during our conversation. Another listener, a golf shop owner, texted me offering prayer and support. It felt cathartic to let it out.
WEDNESDAY JULY 8, 2009—This morning I went to wash my hair and got a gob of it in my hand.
MONDAY, AU. 24, 2009—Today is my last chemo treatment! I was too weak to play golf during treatments but finally played in a scramble tournament in September. Couldn’t wait for my taste buds to return; craved spaghetti.
TUESDAY, NOV. 17, 2009—My hair is starting to grow back and numerous people have commented that the crew cut is working. I may leave it.
TUESDAY, DEC. 1, 2009—My right nipple has been irritated for over a week now. Could I have it on the other side, too? Could it have returned so quickly? I had another mammogram. One other guy was there with his wife. He recognized me from my voice and the Titleist logo on my jacket. How embarrassing. I felt humiliated when they called my name. Generally, I have not felt self-conscious about having breast cancer. It is so widespread in our society that I knew the treatment options had advanced dramatically. So if I had to have cancer, it was good to be diagnosed with something that was treatable. But on this day I felt embarrassment. I shouldn’t have, but I did. At least the test was negative.
During my chemotherapy treatments, I completed a couple of real estate transactions. Couldn’t really start anything new, but tried my best to follow through with existing business. Golf psychologists often advise, “Fake it until you make it.” That’s what I did and found it psychologically uplifting. I think it was comforting for my wife. She never was herself the entire time, and it showed. We had incredibly supportive neighbors, but one in particular always engaged Patty in garden talk or other topics. I know it was just to distract her momentarily.
My treatments were on Mondays or Tuesdays so that I could, ideally, feel OK to do my Saturday morning radio gig. The show starts at 8 a.m., but I get to the station two hours earlier.
In December, I had minor reconstructive surgery so that I might once again take my shirt off on vacation. Haven’t done that yet, but may one day as the scar fades or my sensitivity about it subsides. One night, we had another couple over for dinner—dear friends. She had breast cancer about 10 years ago. We even had the same surgeon. After some wine, we had a brief show and tell comparing our scars while our spouses sat speechless. I guess breast cancer patients can relate to each other on a whole different plane, regardless of gender.
I received wonderful support from the medical community, the golf community, Lyon, KHTK, my family, my wife, my kids, friends, neighbors, business associates, golf course clients and listeners. I really felt the love. Technically, I’m now in remission. Let’s hope I can write a retrospective five years down the road. Hope I’m still talking golf on the radio, too. For now, though, all I can say is, I had breast cancer—how random is that?