“A 200:1 ratio is very difficult to overcome,” said Darryl Mitteldorf, Licensed Clinical Social Worker (LCSW) and program director of Malecare, a 14-year-old support group for male cancer patients, based in New York City. Malecare counsels as many as 700 male breast cancer cases every year, even though the ratio of women diagnosed to men is 200 to one.
There is not much public awareness about male breast cancer. The American Cancer Society predicts that in 2012, there will be approximately 410 deaths and 2,190 new diagnoses of male breast cancer, representing only one percent of all breast cancer cases. Men have a one in 1,000 lifetime risk of contracting the disease, with the average age of detection being between 60 and 70 years.
“Cancer is a disease of the aging,” said Dr. Deborah Axelrod, associate professor at New York University (NYU) Langone Medical Center’s Division of Breast Surgery. “The longer the cells exist, the more they keep dividing, which increases their risk of mutation.” She said the situation is similar for women, with only 10 percent of women’s breast cancer cases being diagnosed before age 45. The mortality rate for men is similar to that of women, and it depends on the stage of cancer at the time of detection.
But age isn’t the only risk factor for male breast cancer. Other possible factors include exposure to radiation, obesity, liver disease and Klinefelter Syndrome, a chromosomal abnormality that affects only males. Generally, the chromosomes that make up male DNA are read as XY, and the female as XX. But men with Klinefelter Syndrome patients have an extra X chromosome, which gives them abnormally proportioned body parts, including breasts.
Mutations of certain genes (BRCA1 and BRCA2) are also an important risk factor. “A man diagnosed with breast cancer should get a mutation test done,” said Axelrod. “This is important knowledge for his family to have, especially if he has kids.” She said that a positive gene mutation test also increases the chances of getting prostate and pancreatic cancer.
A family history of breast cancer, male or female, increases the man’s chance of inheriting the disease, though this isn’t always the case — but as with women, many men have no obvious risk factors. Mark Goldstein, 79, was diagnosed with breast cancer in 1988, at 55, when many people didn’t even know that men could suffer from the disease. “There is no history of breast cancer in my family,” he said, “The disbelief I felt all those years ago is there even today, but now men know a bit more about this cancer.” His son and two daughters have not been tested for the breast cancer gene mutation.
Often, people visit doctors after finding a lump or abnormal tissue mass in their breast. This is followed by a diagnostic work-up, which analyzes the tissue sample and checks for cancerous cells. Goldstein ignored his lump for three months before going to a dermatologist, who couldn’t diagnose the problem. After a few more consultations with various doctors in his native New Jersey, he found a surgeon in New York City who removed the lump.
“The doctors didn’t know how to treat a man, so they did the same thing they did for women,” Goldstein said. His treatment went on from May 1988 to January 1989 and included alternating weeks of chemotherapy and radiation.
The problem, for such a small patient population, is in figuring out what qualifies as a responsible approach, in terms of screening. “There is no health guideline that allows screening for men,” said Mary Solomon, director of Project Renewal’s Scan Van Program – a mobile mammography clinic. “The good news for men is that they do not typically have a lot of breast tissue where breast cancer can hide; the lump is more likely to be discovered easily.” Apart from a lump, early signs of male breast cancer include skin dimpling and redness of the breast and nipple retraction.
After the initial shock of being diagnosed with a “woman’s” disease, men experience a range of emotions. “They feel like they aren’t taken seriously, like the doctors aren’t treating them as well as the female patients,” said Mitteldorf of the patients he has encountered. For Axelrod’s patients, social shame and doubts about their virility were also concerns. “These men lose their nipple and feel very conscious, to the extent of wearing tank tops and t-shirts on the beach so no one stares,” she said. “It’s not just women who suffer when they lose a breast to cancer.”
For cancer “sirvivor” (a moniker he uses to distinguish himself from female survivors) Goldstein, there was no place for fear or pity. “‘Why me?’ is a self-abusive comment,” he said. “It places blame on the individual and God.” His first day back home, he mowed his front lawn and decided he’d do his part in helping other male breast cancer patients. Goldstein volunteers at several cancer support groups such as Share and the Susan G. Komen for the Cure organization, has run in 221 Komen “Race for the Cure” races and manages a website where he shares his experiences.
Goldstein attributes some of the male reluctance to consider developing breast cancer to what he calls a “macho gene” – a fictitious genetic mutation which inculcates the boy and later the man with attitudes of asserting and preserving masculinity. Group support does help though, said Mitteldorf. “They find strength when they connect with each other, otherwise they’d suffer alone.”